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An Electronic Search Algorithm for Early Disseminated Intravascular Coagulopathy Diagnosis in the Intensive Care
Tabinda Jawaid1, Naseema Gangat2, Timothy Weister3
1Pathology, Mayo Clinic, Rochester, USA.
Insights
An electronic search algorithm accurately detects disseminated intravascular coagulopathy (DIC) in medical records. This revised algorithm, focusing on clinical notes, demonstrated high sensitivity and specificity in intensive care unit patients.
Area of Science:
- Medical Informatics
- Clinical Data Mining
- Electronic Health Records
Background:
- Disseminated intravascular coagulopathy (DIC) is a critical condition requiring timely diagnosis.
- Accurate identification of DIC from electronic health records (EHRs) is challenging but essential for patient care and research.
Purpose of the Study:
- To develop and validate an electronic search algorithm for precise detection of disseminated intravascular coagulopathy (DIC).
- To improve the efficiency and accuracy of identifying DIC cases within intensive care unit (ICU) medical records.
Main Methods:
- An algorithm was developed using clinical notes and ICD diagnosis codes from ICU patients diagnosed with DIC.
- The algorithm underwent iterative refinement, including a revised clinical note-only search, with validation cohorts.
- Performance was assessed by comparing algorithm results against manual review, calculating sensitivity and specificity.
Main Results:
- Initial algorithm combining clinical notes and diagnosis codes showed 92% sensitivity and 100% specificity.
- A refined algorithm, utilizing clinical notes exclusively, achieved 91.3% sensitivity and 100% specificity in derivation cohorts.
- The final validated algorithm demonstrated 95.8% sensitivity and 100% specificity in an independent validation cohort.
Conclusions:
- A revised electronic search algorithm based on clinical notes is highly sensitive and specific for detecting DIC.
- This algorithm offers a reliable method for identifying DIC cases within ICU electronic health records.
Aim:
We aim to create and validate an electronic search algorithm for accurate detection of disseminated intravascular coagulopathy (DIC) from medical records.
Methods:
Patients with DIC in Mayo Clinic's intensive care units (ICUs) from Jan 1, 2007, to May 4, 2018, were included in the study. An algorithm was developed based on clinical notes and ICD diagnosis codes. A cohort of 50 patients was included with DIC diagnosis, its variations, and no diagnosis of DIC. Then, the next set of 50 patients was used to refine the algorithm. Results were compared with a manual reviewer and the disagreements were resolved by the third reviewer. The same process was repeated with 'revised clinical note search' for the first and second derivation cohort with additional exclusion terms. The obtained sensitivity and specificity were reported. The generated algorithm was applied to another set of 50 patients for validation.
Results:
In the first derivation cohort- DIC search by clinical notes and diagnosis codes had 92% sensitivity and 100% specificity. Sensitivity dropped to 71% in the second cohort although specificity remains the same. Therefore, the algorithm was refined to clinical notes search only. The revised search was reapplied to first and second derivation cohorts and results obtained for the first derivation were the same but 91.3% sensitive and 100% specific for the second derivation. The search was locked and applied in the validation cohort with 95.8% sensitivity and 100% specificity, respectively.
Conclusion:
The revised clinical note based electronic search algorithm was found to be highly sensitive and specific for DIC during the corresponding ICU duration.
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