Appl Clin Inform - Retrospective derivation and validation of a search algorithm to identify emergent endotracheal intubations in the intensive care unit.

Tópicos

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Resumo

CKGROUND: The development and validation of automated electronic medical record (EMR) search strategies are important in identifying emergent endotracheal intubations in the intensive care unit (ICU).OBJECTIVE: To develop and validate an automated search algorithm (strategy) for emergent endotracheal intubation in the critically ill patient.METHODS: The EMR search algorithm was created through sequential steps with keywords applied to an institutional EMR database. The search strategy was derived retrospectively through a secondary analysis of a 450-patient subset from the 2,684 patients admitted to either a medical or surgical ICU from January 1, 2010, through December 31, 2011. This search algorithm was validated against an additional 450 randomly selected patients. Sensitivity, specificity, and negative and positive predictive values of the automated search algorithm were compared with a manual medical record review (the reference standard) for data extraction of emergent endotracheal intubations.RESULTS: In the derivation subset, the automated electronic note search strategy achieved a sensitivity of 74% (95% CI, 69%-79%) and a specificity of 98% (95% CI, 92%-100%). With refinements in the search algorithm, sensitivity increased to 95% (95% CI, 91%-97%) and specificity decreased to 96% (95% CI, 92%-98%) in this subset. After validation of the algorithm through a separate patient subset, the final reported sensitivity and specificity were 95% (95% CI, 86%-99%) and 100% (95% CI, 98%-100%).CONCLUSIONS: Use of electronic search algorithms allows for correct extraction of emergent endotracheal intubations in the ICU, with high degrees of sensitivity and specificity. Such search algorithms are a reliable alternative to manual chart review for identification of emergent endotracheal intubations.

Resumo Limpo

ckground develop valid autom electron medic record emr search strategi import identifi emerg endotrach intub intens care unit icuobject develop valid autom search algorithm strategi emerg endotrach intub critic ill patientmethod emr search algorithm creat sequenti step keyword appli institut emr databas search strategi deriv retrospect secondari analysi patient subset patient admit either medic surgic icu januari decemb search algorithm valid addit random select patient sensit specif negat posit predict valu autom search algorithm compar manual medic record review refer standard data extract emerg endotrach intubationsresult deriv subset autom electron note search strategi achiev sensit ci specif ci refin search algorithm sensit increas ci specif decreas ci subset valid algorithm separ patient subset final report sensit specif ci ci conclus use electron search algorithm allow correct extract emerg endotrach intub icu high degre sensit specif search algorithm reliabl altern manual chart review identif emerg endotrach intub

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