title: Finding 'Evidence of Absence' in Medical Notes: Using NLP for Clinical Inferencing.
abstract: Extracting evidence of the absence of a target of interest from medical text can be useful in clinical inferencing. The purpose of our study was to develop a natural language processing (NLP) pipelineto identify the presence of indwelling urinary catheters from electronic medical notes to aid in detection of catheter-associated urinary tract infections (CAUTI). Finding clear evidence that a patient does not have an indwelling urinary catheter is useful in making a determination regarding CAUTI. We developed a lexicon of seven core concepts to infer the absence of a urinary catheter. Of the 990,391 concepts extractedby NLP from a large corpus of 744,285 electronic medical notes from 5589 hospitalized patients, 63,516 were labeled as evidence of absence.Human review revealed three primary causes for false negatives. The lexicon and NLP pipeline were refined using this information, resulting in outputs with an acceptable false positive rate of 11%.
authors.affiliation: VA Salt Lake City Health Care System & University of Utah, Salt Lake City, UT, USA.
authors.forename: Marjorie E
authors.initials: ME
authors.lastname: Carter
authors.affiliation: VA Salt Lake City Health Care System & University of Utah, Salt Lake City, UT, USA.
authors.forename: Guy
authors.initials: G
authors.lastname: Divita
authors.affiliation: VA Salt Lake City Health Care System & University of Utah, Salt Lake City, UT, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Redd
authors.affiliation: VA Salt Lake City Health Care System & University of Utah, Salt Lake City, UT, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Rubin
authors.affiliation: VA Salt Lake City Health Care System & University of Utah, Salt Lake City, UT, USA.
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Samore
authors.affiliation: VA Boston Health Care System and Boston University, Boston, MA, USA.
authors.forename: Kalpana
authors.initials: K
authors.lastname: Gupta
authors.affiliation: Center for Innovations in Quality Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA.
authors.forename: Barbara W
authors.initials: BW
authors.lastname: Trautner
authors.affiliation: VA Salt Lake City Health Care System & University of Utah, Salt Lake City, UT, USA.
authors.forename: Adi V
authors.initials: AV
authors.lastname: Gundlapalli
mesh_terms: D055499:Catheter-Related Infections / Q000175:diagnosis*; D003951:Diagnostic Errors; D004282:Documentation / Q000706:statistics & numerical data*; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients; D009323:Natural Language Processing; D062885:Urinary Catheters / Q000009:adverse effects*