Developing Validated Tools to Identify Pulmonary Embolism in Electronic Databases: Rationale and Design of the PE-EHR+ Study
Thrombosis and Haemostasis, vol. 123, pp. 649–662
Abstract
BACKGROUND: Contemporary pulmonary embolism (PE) research, in many cases, relies on data from electronic health records (EHRs) and administrative databases that use International Classification of Diseases (ICD) codes. Natural language processing (NLP) tools can be used for automated chart review and patient identification. However, there remains uncertainty with the validity of ICD-10 codes or NLP algorithms for patient identification. METHODS: The PE-EHR+ study has been designed to validate ICD-10 codes as Principal Discharge Diagnosis, or Secondary Discharge Diagnoses, as well as NLP tools set out in prior studies to identify patients with PE within EHRs. Manual chart review by two independent abstractors by predefined criteria will be the reference standard. Sensitivity, specificity, and positive and negative predictive values will be determined. We will assess the discriminatory function of code subgroups for intermediate- and high-risk PE. In addition, accuracy of NLP algorithms to identify PE from radiology reports will be assessed. RESULTS: A total of 1,734 patients from the Mass General Brigham health system have been identified. These include 578 with ICD-10 Principal Discharge Diagnosis codes for PE, 578 with codes in the secondary position, and 578 without PE codes during the index hospitalization. Patients within each group were selected randomly from the entire pool of patients at the Mass General Brigham health system. A smaller subset of patients will also be identified from the Yale-New Haven Health System. Data validation and analyses will be forthcoming. CONCLUSIONS: The PE-EHR+ study will help validate efficient tools for identification of patients with PE in EHRs, improving the reliability of efficient observational studies or randomized trials of patients with PE using electronic databases.
Authors 24
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Behnood Bikdeli corresponding
Brigham and Women's Hospital · Yale New Haven Hospital · Harvard University · Yale University · Cardiovascular Research Foundation
Affiliation as printed
Cardiovascular Research Foundation (CRF), New York, New York, United States
Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut, United States
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Brigham and Women's Hospital · Harvard University
Affiliation as printed
Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
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Brigham and Women's Hospital · Harvard University
Affiliation as printed
Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
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Brigham and Women's Hospital · Harvard University
Affiliation as printed
Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
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Universidad de Alcalá · Centro de Investigación Biomédica en Red de Enfermedades Respiratorias · Hospital Universitario Ramón y Cajal
Affiliation as printed
Respiratory Department, Hospital Ramón y Cajal and Medicine Department, Universidad de Alcalá (Instituto de Ramón y Cajal de Investigación Sanitaria), Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
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Yale New Haven Hospital · Yale University
Affiliation as printed
Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States
YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut, United States
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Yale New Haven Hospital · Yale University
Affiliation as printed
YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut, United States
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Beth Israel Deaconess Medical Center · Harvard University
Affiliation as printed
Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
Harvard Medical School, Boston, Massachusetts, United States
Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
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Leiden University · Leiden University Medical Center
Affiliation as printed
Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Centre, Leiden, The Netherlands
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Brigham and Women's Hospital · Harvard University
Affiliation as printed
Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
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Brigham and Women's Hospital · Harvard University
Affiliation as printed
Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
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Universidad de Alcalá · Instituto Ramón y Cajal de Investigación Sanitaria · Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública · Hospital Universitario Ramón y Cajal
Affiliation as printed
Clinical Biostatistics Unit. Hospital Universitario Ramón y Cajal. IRYCIS, CIBERESP: Universidad de Alcalá. Madrid, Spain
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Beth Israel Deaconess Medical Center · Yale New Haven Hospital · Yale University
Affiliation as printed
Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut, United States
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Brigham and Women's Hospital · Harvard University
Affiliation as printed
Centre for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
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Affiliation as printed
Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States
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Yale New Haven Hospital · Yale University
Affiliation as printed
YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut, United States
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Yale New Haven Hospital · Yale University
Affiliation as printed
YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut, United States
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Affiliation as printed
Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut, United States
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Yale New Haven Hospital · Yale University
Affiliation as printed
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States
YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut, United States
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Brigham and Women's Hospital · Harvard University
Affiliation as printed
Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
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Brigham and Women's Hospital · Harvard University
Affiliation as printed
Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
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Universidad Católica de Murcia
Affiliation as printed
Cátedra de Enfermedad Tromboembólica, Universidad Católica de Murcia, Murcia, Spain
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Yale New Haven Hospital · Yale University
Affiliation as printed
Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, United States
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States
YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut, United States
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Brigham and Women's Hospital · Harvard University
Affiliation as printed
Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
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