Derivation and Validation of an Automated Search Strategy to Retrospectively Identify Acute Respiratory Distress Patients Per Berlin Definition

Xuan Song; Timothy J Weister; Yue Dong; Kianoush B Kashani; Rahul Kashyap

doi:10.3389/fmed.2021.614380

Derivation and Validation of an Automated Search Strategy to Retrospectively Identify Acute Respiratory Distress Patients Per Berlin Definition

Front Med (Lausanne). 2021 Mar 11:8:614380. doi: 10.3389/fmed.2021.614380. eCollection 2021.

Authors

Xuan Song^{1

2

3}, Timothy J Weister⁴, Yue Dong⁵, Kianoush B Kashani⁶, Rahul Kashyap⁵

Affiliations

¹ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, United States.
² Intensive Care Unit, Liaocheng Cardiac Hospital Affiliated to Shandong First Medical University, Shandong, China.
³ Intensive Care Unit, DongE Hospital Affiliated to Shandong First Medical University, Shandong, China.
⁴ Anesthesia Clinical Research Unit, Mayo Clinic, Rochester, MN, United States.
⁵ Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States.
⁶ Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States.

Abstract

Purpose: Acute respiratory distress syndrome (ARDS) is common in critically ill patients and linked with serious consequences. A manual chart review for ARDS diagnosis could be laborious and time-consuming. We developed an automated search strategy to retrospectively identify ARDS patients using the Berlin definition to allow for timely and accurate ARDS detection. Methods: The automated search strategy was created through sequential steps, with keywords applied to an institutional electronic medical records (EMRs) database. We included all adult patients admitted to the intensive care unit (ICU) at the Mayo Clinic (Rochester, MN) from January 1, 2009 to December 31, 2017. We selected 100 patients at random to be divided into two derivation cohorts and identified 50 patients at random for the validation cohort. The sensitivity and specificity of the automated search strategy were compared with a manual medical record review (gold standard) for data extraction of ARDS patients per Berlin definition. Results: On the first derivation cohort, the automated search strategy achieved a sensitivity of 91.3%, specificity of 100%, positive predictive value (PPV) of 100%, and negative predictive value (NPV) of 93.1%. On the second derivation cohort, it reached the sensitivity of 90.9%, specificity of 100%, PPV of 100%, and NPV of 93.3%. The strategy performance in the validation cohort had a sensitivity of 94.4%, specificity of 96.9%, PPV of 94.4%, and NPV of 96.9%. Conclusions: This automated search strategy for ARDS with the Berlin definition is reliable and accurate, and can serve as an efficient alternative to time-consuming manual data review.

Keywords: ICU; acute respriatory distress syndrome; adult; automation; electronic health records.