Improving Prehospital Stroke Diagnosis Using Natural Language Processing of Paramedic Reports.

Abstract

Accurate prehospital diagnosis of stroke by emergency medical services (EMS) can increase treatments rates, mitigate disability, and reduce stroke deaths. We aimed to develop a model that utilizes natural language processing of EMS reports and machine learning to improve prehospital stroke identification. We conducted a retrospective study of patients transported by the Chicago EMS to 17 regional primary and comprehensive stroke centers. Patients who were suspected of stroke by the EMS or had hospital-diagnosed stroke were included in our cohort. Text within EMS reports were converted to unigram features, which were given as input to a support-vector machine classifier that was trained on 70% of the cohort and tested on the remaining 30%. Outcomes included final diagnosis of stroke versus nonstroke, large vessel occlusion, severe stroke (National Institutes of Health Stroke Scale score >5), and comprehensive stroke center-eligible stroke (large vessel occlusion or hemorrhagic stroke). Of 965 patients, 580 (60%) had confirmed acute stroke. In a test set of 289 patients, the text-based model predicted stroke nominally better than models based on the Cincinnati Prehospital Stroke Scale (c-statistic: 0.73 versus 0.67, P=0.165) and was superior to the 3-Item Stroke Scale (c-statistic: 0.73 versus 0.53, P<0.001) scores. Improvements in discrimination were also observed for the other outcomes. We derived a model that utilizes clinical text from paramedic reports to identify stroke. Our results require validation but have the potential of improving prehospital routing protocols.