BACKGROUND: Previous work in the field of medical informatics has shown that rules-based algorithms can be created to identify patients with various medical conditions; however, these techniques have not been compared to actual clinician notes nor has the ability to predict complications been tested. We hypothesize that a rules-based algorithm can successfully identify patients with the diseases in the Revised Cardiac Risk Index (RCRI). METHODS: Patients undergoing surgery at the University of California, Los Angeles Health System between April 1, 2013 and July 1, 2016 and who had at least 2 previous office visits were included. For each disease in the RCRI except renal failure—congestive heart failure, ischemic heart disease, cerebrovascular disease, and diabetes mellitus—diagnosis algorithms were created based on diagnostic and standard clinical treatment criteria. For each disease state, the prevalence of the disease as determined by the algorithm, International Classification of Disease (ICD) code, and anesthesiologist's preoperative note were determined. Additionally, 400 American Society of Anesthesiologists classes III and IV cases were randomly chosen for manual review by an anesthesiologist. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve were determined using the manual review as a gold standard. Last, the ability of the RCRI as calculated by each of the methods to predict in-hospital mortality was determined, and the time necessary to run the algorithms was calculated. RESULTS: A total of 64,151 patients met inclusion criteria for the study. In general, the incidence of definite or likely disease determined by the algorithms was higher than that detected by the anesthesiologist. Additionally, in all disease states, the prevalence of disease was always lowest for the ICD codes, followed by the preoperative note, followed by the algorithms. In the subset of patients for whom the records were manually reviewed, the algorithms were generally the most sensitive and the ICD codes the most specific. When computing the modified RCRI using each of the methods, the modified RCRI from the algorithms predicted in-hospital mortality with an area under the receiver operating characteristic curve of 0.70 (0.67–0.73), which compared to 0.70 (0.67–0.72) for ICD codes and 0.64 (0.61–0.67) for the preoperative note. On average, the algorithms took 12.64 ± 1.20 minutes to run on 1.4 million patients. CONCLUSIONS: Rules-based algorithms for disease in the RCRI can be created that perform with a similar discriminative ability as compared to physician notes and ICD codes but with significantly increased economies of scale. Accepted for publication March 5, 2018. Funding: None. Conflicts of Interest: See Disclosures at the end of the article. I. S. Hofer and A. Mahajan are working with counsel to patent the algorithms for the diseases described in this article. Reprints will not be available from the authors. Address correspondence to Ira S. Hofer, MD, Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at University of California, Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095. Address e-mail to ihofer@mednet.ucla.edu. © 2018 International Anesthesia Research Society
https://ift.tt/2Jg8HoB
Αρχειοθήκη ιστολογίου
-
►
2020
(289)
- ► Φεβρουαρίου (28)
-
►
2019
(9071)
- ► Δεκεμβρίου (19)
- ► Σεπτεμβρίου (54)
- ► Φεβρουαρίου (3642)
- ► Ιανουαρίου (3200)
-
▼
2018
(39872)
- ► Δεκεμβρίου (3318)
- ► Σεπτεμβρίου (3683)
-
▼
Μαΐου
(3439)
-
▼
Μαΐ 30
(131)
- Obturators versus flaps after maxillary oncologica...
- Unravelling the molecular signatures in HNSCC: Is ...
- Targeting myeloid-derived suppressor cells for can...
- An independent relation of atopic dermatitis to ex...
- Interleukin 17A exacerbates ER-stress-mediated inf...
- Seafood allergy: A comprehensive review of fish an...
- Helminth-induced regulatory T cells and suppressio...
- Dendritic cells, T cells and lymphatics: dialogues...
- Pediatric Residents’ Assessment of Atopic Dermatit...
- Development of Food Protein-Induced Enterocolitis ...
- Pilot study of the CAPS (Clinical extent, Area, Pr...
- Different Treatments With the TRV Reposition Chair
- Audit of the Spanish EURECCA Esophagogastric Cance...
- Thykamine Safety and Efficacy Study in Mild-to-Mod...
- ctDNA as a Biomarker for Treatment Response in HNSCC
- Re: “High Thyroid Cancer Mortality Rate in Japan: ...
- No-Scar Transoral Thyroglossal Duct Cyst Excision ...
- The impact of cold on the respiratory tract and it...
- Reconstrucción de defectos orofaríngeos tras cirug...
- Monophasic Synovial Sarcoma of Tongue: A Rarest of...
- Robot Assisted Trans Axillary Thyroidectomy: A Sub...
- Successful treatment of primary bone marrow Hodgki...
- Bike Safety for the Whole Family
- Trichophyton erinacei Transmitted to a Pregnant Wo...
- Lentigo Maligna—Challenges, Observations, Imiquimo...
- Prevalence of Skin Cancer Examination Among Indoor...
- Lentigo Maligna Treated With Off-Label Neoadjuvant...
- Adolescents’ Perspectives on Atopic Dermatitis Tre...
- Multidisciplinary management of oculo-auriculo-ver...
- Deconstructive SCNT reveals novel Treg subsets
- Saturated fatty acids, obesity and the NLRP3 infla...
- Ketamine Anesthesia Does Not Improve Depression Sc...
- Epitope mapping and kinetics of CD4 T cell immunit...
- Tear Off the Masks: Identity and Imposture in Twen...
- Political knowledge: Measurement, misinformation a...
- The Saga of History 492: The Transformation of Wor...
- Flexible scintillator autoradiography for tumor ma...
- The link between interoceptive processing and anxi...
- How effective and cost-effective are behaviour cha...
- Sociolinguistics, translation and interpreting
- Changes in environmental tobacco smoke (ETS) expos...
- Diagnostic accuracy for the extent and activity of...
- Franchising the disenfranchised? The paradoxical s...
- Sequencing of prostate cancers identifies new canc...
- Visual attention mechanisms in happiness vs. trust...
- The behavioural variant frontotemporal dementia ph...
- Genome-wide association analyses identify 44 risk ...
- Socioeconomic segregation in secondary schools: ev...
- What Does a Red Meat Allergy Have to Do With Anest...
- Automated Assessment of Existing Patient’s Revised...
- Pain Medicine Board Review
- Assessing the Association Between Blood Loss and P...
- Phentolamine Reverses Epinephrine-Enhanced Skin An...
- Intraoperative Methadone in Same-Day Ambulatory Su...
- Mixing Studies in Patients With Prolonged Activate...
- Opening the Black Box: Understanding the Science B...
- Reversing Cholinergic Bronchoconstriction by Commo...
- The Effect of Labor Epidural Analgesia on Breastfe...
- Readiness for Discharge After Foot and Ankle Surge...
- In Response
- Opioid Use Disorders: Perioperative Management of ...
- The Use of Hydroxyethyl Starch 130/0.4 in Surgery ...
- Efficacy of Malignant Hyperthermia Association of ...
- TIP SHEET: Johns Hopkins Researchers Well Represen...
- Supraglottoplasty surgery types 1–3: A practical c...
- Is the evidence of local allergic rhinitis growing?
- Multidisciplinary management of oculo-auriculo-ver...
- Development and Assessment of a Transoral Robotic ...
- Follicular dendritic cell sarcoma presenting as a ...
- Maxillary sinus schwannoma
- Unusual presentation of Henöch-Schonlein purpura
- Toe walking after three: how serious could it be?
- A 3-month-old infant with atypical Kawasaki disease
- Denosumab causing severe, refractory hypocalcaemia...
- Subcutaneous oedema of upper limbs heralding an ag...
- Lactation ketoacidosis: case presentation and lite...
- Myeloid sarcoma of the small intestine in a patien...
- Left ventricular mural thrombus despite treatment ...
- Facilitated subcutaneous immunoglobulin treatment ...
- Congenital limb deficiency requiring transfemoral ...
- Renal cell carcinoma with sarcomatoid transformati...
- Giant cell lesion of the jaw as a presenting featu...
- Endometrial metastasis of primary malignant melano...
- Superior sagittal sinus thrombosis in a case of Mi...
- A chronic alcoholic man with high fever, neck rigi...
- Unusual case of cerebral demyelination and bilater...
- Scleral dellen following strabismus surgery
- Severe Babesia microti infection presenting as mul...
- Acute Kidney Injury after Liver Transplantation
- OPTICAL OR TRANSBRONCHIAL BIOPSY TO DIAGNOSE ACUTE...
- Donating Another Person’s Kidney: Avoiding the Dis...
- Diagnosis of Acute Cellular Rejection Using Probe-...
- Invited author's reply to "Optimal culture methods...
- Optimal culture methods and microbial contaminatio...
- Domino Liver Transplant in Maple Syrup Urine Disea...
- Hyperfiltration-mediated injury in the remaining k...
- A comparison of the incidence of supraventricular ...
- Safety of moderate-to-deep sedation performed by s...
- Validation of the Brief Developmental Assessment i...
- In Vivo Observation of Structural Changes in Neoco...
-
▼
Μαΐ 30
(131)
- ► Φεβρουαρίου (2693)
- ► Ιανουαρίου (3198)
-
►
2017
(41099)
- ► Δεκεμβρίου (3127)
- ► Σεπτεμβρίου (2173)
-
►
2016
(13807)
- ► Δεκεμβρίου (700)
- ► Σεπτεμβρίου (600)
- ► Φεβρουαρίου (1350)
- ► Ιανουαρίου (1400)
-
►
2015
(1500)
- ► Δεκεμβρίου (1450)
Ετικέτες
Εγγραφή σε:
Σχόλια ανάρτησης (Atom)
Δεν υπάρχουν σχόλια:
Δημοσίευση σχολίου