Novel Method of Atrial Fibrillation Case Identification and Burden Estimation Using the MIMIC-III Electronic Health Data Set

医学 心房颤动 重症监护室 置信区间 重症监护 诊断代码 急诊医学 电子健康档案 金标准(测试) 败血症 内科学 病历 心脏病学 重症监护医学 医疗保健 人口 经济 环境卫生 经济增长
作者
Eric Ding,Daniella Albuquerque,Michael Winter,Sophia Binici,Jaclyn Piche,Syed Khairul Bashar,Ki H. Chon,Allan J. Walkey,David D. McManus
出处
期刊:Journal of Intensive Care Medicine [SAGE]
卷期号:34 (10): 851-857 被引量:23
标识
DOI:10.1177/0885066619866172
摘要

Background: Atrial fibrillation (AF) portends poor prognoses in intensive care unit patients with sepsis. However, AF research is challenging: Previous studies demonstrate that International Classification of Disease ( ICD) codes may underestimate the incidence of AF, but chart review is expensive and often not feasible. We aim to examine the accuracy of nurse-charted AF and its temporal precision in critical care patients with sepsis. Methods: Patients with sepsis with continuous electrocardiogram (ECG) waveforms were identified from the Medical Information Mart for Intensive Care (MIMIC-III) database, a de-identified, single-center intensive care unit electronic health record (EHR) source. We selected a random sample of ECGs of 6 to 50 hours’ duration for manual review. Nurse-charted AF occurrence and onset time and ICD-9-coded AF were compared to gold-standard ECG adjudication by a board-certified cardiac electrophysiologist blinded to AF status. Descriptive statistics were calculated for all variables in patients diagnosed with AF by nurse charting, ICD-9 code, or both. Results: From 142 ECG waveforms (58 AF and 84 sinus rhythm), nurse charting identified AF events with 93% sensitivity (95% confidence interval [CI]: 87%-100%) and 87% specificity (95% CI: 80%-94%) compared to the gold standard manual ECG review. Furthermore, nurse-charted AF onset time was within 1 hour of expert reader onset time for 85% of the reviewed tracings. The ICD-9 codes were 97% sensitive (95% CI: 88-100%) and 82% specific (95% CI: 74-90%) for incident AF during admission but unable to identify AF time of onset. Conclusion: Nurse documentation of AF in EHR is accurate and has high precision for determining AF onset to within 1 hour. Our study suggests that nurse-charted AF in the EHR represents a potentially novel method for AF case identification, timing, and burden estimation.
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