在急诊室识别阿片类药物过量剂量的增强表型访问电子健康记录数据
Ralph Ward1, Jihad S Obeid2, Lindsey Jennings3
1Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, United States.
JAMIA open
|March 15, 2024
概括
通过新的机器学习模型,在电子医疗记录 (EHR) 中准确识别阿片类药物过量 (OOD) 病例得到了改进. 这些模型增强了对OOD预测的监测和临床决策支持.
科学领域:
- 医疗信息学 医疗信息学
- 医疗保健中的机器学习
- 公共卫生监督 公共卫生监督
背景情况:
- 从电子医疗记录 (EHR) 数据中准确识别阿片类药物过量 (OOD) 病例对于监测,研究和临床干预至关重要.
- 通过整合各种数据类型和先进的分析方法,可以增强现有的OOD电子现象.
研究的目的:
- 通过结合诊断代码之外的新型数据类型来改进现有的OOD电子表型.
- 应用统计和机器学习方法,以在EHR数据中增强OOD案例识别.
主要方法:
- 开发了对OOD病例和风险患者的急诊室访问的EHR数据集,通过手册图表审查确认了真正的OOD状态.
- 经过验证的预测模型 (随机森林,极度梯度提升,弹性网) 使用717个功能,包括诊断,首席投诉,药物,生命体征,实验室和程序.
- 开发的模型仅限于单个数据类型和实时可用的决策支持数据.
主要成果:
- 在对1718份记录 (1485名患者) 的手动审查中,发现了541名 (36.4%) OOD.
- 所有开发的模型都显示出高预测性能,灵敏度在94%至97%之间,接收器操作特征曲线 (AUC) 下的面积为98%.
- 主要诊断和主要投诉是AUC的关键驱动因素; 主要诊断和药物类别影响了灵敏度; 主要投诉,首要诊断和生命体征影响了特异性. 使用实时数据的模型显示出强大的性能.
结论:
- 在EHR数据中识别OOD的预测性能方面取得了显著的改进.
- 开发的e-phenotypes适用于公共卫生监测,追溯实证研究和临床决策支持系统中的应用.
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