An Electronic Search Algorithm for Early Disseminated Intravascular Coagulopathy Diagnosis in the Intensive Care Unit: A Derivation and Validation Study.

Tabinda Jawaid,Rahul Kashyap,Timothy Weister,Naseema Gangat

doi:10.7759/cureus.10972

Abstract

Aim: We aim to create and validate an electronic search algorithm for accurate detection of disseminated intravascular coagulopathy (DIC) from medical records.Methods: Patients with DIC in Mayo Clinic’s intensive care units (ICUs) from Jan 1, 2007, to May 4, 2018, were included in the study. An algorithm was developed based on clinical notes and ICD diagnosis codes. A cohort of 50 patients was included with DIC diagnosis, its variations, and no diagnosis of DIC. Then, the next set of 50 patients was used to refine the algorithm. Results were compared with a manual reviewer and the disagreements were resolved by the third reviewer. The same process was repeated with 'revised clinical note search' for the first and second derivation cohort with additional exclusion terms. The obtained sensitivity and specificity were reported. The generated algorithm was applied to another set of 50 patients for validation.Results: In the first derivation cohort- DIC search by clinical notes and diagnosis codes had 92% sensitivity and 100% specificity. Sensitivity dropped to 71% in the second cohort although specificity remains the same. Therefore, the algorithm was refined to clinical notes search only. The revised search was reapplied to first and second derivation cohorts and results obtained for the first derivation were the same but 91.3% sensitive and 100% specific for the second derivation. The search was locked and applied in the validation cohort with 95.8% sensitivity and 100% specificity, respectively.Conclusion: The revised clinical note based electronic search algorithm was found to be highly sensitive and specific for DIC during the corresponding ICU duration.

Highlights

Disseminated intravascular coagulopathy (DIC) can be classified into two parts: thrombotic; formation of multiple small blood clots in the different vessels of the body leading to reduced blood flow to organs, damage of multiple body systems, and hemorrhagic, with fewer platelets and clotting factor, the body becomes prone to severe hemorrhage
According to the Japanese Association for Acute Medicine (JAAM) and the International Society of Thrombosis and Hemostasis (ISTH), DIC patients have higher mortality among patients admitted in the hospital [7]
We aim to develop an automated algorithm for retrospective research studies that will require DIC diagnosis identification

Summary

Introduction

Disseminated intravascular coagulopathy (DIC) can be classified into two parts: thrombotic; formation of multiple small blood clots (thrombi) in the different vessels of the body leading to reduced blood flow to organs, damage of multiple body systems, and hemorrhagic, with fewer platelets and clotting factor, the body becomes prone to severe hemorrhage (internal and external). Sometimes DIC can remain clinically silent and undetected in laboratory findings but can only be identified by coagulation profile (elevated prothrombin time [PT], activated partial thromboplastin time [aPTT]) [1]. DIC can present with dyspnea, acrocyanosis, pallor, severe muscle, back, and abdominal pain, oliguria, multi-organ convulsion, and coma. The common causes for the development of disseminated intravascular coagulopathy are sepsis or severe infection, malignancy, trauma, and obstetric disorders such as placental abruption, amniotic fluid embolism, etc. According to the Japanese Association for Acute Medicine (JAAM) and the International Society of Thrombosis and Hemostasis (ISTH), DIC patients have higher mortality among patients admitted in the hospital [7]

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