DOI: 10.1101/458976Nov 2, 2018Paper

Comparison of Approaches to the identification of Symptom Burden in Hemodialysis Patients Utilizing Electronic Health Records

BioRxiv : the Preprint Server for Biology
Lili ChanGirish N Nadkarni


Background: Identification of symptoms is challenging with surveys, which are time-intensive and low-throughput. Natural language processing (NLP) could be utilized to identify symptoms from narrative documentation in the electronic health record (EHR). Methods: We utilized NLP to parse notes for maintenance hemodialysis (HD) patients from two EHR databases (BioMe and MIMIC-III) to identify fatigue, nausea/vomiting, anxiety, depression, cramping, itching, and pain. We compared NLP performance with International Classification of Diseases (ICD) codes and validated the performance of both NLP and codes against manual chart review in a representative subset. Results: We identified 1034 and 929 HD patients from BioMe and MIMIC-III respectively. The most frequently identified symptoms by NLP from both cohorts were fatigue, pain, and nausea and/or vomiting. NLP was significantly more sensitive than ICD codes for nearly all symptoms. In the BioMe dataset, sensitivity for NLP ranged from 0.85-0.99 vs. 0.09-0.59 for ICD codes. In the MIMIC-III dataset, NLP sensitivity was 0.8-0.98 vs. 0.02-0.53 for ICD. ICD codes were significantly more specific for nausea and/or vomiting (NLP 0.57 vs. ICD 0.97, P=0.03) in BioMe and for depression (NLP ...Continue Reading

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