Identification of acute brain failure using electronic medical records.
Up to 80% of critically ill patients have acute neurologic dysfunction syndromes. We evaluated interrater reliability between the examination by the investigator and the charted assessment by the nurse because the accuracy and reliability of detailed data sets extracted from the electronic medical records represents a keystone for creating EMR-based definitions.



We conducted a prospective observational study of intensive care unit (ICU) patients to assess the reliability of charted Confusion Assessment Method for the ICU, Glasgow Coma Scale (GSC), Full Outline of Unresponsiveness, and Richmond Agitation Sedation Scale (RASS) scores, and a composite measure of ABF defined as new-onset coma or delirium. Trained investigator blinded to nursing assessments performed the neurologic evaluations that were compared with nursing documentation.



A total of 202 observations were performed in 55 ICU patients. Excellent correlation was noted for GCS and Full Outline of Unresponsiveness scores on Bland-Altman plots (Pearson correlation 0.87 and 0.92, respectively). Correlation for Confusion Assessment Method for the ICU was also high (κ= 0.86; 95% confidence interval [CI], 0.70-1.01). Richmond Agitation Sedation Scale had good agreement when scores were dichotomized as oversedated (less than -2) vs not oversedated, with κ= 0.76 (95% CI, 0.54-0.98). Investigator assessment and nurse charting were highly concordant (κ= 0.84; 95% CI, 0.71-0.99).



Neurologic assessments documented on the EMR are reliable.
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN; Department of Medicine, Multidisciplinary Epidemiology and Translational Research in Intensive Care, Emergency and Perioperative Medicine (METRIC), Mayo Clinic, Rochester, MN. Electronic address: drraja.reddy2005@gmail.com.
Dereddi Raja Shekar
DR
Reddy
Department of Medicine, Multidisciplinary Epidemiology and Translational Research in Intensive Care, Emergency and Perioperative Medicine (METRIC), Mayo Clinic, Rochester, MN; Department of Neurology, Division of Critical Care Neurology, Mayo Clinic, Rochester, MN. Electronic address: tarundsingh6@gmail.com.
Tarun D
TD
Singh
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN; Department of Medicine, Multidisciplinary Epidemiology and Translational Research in Intensive Care, Emergency and Perioperative Medicine (METRIC), Mayo Clinic, Rochester, MN. Electronic address: guru.pramod@mayo.edu.
Pramod K
PK
Guru
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN. Electronic address: sakusic.amra@mayo.edu.
Amra
A
Sakusic
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN; Department of Medicine, Multidisciplinary Epidemiology and Translational Research in Intensive Care, Emergency and Perioperative Medicine (METRIC), Mayo Clinic, Rochester, MN. Electronic address: gajic.ognjen@mayo.edu.
Ognjen
O
Gajic
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN; Department of Medicine, Multidisciplinary Epidemiology and Translational Research in Intensive Care, Emergency and Perioperative Medicine (METRIC), Mayo Clinic, Rochester, MN; Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, MN. Electronic address: OHoro.John@mayo.edu.
John C
JC
O'Horo
Department of Medicine, Multidisciplinary Epidemiology and Translational Research in Intensive Care, Emergency and Perioperative Medicine (METRIC), Mayo Clinic, Rochester, MN; Department of Neurology, Division of Critical Care Neurology, Mayo Clinic, Rochester, MN. Electronic address: rabinstein.alejandro@mayo.edu.
Alejandro A
AA
Rabinstein
D000368:Aged; D001926:Brain Death / Q000175:diagnosis*; D016638:Critical Illness; D057286:Electronic Health Records / Q000592:standards*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009730:Nursing Assessment / Q000592:standards*; D011446:Prospective Studies; D011595:Psychomotor Agitation; D015203:Reproducibility of Results
Acute brain failure; Coma; Delirium; Electronic digital signature; ICU