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Published in: BMC Geriatrics 1/2022

Open Access 01-12-2022 | Research

A novel semiautomatic Chinese keywords instrument screening delirium based on electronic medical records

Authors: Ling Chen, Nan Li, Yuxia Zheng, Langli Gao, Ning Ge, Dongmei Xie, Jirong Yue

Published in: BMC Geriatrics | Issue 1/2022

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Abstract

Background

Delirium is frequently unrecognized due to the absence of regular screening. In addition to validated bedside tools, the computer-assisted instrument based on clinical notes from electronic medical records may be useful.

Aims

To assess the psychometric properties of a Chinese-chart-based keyword instrument for semiautomatically screening delirium using Natural language processing (NLP) based on clinical notes from electronic medical records.

Methods

The patients were admitted to West China Hospital from January 2015 to December 2017. Grouping patients based on the medical notes, those with accessible physician documents but no nurse documents were classified as the physician & no-nurse (PNN) group, while those with accessible physician and nurse documents were classified as the physician & nurse (PN) group. The psychometric properties, test–retest reliability, internal consistency reliability (Cronbach's α), and criterion validity were calculated. Using receiver operating characteristic (ROC) analysis, the criterion validity of delirium was evaluated in comparison to the results of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

Results

A total of 779 patients were enrolled in the study. Their ages ranged from 65 to 103 years (82.5 ± 6.5), with men accounting for 71.9% of the total. A total of 312 patients had access to only physician documents in the physician & no-nurse (PNN) group, whereas 467 patients had access to both physician and nurse documents in the physician & nurse (PN) group. All 779 patients had a Cronbach's alpha of 0.728 in terms of reliability, with 100% test–retest reliability. The area under the ROC curve (AUC) values of the delirium screening instrument for criterion validity were 0.76 (all patients, n = 779), 0.72 (PNN, n = 312), and 0.79 (PN, n = 467), respectively.

Conclusion

A delirium screening instrument composed of Chinese keywords that can be easily and quickly obtained from electronic medical records was developed, which improved delirium detection in older people.

Trial registration

Not applicable.
Appendix
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Literature
1.
go back to reference Inouye SK. The dilemma of delirium: clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly medical patients. Am J Med. 1994;97:278–88.CrossRef Inouye SK. The dilemma of delirium: clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly medical patients. Am J Med. 1994;97:278–88.CrossRef
2.
go back to reference Inouye SK, Westendorp RGJ, Saczynski JS. Delirium in elderly people. The Lancet. 2014;383:911–22.CrossRef Inouye SK, Westendorp RGJ, Saczynski JS. Delirium in elderly people. The Lancet. 2014;383:911–22.CrossRef
3.
go back to reference Wong CL, Holroyd-Leduc J, Simel DL, Straus SE. Does this patient have delirium?: value of bedside instruments. JAMA. 2010;304:779–86.CrossRef Wong CL, Holroyd-Leduc J, Simel DL, Straus SE. Does this patient have delirium?: value of bedside instruments. JAMA. 2010;304:779–86.CrossRef
4.
go back to reference Han JH, Zimmerman EE, Cutler N, Schnelle J, Morandi A, Dittus RS, Storrow AB, Ely EW. Delirium in older emergency department patients: recognition, risk factors, and psychomotor subtypes. Acad Emerg Med Off J Soc Acad Emerg Med. 2009;16:193–200.CrossRef Han JH, Zimmerman EE, Cutler N, Schnelle J, Morandi A, Dittus RS, Storrow AB, Ely EW. Delirium in older emergency department patients: recognition, risk factors, and psychomotor subtypes. Acad Emerg Med Off J Soc Acad Emerg Med. 2009;16:193–200.CrossRef
5.
go back to reference Luetz A, Weiss B, Boettcher S, Burmeister J, Wernecke KD, Spies C. Routine delirium monitoring is independently associated with a reduction of hospital mortality in critically ill surgical patients: A prospective, observational cohort study. J Crit Care. 2016;35:168–73.CrossRef Luetz A, Weiss B, Boettcher S, Burmeister J, Wernecke KD, Spies C. Routine delirium monitoring is independently associated with a reduction of hospital mortality in critically ill surgical patients: A prospective, observational cohort study. J Crit Care. 2016;35:168–73.CrossRef
6.
go back to reference Voyer P, Cole MG, McCusker J, St-Jacques S, Laplante J. Accuracy of nurse documentation of delirium symptoms in medical charts. Int J Nurs Pract. 2008;14:165–77.CrossRef Voyer P, Cole MG, McCusker J, St-Jacques S, Laplante J. Accuracy of nurse documentation of delirium symptoms in medical charts. Int J Nurs Pract. 2008;14:165–77.CrossRef
7.
go back to reference Kuhn E, Du X, McGrath K, Coveney S, O’Regan N, Richardson S, Teodorczuk A, Allan L, Wilson D, Inouye SK, MacLullich AM, Meagher D, Brayne C, Timmons S, Davis D. Validation of a consensus method for identifying delirium from hospital records. PLoS ONE. 2014;9: e111823.CrossRef Kuhn E, Du X, McGrath K, Coveney S, O’Regan N, Richardson S, Teodorczuk A, Allan L, Wilson D, Inouye SK, MacLullich AM, Meagher D, Brayne C, Timmons S, Davis D. Validation of a consensus method for identifying delirium from hospital records. PLoS ONE. 2014;9: e111823.CrossRef
8.
go back to reference Spuhl J, Doing-Harris K, Nelson S, Estrada N, Del Fiol G, Weir C. Concordance of Electronic Health Record (EHR) data describing delirium at a VA hospital. AMIA Annu Symp Proc. 2014;2014:1066–71.PubMedPubMedCentral Spuhl J, Doing-Harris K, Nelson S, Estrada N, Del Fiol G, Weir C. Concordance of Electronic Health Record (EHR) data describing delirium at a VA hospital. AMIA Annu Symp Proc. 2014;2014:1066–71.PubMedPubMedCentral
9.
go back to reference Inouye SK, Leo-Summers L, Zhang Y, Bogardus ST Jr, Leslie DL, Agostini JV. A chart-based method for identification of delirium: validation compared with interviewer ratings using the confusion assessment method. J Am Geriatr Soc. 2005;53:312–8.CrossRef Inouye SK, Leo-Summers L, Zhang Y, Bogardus ST Jr, Leslie DL, Agostini JV. A chart-based method for identification of delirium: validation compared with interviewer ratings using the confusion assessment method. J Am Geriatr Soc. 2005;53:312–8.CrossRef
10.
go back to reference Puelle MR, Kosar CM, Xu G, Schmitt E, Jones RN, Marcantonio ER, Cooper Z, Inouye SK, Saczynski JS. The Language of delirium: keywords for identifying delirium from medical records. J Gerontol Nurs. 2015;41:34–42.CrossRef Puelle MR, Kosar CM, Xu G, Schmitt E, Jones RN, Marcantonio ER, Cooper Z, Inouye SK, Saczynski JS. The Language of delirium: keywords for identifying delirium from medical records. J Gerontol Nurs. 2015;41:34–42.CrossRef
11.
go back to reference Cai T, Giannopoulos AA, Yu S, Kelil T, Ripley B, Kumamaru KK, Rybicki FJ, Mitsouras D. Natural language processing technologies in radiology research and clinical applications. Radiographics. 2016;36:176–91.CrossRef Cai T, Giannopoulos AA, Yu S, Kelil T, Ripley B, Kumamaru KK, Rybicki FJ, Mitsouras D. Natural language processing technologies in radiology research and clinical applications. Radiographics. 2016;36:176–91.CrossRef
12.
go back to reference Wang J, Deng H, Liu B, Hu A, Liang J, Fan L, Zheng X, Wang T, Lei J. Systematic evaluation of research progress on natural language processing in medicine over the past 20 years: bibliometric study on pubMed. J Med Internet Res. 2020;22: e16816.CrossRef Wang J, Deng H, Liu B, Hu A, Liang J, Fan L, Zheng X, Wang T, Lei J. Systematic evaluation of research progress on natural language processing in medicine over the past 20 years: bibliometric study on pubMed. J Med Internet Res. 2020;22: e16816.CrossRef
13.
go back to reference Chen T, Dredze M, Weiner JP, Hernandez L, Kimura J, Kharrazi H. Extraction of geriatric syndromes from electronic health record clinical notes: assessment of statistical natural language processing methods. JMIR Med Inform. 2019;7: e13039.CrossRef Chen T, Dredze M, Weiner JP, Hernandez L, Kimura J, Kharrazi H. Extraction of geriatric syndromes from electronic health record clinical notes: assessment of statistical natural language processing methods. JMIR Med Inform. 2019;7: e13039.CrossRef
14.
go back to reference Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. a new method for detection of delirium. Ann Intern Med. 1990;113:941–8.CrossRef Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. a new method for detection of delirium. Ann Intern Med. 1990;113:941–8.CrossRef
15.
go back to reference Marcantonio ER, Ngo LH, O’Connor M, Jones RN, Crane PK, Metzger ED, Inouye SK. 3D-CAM: derivation and validation of a 3-minute diagnostic interview for CAM-defined delirium: a cross-sectional diagnostic test study. Ann Intern Med. 2014;161:554–61.CrossRef Marcantonio ER, Ngo LH, O’Connor M, Jones RN, Crane PK, Metzger ED, Inouye SK. 3D-CAM: derivation and validation of a 3-minute diagnostic interview for CAM-defined delirium: a cross-sectional diagnostic test study. Ann Intern Med. 2014;161:554–61.CrossRef
16.
go back to reference Juan L, Zhouyi Z, Feng F, Yuying T. Reversion of CAM for assisting the evaluation and diagnosis of delirium. J Clin Psychiatry. 2003;13:3. Juan L, Zhouyi Z, Feng F, Yuying T. Reversion of CAM for assisting the evaluation and diagnosis of delirium. J Clin Psychiatry. 2003;13:3.
17.
go back to reference Albert MS, Levkoff SE, Reilly C, Liptzin B, Pilgrim D, Cleary PD, Evans D, Rowe JW. The delirium symptom interview: an interview for the detection of delirium symptoms in hospitalized patients. J Geriatr Psychiatry Neurol. 1992;5:14–21.CrossRef Albert MS, Levkoff SE, Reilly C, Liptzin B, Pilgrim D, Cleary PD, Evans D, Rowe JW. The delirium symptom interview: an interview for the detection of delirium symptoms in hospitalized patients. J Geriatr Psychiatry Neurol. 1992;5:14–21.CrossRef
18.
go back to reference Schuurmans MJ, Shortridge-Baggett LM, Duursma SA. The delirium observation screening scale: a screening instrument for delirium. Res Theory Nurs Pract. 2003;17:31–50.CrossRef Schuurmans MJ, Shortridge-Baggett LM, Duursma SA. The delirium observation screening scale: a screening instrument for delirium. Res Theory Nurs Pract. 2003;17:31–50.CrossRef
19.
go back to reference Trzepacz PT, Baker RW, Greenhouse J. A symptom rating scale for delirium. Psychiatry Res. 1988;23:89–97.CrossRef Trzepacz PT, Baker RW, Greenhouse J. A symptom rating scale for delirium. Psychiatry Res. 1988;23:89–97.CrossRef
20.
go back to reference Trzepacz PT, Mittal D, Torres R, Kanary K, Norton J, Jimerson N. Validation of the delirium rating scale-revised-98: comparison with the delirium rating scale and the cognitive test for delirium. J Neuropsychiatry Clin Neurosci. 2001;13:229–42.CrossRef Trzepacz PT, Mittal D, Torres R, Kanary K, Norton J, Jimerson N. Validation of the delirium rating scale-revised-98: comparison with the delirium rating scale and the cognitive test for delirium. J Neuropsychiatry Clin Neurosci. 2001;13:229–42.CrossRef
21.
go back to reference Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y. Intensive care delirium screening checklist: evaluation of a new screening tool. Intensive Care Med. 2001;27:859–64.CrossRef Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y. Intensive care delirium screening checklist: evaluation of a new screening tool. Intensive Care Med. 2001;27:859–64.CrossRef
22.
go back to reference Breitbart W, Rosenfeld B, Roth A, Smith MJ, Cohen K, Passik S. The memorial delirium assessment scale. J Pain Symptom Manage. 1997;13:128–37.CrossRef Breitbart W, Rosenfeld B, Roth A, Smith MJ, Cohen K, Passik S. The memorial delirium assessment scale. J Pain Symptom Manage. 1997;13:128–37.CrossRef
23.
go back to reference Marcantonio ER, Simon SE, Bergmann MA, Jones RN, Murphy KM, Morris JN. Delirium symptoms in post-acute care: prevalent, persistent, and associated with poor functional recovery. J Am Geriatr Soc. 2003;51:4–9.CrossRef Marcantonio ER, Simon SE, Bergmann MA, Jones RN, Murphy KM, Morris JN. Delirium symptoms in post-acute care: prevalent, persistent, and associated with poor functional recovery. J Am Geriatr Soc. 2003;51:4–9.CrossRef
24.
go back to reference Neelon VJ, Champagne MT, Carlson JR, Funk SG. The NEECHAM confusion scale: construction, validation, and clinical testing. Nurs Res. 1996;45:324–30.CrossRef Neelon VJ, Champagne MT, Carlson JR, Funk SG. The NEECHAM confusion scale: construction, validation, and clinical testing. Nurs Res. 1996;45:324–30.CrossRef
25.
go back to reference Lütz A, Radtke FM, Franck M, Seeling M, Gaudreau JD, Kleinwächter R, Kork F, Zieb A, Heymann A, Spies CD. The nursing delirium screening scale (NU-DESC). Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS. 2008;43:98–102.CrossRef Lütz A, Radtke FM, Franck M, Seeling M, Gaudreau JD, Kleinwächter R, Kork F, Zieb A, Heymann A, Spies CD. The nursing delirium screening scale (NU-DESC). Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS. 2008;43:98–102.CrossRef
26.
go back to reference Association AP. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Washington DC: American Psychiatric Association; 2013 Association AP. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Washington DC: American Psychiatric Association; 2013
27.
go back to reference Organization WH. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organization; 1992. Organization WH. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organization; 1992.
28.
go back to reference Hshieh TT, Inouye SK, Oh ES. Delirium in the elderly. Clin Geriatr Med. 2020;36:183–99.CrossRef Hshieh TT, Inouye SK, Oh ES. Delirium in the elderly. Clin Geriatr Med. 2020;36:183–99.CrossRef
29.
go back to reference Yanli Z, Ling C, Dongmei X, Nan L, Langli G, Jirong Y. Developing an automatic scale to delirium detection based on the electronic medical record system. J Med Postgrad. 2020;33:4. Yanli Z, Ling C, Dongmei X, Nan L, Langli G, Jirong Y. Developing an automatic scale to delirium detection based on the electronic medical record system. J Med Postgrad. 2020;33:4.
30.
go back to reference Cronbach L. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16:297–334. Cronbach L. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16:297–334.
31.
go back to reference Ceppi MG, Rauch MS, Sándor PS, Gantenbein AR, Krishnakumar S, Albert M, Meier CR. Detecting incident delirium within routinely collected inpatient rehabilitation data: validation of a chart-based method. Neurol Int. 2021;13:701–11.CrossRef Ceppi MG, Rauch MS, Sándor PS, Gantenbein AR, Krishnakumar S, Albert M, Meier CR. Detecting incident delirium within routinely collected inpatient rehabilitation data: validation of a chart-based method. Neurol Int. 2021;13:701–11.CrossRef
Metadata
Title
A novel semiautomatic Chinese keywords instrument screening delirium based on electronic medical records
Authors
Ling Chen
Nan Li
Yuxia Zheng
Langli Gao
Ning Ge
Dongmei Xie
Jirong Yue
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2022
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-022-03474-w

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