TY - JOUR AU - Yu, AU -赵云翠，AU -曹秋叶，Wang AU - Wang, Xiaochuan AU - Li, Yanming AU - Xie，岳峰AU - Wang, Xiaoling PY - 2022 DA - 2022/9/13 TI -挖掘儿童电子病历中严重药物过敏反应病例:方法开发和应用JO - JMIR Med Inform SP - e37812 VL - 10 IS - 9kw -药物过敏反应KW -电子健康记录KW -临床记录KW -表型KW -自然语言处理KW -医学语言处理KW -从变压器AB双向编码器表示-背景:重度药物超敏反应(Severe drug hypersensitivity reactions, DHRs)是指由药物引起的过敏反应，通常以严重的皮疹和内损为主要症状。目前，医院中严重dhr的报告仅通过由主管临床医生操作的自发报告系统(SRSs)进行。自动识别系统仔细检查临床记录并报告潜在的严重DHR病例。目的:本研究的目标是开发一种能够挖掘重症DHR病例的自动识别系统，发现更多DHR病例供进一步研究。将该方法应用于北京儿童医院9年的儿科电子病历数据。方法:表型任务被视为一个文档分类问题。准备了DHR数据集，其中包含用于训练的标记文档。每个文件包含在这个数据集中的一次住院期间产生的所有临床记录。 Document-level tags correspond to DHR types and a negative category. Strategies were evaluated for long document classification on the openly available National NLP Clinical Challenges 2016 smoking task. Four strategies were evaluated in this work: document truncation, hierarchy representation, efficient self-attention, and key sentence selection. In-domain and open-domain pretrained embeddings were evaluated on the DHR dataset. An automatic grid search was performed to tune statistical classifiers for the best performance over the transformed data. Inference efficiency and memory requirements of the best performing models were analyzed. The most efficient model for mining DHR cases from millions of documents in the EHR system was run. Results: For long document classification, key sentence selection with guideline keywords achieved the best performance and was 9 times faster than hierarchy representation models for inference. The best model discovered 1155 DHR cases in Beijing Children’s Hospital EHR system. After double-checking by clinician experts, 357 cases of severe DHRs were finally identified. For the smoking challenge, our model reached the record of state-of-the-art performance (94.1% vs 94.2%). Conclusions: The proposed method discovered 357 positive DHR cases from a large archive of EHR records, about 90% of which were missed by SRSs. SRSs reported only 36 cases during the same period. The case analysis also found more suspected drugs associated with severe DHRs in pediatrics. SN - 2291-9694 UR - https://medinform.www.mybigtv.com/2022/9/e37812 UR - https://doi.org/10.2196/37812 UR - http://www.ncbi.nlm.nih.gov/pubmed/36099001 DO - 10.2196/37812 ID - info:doi/10.2196/37812 ER -