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Post-traumatic Stress Disorder01:27

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Post-traumatic stress disorder (PTSD) is a psychiatric condition that arises following exposure to traumatic events such as natural disasters, forced displacement, or severe accidents. It significantly impairs individuals' ability to cope with daily activities and disrupts their emotional and psychological equilibrium.
Symptoms and Behavioral Manifestations
A spectrum of distressing symptoms characterizes PTSD. Recurrent flashbacks, where individuals involuntarily relive traumatic events,...
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Pan-Canadian Electronic Medical Record Diagnostic and Unstructured Text Data for Capturing PTSD: Retrospective

Leanne Kosowan1, Alexander Singer1, Farhana Zulkernine2

  • 1Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.

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Summary

Short diagnostic text fields in electronic medical records (EMR) provide accurate identification of posttraumatic stress disorder (PTSD) cases. This method is valuable for research when free-text notes are unavailable.

Keywords:
EHRNLPPTSDelectronic health recordsmedical informaticsnatural language processingposttraumatic stress disorderprimary health carestress disorders, posttraumatic

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Area of Science:

  • Health Informatics
  • Clinical Research
  • Psychiatry

Background:

  • Electronic Medical Record (EMR) free-text data for research is limited.
  • Short diagnostic text fields offer broader accessibility for research.

Purpose of the Study:

  • To assess agreement between free-text and short diagnostic text data in primary care EMR for posttraumatic stress disorder (PTSD) identification.
  • To evaluate the utility of short diagnostic text fields in EMR for PTSD case identification.

Main Methods:

  • Retrospective cross-sectional study using pan-Canadian EMR data from 1574 primary care providers across 265 clinics.
  • Medical record review of free-text and short diagnostic fields to establish PTSD reference standards.
  • Agreement assessed using sensitivity, specificity, positive predictive value, negative predictive value, and accuracy.

Main Results:

  • High accuracy (93.6%) in agreement between free-text and short diagnostic text for PTSD identification.
  • Case definition 4 demonstrated strong agreement in a pan-Canadian reference set (n=12,104), with sensitivity of 91.1% and specificity of 99.1%.

Conclusions:

  • Free-text encounter notes did not significantly improve PTSD case capture or case definition agreement.
  • Jurisdictional EMR variations necessitate natural language processing to supplement diagnostic codes for PTSD capture.
  • Short diagnostic text fields can effectively supplement free-text data for reference set creation and case validation when free-text is unavailable.