title: "Sitting on pins and needles": characterization of symptom descriptions in clinical notes".
abstract: Patients report their symptoms and subjective experiences in their own words. These expressions may be clinically meaningful yet are difficult to capture using automated methods. We annotated subjective symptom expressions in 750 clinical notes from the Veterans Affairs EHR. Within each document, subjective symptom expressions were compared to mentions of symptoms in clinical terms and to the assigned ICD-9-CM codes for the encounter. A total of 543 subjective symptom expressions were identified, of which 66.5% were categorized as mental/behavioral experiences and 33.5% somatic experiences. Only two subjective expressions were coded using ICD-9-CM. Subjective expressions were restated in semantically related clinical terms in 246 (45.3%) instances. Nearly one third (31%) of subjective expressions were not coded or restated in standard terminology. The results highlight the diversity of symptom descriptions and the opportunities to further develop natural language processing to extract symptom expressions that are unobtainable by other automated methods.
authors.affiliation: Salt Lake City VA Health Care System, University of Utah, Salt Lake City, Utah ; Departments of Internal Medicine, University of Utah, Salt Lake City, Utah.
authors.forename: Tyler B
authors.initials: TB
authors.lastname: Forbush
authors.forename: Adi V
authors.initials: AV
authors.lastname: Gundlapalli
authors.forename: Miland N
authors.initials: MN
authors.lastname: Palmer
authors.forename: Shuying
authors.initials: S
authors.lastname: Shen
authors.forename: Brett R
authors.initials: BR
authors.lastname: South
authors.forename: Guy
authors.initials: G
authors.lastname: Divita
authors.forename: Marjorie
authors.initials: M
authors.lastname: Carter
authors.forename: Andrew
authors.initials: A
authors.lastname: Redd
authors.forename: Jorie M
authors.initials: JM
authors.lastname: Butler
authors.forename: Matthew
authors.initials: M
authors.lastname: Samore