Electronic Medical Record Search Research Articles

Risk factors for readmission with preeclampsia: a call for more preventative surveillance and counseling.

Postpartum readmission for preeclampsia is a difficult predicament for patients which creates financial, psychosocial, and physical stress. It is often a challenge to predict postpartum preeclampsia and therefore identify patients that may be at risk prior to discharge. This study aims to identify risk factors in patients that are at high risk for readmission due to preeclampsia. The identification of these risk factors may also lead to enhanced education and counseling prior to discharge. Researchers conducted a case-control study using a data set collected from 2015 to 2022 looking at obstetric readmissions within 6weeks of delivery and then stratified these patients for preeclampsia diagnosis. A control set was created within the healthcare system's electronic medical record's search tools for patients diagnosed with preeclampsia who were not readmitted to the hospital. This study evaluates 78 patients who were readmitted with a diagnosis of preeclampsia and compared to 77 patients who were diagnosed with preeclampsia who were not readmitted. Again, the aim of this study was to investigate risk factors for readmission among patients with preeclampsia. A multivariable logistic regression model was used to assess predictors which revealed that older age (OR 1.13, CI 1.03-1.24), no history of preeclampsia with or without severe features within pregnancy before delivery (OR 15.29, CI 5.56-41.98 and 13.58, CI 4.46-12.85), no aspirin use in pregnancy (OR 4.38, CI 2.02-9.48), and number of triage visits related to hypertension during prenatal care were all significant predictors for readmission due to preeclampsia. With these risk factors in mind, better counseling and preventative surveillance can be provided to patients. Future studies are needed to evaluate the effectiveness of predictive models developed using these found risk factors.

Long-Acting Injectable Antipsychotics in the Geriatric Population: A longitudinal Study

ObjectiveThis study compares demographic, clinical characteristics, and outcomes in older adults on long-acting injectable antipsychotics (LAI-AP) vs. oral antipsychotics (PO-AP). DesignThis observational study with a retrospective cohort utilized the electronic medical record's search engine to review charts of geriatric patients on LAI-AP for a two-year period. A convenience sample on PO-AP formed the comparison group. LAI-AP patients were subcategorized into discontinuation and continuation groups. SettingConducted at an urban, psychiatric outpatient clinic, using charts from October 2020 to 2022. ParticipantsPatients at least 60 years-old with psychotic or mood disorders on antipsychotics for at least 3-months during the study period. MeasurementsDemographic and clinical variables, including diagnosis, medication type, side effects, medical comorbidities, neurocognitive status, and secondary medications, were collected for both PO-AP and LAI-AP groups. Outcome variables included missed appointments, psychiatric and medical hospitalizations, and emergency room visits. Correlates of discontinuation of LAI-AP were also assessed. ResultsLAI-AP had a higher proportion than PO-AP of primary psychotic disorders (87.8% vs. 64.3%). During the study, PO-AP had higher rates of missed appointments (median 18% vs. 13% for LAI-AP) and psychiatric admissions (mean 0.019/month vs. 0.006/month for LAI-AP;); Female sex was a risk factor for discontinuation of LAI-AP (86.7% of discontinuation group vs. 55.2% of continuation group). ConclusionsThe LAI-AP group showed reduced hospitalizations, better treatment engagement, and comparable tolerability to PO-AP. Preliminary data suggests gender may influence LAI-AP discontinuation rates. This study adds to the sparse literature investigating the efficacy and tolerability of LAI-AP in geriatric patients.

Fever of unknown origin: A 12-year case series in Colombia.

Fever of unknown origin (FUO) is a diagnostic challenge with highly heterogeneous causes. Its etiology can change according to the studied regions, and the chance of reaching a diagnosis depends on available resources. The aim of this study is to describe the clinical characteristics, etiology and the usefulness of diagnostic aids in cases of FUO managed over 12 years in a Colombian reference center. Single-institution retrospective case series. All cases of FUO between 2006 and 2017 were identified with the help of an electronic medical record search software. Cases of adults with fever for more than three weeks who remained undiagnosed after three days of hospitalization are described. Of 1,009 cases evaluated, 112 cases met the inclusion criteria (median age 43 years, 66% men). The etiologies identified were infectious (31.2%), inflammatory (20.5%), neoplastic (14.3%), and miscellaneous (2.7%) diseases. 31.2% remained without etiological diagnosis. The most frequent conditions were tuberculosis (17%), Hodgkin's lymphoma (7.1%), systemic lupus erythematosus (6.3%), disseminated histoplasmosis, and adult Still's disease. Contrast tomography and biopsies were the studies that most frequently supported or confirmed the final diagnosis. This series of contemporary Latin American cases suggests that the categories of FUO etiologies are similar to those reported in studies from developed countries, with tuberculosis being the most frequent cause in our setting. Our results highlight the importance of tomography-guided invasive studies in the diagnostic approach to FUO.

Involvement of veterinary students in the placement of intravenous catheters in adult horses in a teaching hospital does not significantly increase the rate of catheter complications.

To determine whether student involvement in intravenous catheter (IVC) placement increases the risk for complications and to report the rate and types of complications associated with IVCs in adult horses in a university teaching hospital. 455 IVCs placed in 394 horses. Data relevant to IVC placement and removal were retrieved from an electronic medical record search including records of adult horses from January 1 to December 31, 2022. Data retrieved from records included the role of the individual who prepared the site and placed the IVC, site of IVC placement, and type of IVC. The reason for removal of the IVC and presence or absence of detectable changes within the vein at the time of removal were documented in addition to clinical data, allowing for classification of each case. Data were reviewed retrospectively, and statistical analyses were performed using mixed-effects logistic regression models. Significance was set at P ≤ .05. The overall rate of complications was 15.6%, and the most common type of complication was swelling of the vein. Students were involved in 87 of 455 IVC site preparations and placements, and there were no statistically significant differences in complication rates between IVC sites prepared or placed by veterinary students versus nonstudent personnel. Veterinary personnel and clients may be hesitant to allow student involvement in IVC placement in horses, but these data suggest that student involvement does not increase the risk of IVC complications.

Septic Cavernous Sinus Thrombosis: Clinical Characteristics, Management, and Outcomes.

Septic cavernous sinus thrombosis (CST) is a rare condition traditionally associated with high morbidity and mortality. More recent case series report more favorable outcomes, including full functional recovery. A comprehensive assessment of the clinical characteristics and prognostic factors of visual and survival outcomes in septic CST is warranted to contemporize current understanding and help guide management. A multicentered retrospective cohort study was conducted at 2 tertiary care centers using an electronic medical record search of the term, "thrombosis of cavernous venous sinus" between January 1, 2000, and December 31, 2021. Inclusion criteria consisted of active infection and radiographic evidence of associated CST. Demographic and clinical data extracted included age at presentation, sex, infection type and extent, and ophthalmic examination findings at presentation-best-corrected visual acuity (BCVA), presence of relative afferent pupillary defect (RAPD), intraocular pressure (IOP), and extraocular motility (EOM) limitation. Management data collected consisted of type and length of antimicrobial therapy, type and length of anticoagulation administration, and surgical intervention. Primary outcomes assessed were ophthalmic examination findings at final evaluation and same-hospitalization mortality. A total of 27 patients with imaging-confirmed septic CST were identified at 2 tertiary care centers. At presentation, 2 (8.7%) patients had no light perception (NLP) vision, 8 (29.6%) patients had RAPD, 17 (73.9%) patients had EOM limitation, and 13 (54.2%) had IOP >21 mm Hg. All patients received antimicrobial therapy, with vancomycin being the most common agent. Fifteen patients (55.6%) received anticoagulation, and 21 (81.5%) patients underwent surgical intervention. Same-hospitalization mortality was 3 (11.1%). Among the 21 patients with ophthalmic data at follow-up, 3 (16.7%) had NLP vision, 5 (23.8%) had a persistent RAPD, 7 (31.8%) had persistent EOM limitation, and no patients had IOP elevated above 21 mm Hg. Patients with RAPD at presentation had significantly worse BCVA at final evaluation (logMAR BCVA 1.43 higher on average, P = 0.01) and a significantly higher mortality rate (37.5% vs. 0.0%, P < 0.01) than non-RAPD patients. Demographic features, BCVA at presentation, EOM limitation at presentation, elevated IOP at presentation, and comorbid orbital cellulitis were not associated with worse visual or mortality outcomes. Septic CST may result in permanent ophthalmic functional deficit in almost one-third of cases and mortality in approximately 11% of patients under contemporary management. New RAPD at presentation may indicate higher risk of poor visual and survival outcomes.

Abstract LB139: Disparities in oral precancerous lesion surveillance in the United States upper Midwest

Abstract Objective: To determine whether geographic representation and race of patients in a regional oral cancer surveillance program (University of Minnesota Cancer Active Surveillance Population (UMN CASP)) mirror characteristics in the corresponding National Cancer Institute (NCI) designated comprehensive cancer center catchment. Introduction: Oral cancer poses a significant public health concern that may be mitigated through lesion surveillance. Representation of patients for clinical trials throughout an NCI cancer center catchment area is a crucial goal to promote improved health outcomes. This study investigates the demographic landscape of patients with preneoplastic oral lesions seen at the CASP. Methods: Through the UMN Clinical and Translational Sciences Institute, we queried 30 International Classification of Disease (ICD) 9 and 10 codes corresponding to 120 unique mucosal oral precancerous lesion descriptors of CASP patients. Automated extraction of electronic medical record (EMR) data for 4,496 patients treated by the senior author between 2011 and 2023 identified 1,375 patients with preneoplastic lesions. The proportion of patients residing in three-digit zip code regions of Minnesota were compared to 2021 American Community Survey state population data. Additionally, race data were compared between CASP patients and the UMN Masonic Cancer Center (MCC) patient catchment data. Results: CASP patients were over-represented relative to state population distributions within the Minneapolis-St. Paul metropolitan area and surrounding suburbs (region 554 p&amp;lt;0.0001 and region 551 p&amp;lt;0.0001). Under-representation of CASP patients was observed in all western and southern border regions (regions 559 p&amp;lt;0.0001, 560 p&amp;lt;0.0001, 561 p&amp;lt;0.0001, 562 p=0.0037, 565 p&amp;lt;0.0001, and 567 p=0.0006) as well as portions of central (563 p&amp;lt;0.0001), northern (566 p=0.0015), and north-eastern (558 p&amp;lt;0.0001) Minnesota. Proportional representation was observed in several regions of central (553 and 564), eastern (550), and north-eastern (557 and 556) Minnesota. Comparisons of CASP race data revealed a higher proportion of black patients (CASP 8.59% [95% CI 7.17-10.27%] vs. MCC 7.16% [95% CI 7.14-7.17%]) and a lower proportion of Asian/Pacific Islander patients (CASP 3.74% [95% CI 2.82-4.94%] vs. MCC 5.32% [95% CI 5.30-5.34%]) relative to MCC catchment patients. White, American Indian/Alaskan Native, and mixed-race groups were proportionally represented in both data sets. Conclusions: These data show that system wide EMR searches can be implemented to identify patients in an NCI cancer center catchment area with precancerous or other at-risk conditions for cancer. Importantly, Native patients were proportionally represented in the screening program while several rural locations were under-represented. This information can instruct the expenditure of additional resources for under-represented groups and permit streamlined enrollment of patients for cancer prevention clinical trials. Citation Format: Alexander J. Dwyer, Lindsey Mortensen, Beverly R. Wuertz, Frank G. Ondrey. Disparities in oral precancerous lesion surveillance in the United States upper Midwest [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr LB139.

Next generation of electronic medical record search engines to support chart reviews: A systematic user study and future research direction

ObjectiveLittle research has been done on the user-centered document ranking approach, especially in a crowdsourcing chart review environment. As the starting point of designing and implementing the next generation of Electronic Medical Record (EMR) search engines, a systematic user study is needed to better understand the users' needs, challenges, and future research directions of EMR search engines. Materials and methodsOne primary observation during the user study is the need for a ranking method to better support the so-called "early stopping" reviewing strategy (i.e., reviewing only a subset of EMRs of one patient to make the final decision) during the clinical chart reviews. The authors proposed two novel user-centered ranking metrics: "critical documents" and "negative guarantee ratio," to better measure the power of a ranking method in supporting the “early stopping” requirements during clinical chart reviews. ResultsThe evaluation results show that i) traditional information retrieval metrics, such as the precision-at-K, have limitations in guiding the design and development of EMR search engines to better support clinical chart reviews; ii) there is not a global optimal ranking method that fits the needs of different chart reviews and different users; iii) a learning-to-rank approach cannot guarantee a stable and optimal ranking for different chart reviews and different users; and iv) A user-centered ranking metric, such as the negative guarantee ratio (NGR) metric is able to measure the “early-stopping” performance of ranking methods. ConclusionsUser-centered ranking metrics can better measure the power of ranking methods in supporting clinical chart reviews. Future research should explore more user-centered ranking metrics and evaluate their impact on real-world EMR search engines.

Male genitourinary schistosomiasis-related symptoms among long-term Western African migrants in Spain: a prospective population-based screening study

BackgroundSchistosomiasis is highly endemic in sub-Saharan Africa and frequently imported to Europe. Male urogenital manifestations are often neglected. We aimed to ascertain the prevalence of genitourinary clinical signs and symptoms among long-term African migrants in a non-endemic European country using a serology test.MethodsWe carried out a prospective, community-based cross-sectional study of adult male migrants from sub-Saharan Africa living in Spain. Schistosoma serology tests and microscopic urine examinations were carried out, and clinical data were obtained from an electronic medical record search and a structured questionnaire.ResultsWe included 388 adult males, mean age 43.5 years [Standard Deviation (SD) = 12.0, range: 18–76]. The median time since migration to the European Union was 17 [Interquartile range (IQR): 11–21] years. The most frequent country of origin was Senegal (N = 179, 46.1%). Of the 338, 147 (37.6%) tested positive for Schistosoma. Parasite eggs were present in the urine of only 1.3%. Nine genitourinary clinical items were significantly associated with positive Schistosoma serology results: pelvic pain (45.2%; OR = 1.57, 95% CI: 1.0–2.4), pain on ejaculation (14.5%; OR = 1.85, 95% CI: 1.0–3.5), dyspareunia (12.4%; OR = 2.45, 95% CI: 1.2–5.2), erectile dysfunction (9.5%; OR = 3.10, 95% CI: 1.3–7.6), self-reported episodes of infertility (32.1%; OR = 1.69, 95% CI: 1.0–2.8), haematuria (55.2%; OR = 2.37, 95% CI: 1.5–3.6), dysuria (52.1%; OR = 2.01, 95% CI: 1.3–3.1), undiagnosed syndromic STIs (5.4%), and orchitis (20.7%; OR = 1.81, 95% CI: 1.0–3.1). Clinical signs tended to cluster.ConclusionsUrogenital clinical signs and symptoms are prevalent among male African long-term migrants with a positive Schistosoma serology results. Genital involvement can be frequent even among those with long periods of non-residence in their sub-Saharan African countries of origin. Further research is needed to develop diagnostic tools and validate therapeutic approaches to chronic schistosomiasis.Graphical

Advantages of an Image-Guided Subcranial Technique for Le Fort III Osteotomies for Midface Advancement: A Case Series

Objective: Le Fort III osteotomies are used to advance the midface in children with midface hypoplasia and syndromic craniosynostosis. Complications can occur during the subcranial osteotomies, leading todural violations as well as vascular and neurologic injuries. In patients with cerebrospinal fluid (CSF) shunts, CSF leak places them at risk of shunt infection. To avoid these injuries, surgeons may utilize an intracranial approach to gain optimal visualization of the cranial base for the horizontal cut through the ethmoid bone, at the naso-frontal junction, below the cribiform plate. A formal craniotomy to simply assure a safe osteotomy, however, may well be an unnecessary morbidity. The aim of this study was to describe the indications for and technical advantages of image guidance for subcranial Le Fort III osteotomies without a craniotomy. Methods: We describe the use of the StealthStation 3-D intraoperative image guidance system for subcranial Le Fort III osteotomies and associated clinical outcomes. An electronic medical record search at a single academic institution identified 10 patients with Current Procedural Terminology codes 21154-21155 (reconstruction midface, Le Fort III). Results: Six patients underwent image-guided subcranial Le Fort III osteotomies between 2008 and 2023. There were no cases of vascular injury, cranial nerve injury, or cerebrospinal fluid leak. No patients with a CSF shunt experienced shunt infection during follow up. Conclusions: Image-guidance provides technical advantages as an alternative approach to subcranial Le Fort III osteotomies while allowing the surgeon to avoid the morbidity of a craniotomy.

Venous thromboembolism management in people with cystic fibrosis.

Rates of venous thromboembolism (VTE) are increasing in people with cystic fibrosis (PwCF). Providers treating VTE in PwCF have reported low confidence concerning anticoagulant drug selection, dose, duration, and drug-drug interactions. As there are currently no published reports regarding management of VTE in PwCF, our objective was to describe the management of VTE in PwCF. PwCF and VTE at the University of Utah Health were identified through electronic medical record searches. Patients were categorized into one of three treatment groups: warfarin, direct oral anticoagulant (DOAC), and low molecular weight heparin (LMWH). The primary outcome was episodes of major bleeding. Secondary outcomes included clinically relevant nonmajor (CRNM) bleeding. Nine PwCF with a total of 12 unique VTE episodes were included in the study, with all but one episode associated with a peripherally inserted central catheter (PICC). Of the 12 VTE cases, 25% were treated with warfarin, 50% with a DOAC, and 25% with LMWH. There were no episodes of major bleeding and only one episode of CRNM bleeding (Hemoptysis) in the LMWH group. All anticoagulant doses and durations generally followed guidelines for persons without CF. DOACs were the most common VTE treatment, at doses and duration consistent with guidelines for persons without CF, with no major or CRNM bleeding. VTE treatment in PwCF is generally consistent with guidelines for persons without CF with low rates of bleeding. DOACs are a potential option for treatment of VTE in PwCF, but more research is needed.

Multicenter Retrospective Analysis of Eosinophilic Myeloid Neoplasms

Background. Some patients who present with clinical features consistent with idiopathic hypereosinophilic syndrome (HES; absolute eosinophil count (AEC) ≥1.5 x 10 9/L with related end organ damage) are ultimately diagnosed with a myeloid neoplasm. Although FIP1L1::PDGFRA is the most common molecular abnormality in this setting, many other fusion genes, point mutations and cytogenetic abnormalities have been implicated in driving primary (neoplastic) eosinophilia. Given the poor prognosis of these disorders in the absence of treatment and the availability of targeted therapies for many of the driver mutations, it is becoming increasingly important to rapidly identify the underlying genetic alteration. In this regard, the expense and variable sensitivity of molecular diagnostic tests remains problematic. Although clinical features have been reported to distinguish between PDGFRA-associated myeloid neoplasms and D816V KIT-positive systemic mastocytosis with hypereosinophilia, little is known about the clinical phenotypes of other subsets of patients. This multicenter retrospective study aimed to assemble a large cohort of patients with HES secondary to a myeloid neoplasm to explore the utility of clinical and laboratory features in predicting the underlying molecular abnormality. Methods. Retrospective, de-identified data from 16 centers were collected via an online Research Electronic Data Capture repository. Patients and associated data were obtained from in-house research databases and/or electronic medical record searches at each site. Clinical and laboratory data were entered in accordance with local Institutional Review Boards. Inclusion criteria were peripheral blood hypereosinophilia (AEC &amp;gt;1.5 x 10 9/L) on at least two occasions and one of the following: ≥1 confirmed genetic abnormality recurrently associated with primary myeloid neoplasms, other evidence of clonal eosinophilia, or increased blasts (≥2% in the blood or &amp;gt;5% but &amp;lt;20% in the marrow). Patients with acute myeloid leukemia were excluded. Results. A total of 277 patients followed between 1990 and 2022 were included in the analysis. Median length of follow up was 31 months (range &amp;lt;1-356), and 217/277 (78%) were alive at last follow up. The most common genetic abnormality was FIP1L1::PDGFRA (n=131) followed by D816V KIT mutations (n=39) and alterations involving JAK2 (n=22) (Figure 1). Five patients had genetic abnormalities involving two distinct genes recurrently associated with eosinophilic myeloid neoplasms. The overall median age at diagnosis was 55 years (range 12-89) and 79% of the patients were male. When patients with abnormalities involving PDGFRA and PDGFRB were excluded from the analysis, the male predominance was significantly lower at 62% (p&amp;lt;0.001, Fisher's exact test as compared to the data set as a whole). The overall pattern of organ system involvement was similar irrespective of the underlying genetic abnormality with a few notable exceptions. Cardiac involvement was most common in patients with FIP1L1:: PDGFRA, abnormalities involving JAK2 or without pathologic alterations identified (reported in 22%, 32% and 30%, respectively); whereas skin and gastrointestinal involvement, lymphadenopathy and splenomegaly were most frequent in patients with KIT D816V. Laboratory abnormalities also differed between groups. Whereas anemia was the most common blood abnormality (reported in &amp;gt;50% of patients), erythrocytosis was noted primarily in patients with abnormalities involving JAK2. In contrast, circulating blasts were identified in 70% of patient with BCR::ABL1 and 29% of patients with chromosomal abnormalities or KIT D816V, but in &amp;lt;15% of patients in any of the other groups. Whereas peak AEC alone did not discriminate between the different patient groups, the AEC/tryptase ratio was increased in patients with PDGFRA-associated myeloid neoplasms, molecular abnormalities involving JAK2, or chromosomal abnormalities as compared to those with KIT mutations (Figure 2). Conclusions. Despite the limitations of retrospective data analysis, the data from this large multicenter cohort of patients with HES due to a chronic myeloid neoplasm suggest that routine demographic, clinical and laboratory features vary depending on the underlying molecular abnormality. This approach could ultimately help guide empiric therapy when molecular studies are negative or unavailable.

A Real-World Analysis of the Diagnostic Evaluation for Hemophagocytic Lymphohistiocytosis in a Pediatric Population

Hemophagocytic lymphohistiocytosis (HLH) is a severe hyperinflammatory syndrome that is often fatal without immunosuppressive treatment to quell the overactive immune response. Accordingly, it is crucial to diagnose HLH promptly and accurately. Nevertheless, diagnosing HLH is challenging due to its phenotypic overlap with other inflammatory conditions. Furthermore, existing HLH diagnostic criteria consist largely of nonspecific clinical and laboratory findings. Together, these factors contribute to significant diagnostic uncertainty, which can delay initiation of treatment in patients who actually have HLH while exposing other patients who do not have HLH to unnecessary immunosuppressive therapy. We sought to better understand how these challenges manifest in a real-world setting and identify opportunities to improve upon existing diagnostic algorithms. To this end, we queried the UCSF Electronic Medical Record Search Engine for clinical notes containing mention of HLH or the related disease, macrophage activation syndrome (MAS), in patients presenting to the UCSF Medical Center between 2008 and 2021. The resulting 2,360 patients were filtered to include only those who were admitted to an inpatient unit and managed by a pediatric care team. Patients with existing malignant, autoimmune, or immunodeficiency conditions were excluded. The resulting 635 patients were divided into an “HLH-diagnosed” group, consisting of 68 patients assigned an ICD-10 code for HLH/MAS, and an “HLH-considered” group, containing the remaining 567 patients without such a code but in whom HLH/MAS was considered on the differential diagnosis. There was an equal distribution of males and females across the cohort. Ages ranged from 0 to 25 years, with no significant difference between groups. Patients in the HLH-diagnosed group were more likely to be deceased at the end of the admission (21% versus 5%, p&amp;lt;0.0001). The most common presenting symptoms were fever, rash, emesis, and fatigue, and there were no differences in the frequency of any presenting features between the two groups. Among the discharge diagnoses for patients in the HLH-considered group, infections were most common (23%), followed by rheumatologic diseases (20%), new malignancies (9%), and fever of unknown origin (8%). We evaluated the performance of the two most commonly used diagnostic algorithms, namely the HLH-2004 criteria and H-score. The HLH-2004 criteria demonstrated a sensitivity of 65% and a specificity of 92%, versus 82% and 83% for the H-score. Patients in the HLH-considered group with newly-diagnosed malignancies had the highest false positivity rate, with 20% testing positive by the HLH-2004 criteria and 34% by the H-score. We also applied these algorithms to patients in the HLH-considered group who were assigned an ICD-10 code for sepsis (n=62). Fifteen and 42% had a false positive result by the HLH-2004 criteria and the H-score, respectively. Given that many HLH-considered patients tested positive by these existing algorithms but were ultimately ruled out based on other clinical data, we sought to create a new model relying only on basic laboratory parameters to help better differentiate HLH-diagnosed and HLH-considered patients. To address this, we performed multivariate logistic regression analysis. Cytopenias and levels of ferritin, triglycerides, and fibrinogen were all significant predictors in univariate analyses and independent predictors in the multivariate analysis. The resulting model produced an area under the curve of 0.86 (0.81-0.90). HLH is commonly considered on the differential diagnosis in hospitalized children, and in our cohort, was ruled out eight times more often than it was diagnosed. Infections, malignancies, and rheumatologic diseases are the most common HLH mimics and cannot be readily distinguished from HLH on the basis of presenting features. Existing diagnostic algorithms showed suboptimal performance in this cohort, particularly in patients with malignancy and sepsis. Our alternative model consisting only of basic laboratory parameters may help streamline the initial diagnostic workup for pediatric patients with concern for HLH and more accurately identify those who require further specialized testing.

Developing a Semantically Based Query Recommendation for an Electronic Medical Record Search Engine: Query Log Analysis and Design Implications.

An effective and scalable information retrieval (IR) system plays a crucial role in enabling clinicians and researchers to harness the valuable information present in electronic health records. In a previous study, we developed a prototype medical IR system, which incorporated a semantically based query recommendation (SBQR) feature. The system was evaluated empirically and demonstrated high perceived performance by end users. To delve deeper into the factors contributing to this perceived performance, we conducted a follow-up study using query log analysis. One of the primary challenges faced in IR is that users often have limited knowledge regarding their specific information needs. Consequently, an IR system, particularly its user interface, needs to be thoughtfully designed to assist users through the iterative process of refining their queries as they encounter relevant documents during their search. To address these challenges, we incorporated "query recommendation" into our Electronic Medical Record Search Engine (EMERSE), drawing inspiration from the success of similar features in modern IR systems for general purposes. The query log data analyzed in this study were collected during our previous experimental study, where we developed EMERSE with the SBQR feature. We implemented a logging mechanism to capture user query behaviors and the output of the IR system (retrieved documents). In this analysis, we compared the initial query entered by users with the query formulated with the assistance of the SBQR. By examining the results of this comparison, we could examine whether the use of SBQR helped in constructing improved queries that differed from the original ones. Our findings revealed that the first query entered without SBQR and the final query with SBQR assistance were highly similar (Jaccard similarity coefficient=0.77). This suggests that the perceived positive performance of the system was primarily attributed to the automatic query expansion facilitated by the SBQR rather than users manually manipulating their queries. In addition, through entropy analysis, we observed that search results converged in scenarios of moderate difficulty, and the degree of convergence correlated strongly with the perceived system performance. The study demonstrated the potential contribution of the SBQR in shaping participants' positive perceptions of system performance, contingent upon the difficulty of the search scenario. Medical IR systems should therefore consider incorporating an SBQR as a user-controlled option or a semiautomated feature. Future work entails redesigning the experiment in a more controlled manner and conducting multisite studies to demonstrate the effectiveness of EMERSE with SBQR for patient cohort identification. By further exploring and validating these findings, we can enhance the usability and functionality of medical IR systems in real-world settings.

Risk factors influencing death prior to discharge in 302 dogs undergoing unilateral adrenalectomy for treatment of primary adrenal gland tumours.

Adrenalectomies for canine adrenal tumours are associated with peri-operative morbidity and mortality. Objectives of this study included assessing the prognostic value of tumour- or surgery-related variables in predicting peri-operative mortality and overall survival in dogs undergoing adrenalectomies for primary adrenal tumours as well as pre-treatment with phenoxybenzamine on survival to discharge with pheochromocytomas specifically. A multi-institutional retrospective cohort study was performed across nine institutions. Electronic medical record searches identified 302 dogs which met the inclusion criteria. Data collected included dog-related, tumour-related, treatment-related, surgery-related, and outcome variables. Univariate and multivariable logistic regression and cox proportional hazards models were used to identify variables associated with death prior to discharge and tumour-related survival. Overall, 87% of dogs survived to discharge with a tumour-related survival time of 3.96 years. Post-operative complications were reported in 25%. Increased surgical time (p = 0.002) and pre-surgical medical treatment other than phenoxybenzamine (p = 0.024) were significantly associated with increased peri-operative mortality while ureteronephrectomy (p = 0.021), post-operative pancreatitis (p = 0.025), and post-operative aspiration pneumonia (p < 0.001) were significantly associated with decreased overall survival. Phenoxybenzamine pretreatment had no effect on peri-operative mortality. Thirty-seven of 45 (82%) dogs with pheochromocytomas not pretreated survived to discharge, and 50 of 59 (85%) dogs with pheochromocytomas pretreated with phenoxybenzamine survived to discharge (p = 0.730). This study provides information on risk factors for death prior to discharge and tumour-related survival that may help guide clinical management and owner expectations. In addition, the study findings challenge the previously reported benefit of phenoxybenzamine for pretreatment of dogs undergoing adrenalectomies for pheochromocytomas.

Social Determinants of Health Documentation in Structured and Unstructured Clinical Data of Patients With Diabetes: Comparative Analysis.

Electronic health records (EHRs) have yet to fully capture social determinants of health (SDOH) due to challenges such as nonexistent or inconsistent data capture tools across clinics, lack of time, and the burden of extra steps for the clinician. However, patient clinical notes (unstructured data) may be a better source of patient-related SDOH information. It is unclear how accurately EHR data reflect patients' lived experience of SDOH. The manual process of retrieving SDOH information from clinical notes is time-consuming and not feasible. We leveraged two high-throughput tools to identify SDOH mappings to structured and unstructured patient data: PatientExploreR and Electronic Medical Record Search Engine (EMERSE). We included adult patients (≥18 years of age) receiving primary care for their diabetes at the University of California, San Francisco (UCSF), from January 1, 2018, to December 31, 2019. We used expert raters to develop a corpus using SDOH in the compendium as a knowledge base as targets for the natural language processing (NLP) text string mapping to find string stems, roots, and syntactic similarities in the clinical notes of patients with diabetes. We applied advanced built-in EMERSE NLP query parsers implemented with JavaCC. We included 4283 adult patients receiving primary care for diabetes at UCSF. Our study revealed that SDOH may be more significant in the lives of patients with diabetes than is evident from structured data recorded on EHRs. With the application of EMERSE NLP rules, we uncovered additional information from patient clinical notes on problems related to social connectionsisolation, employment, financial insecurity, housing insecurity, food insecurity, education, and stress. We discovered more patient information related to SDOH in unstructured data than in structured data. The application of this technique and further investment in similar user-friendly tools and infrastructure to extract SDOH information from unstructured data may help to identify the range of social conditions that influence patients' disease experiences and inform clinical decision-making.

Diabetic Ketoacidosis Associated with Sodium-Glucose Cotransporter 2 Inhibitors: Clinical and Biochemical Characteristics of 29 Cases.

To describe the clinical and biochemical characteristics of all reported cases of DKA associated with SGLT2 inhibitor use in patients with type 2 diabetes mellitus and to identify potential risk factors. A retrospective case series was conducted between March 2013 and August 2019 using an electronic medical record search algorithm. 25 patients met the criteria for DKA associated with SGLT2i use (total of 29 cases), 15 were female, average age was 54.24 years, and mean diabetes duration was 8.76 years. The majority of the patients (23 patients) had no history of prior DKA. Average blood glucose concentrations at presentation were 298.9 ± 152.7 mg/dl. Interestingly, nearly half of the episodes (14) met the criteria of euglycemic DKA (glucose <250 mg/dl). Average anion gap values were 26.59 ± 6.15 mg/dl, bicarbonate values were 11.14 ± 5.57 mg/dl, and pH values were 7.16 ± 0.12. All had positive serum and urine ketones. The most common presenting symptoms were nausea, vomiting (18 cases), and abdominal pain (10 cases). Common precipitants were poor oral intake (18 cases) and infection (10 cases). A variety of drugs were prescribed along with an SGLT2i, and 11 of the patients were using insulin. None of the cases were fatal. Comparison between euglycemic DKA and hyperglycemic DKA did not identify any significant difference. A major limitation factor of the study was the lack of control group or comparison to other antiglycemic agents to assess the relative risk. The majority of SGLT2i-associated DKA cases occurred in patients with T2DM without prior episodes of DKA. The most common presenting symptoms were nausea, vomiting, and abdominal pain, while poor food intake and infection were the main precipitants. Clinicians should consider the possibility of DKA in SGLT2i-treated patients presenting with these symptoms, even in absence of marked hyperglycemia.

151-OR: Social Determinants of Health Predict Diabetic Foot Infection Development

The objective was to identify social determinants of health (SDOH) associated with development of diabetic foot infection using the CDC Healthy People Framework at a tertiary care center. Targeted interrogation of structured and unstructured data using novel electronic medical record search engines was used to analyze patient encounters in individuals with diabetes and a concomitant diabetic foot complication during a twenty-year period (2001-2021). Among ~ 200 million encounters from people with diabetic foot complications, 8351 developed diabetic foot ulcers (DFU), and 1671 suffered a DFU infection. The risk of infection development in people with a DFU was assessed with the neighborhood disadvantaged index score from over 200 million separate patient encounters. The neighborhood disadvantaged index based on available geolocation data, provides a unitless value to describe the relative socioeconomic background of an individual as determined by the proportion (%) of non-Hispanic black, proportion (%) of female headed families with children, and the proportion of households (%) with public assistance income or food stamps in a defined area. The average disadvantaged index score for the DFU population was 0.06 and was comparable to the state of Michigan's average disadvantaged index of 0.05. In those persons who developed DFU infection, the index score averaged 0.13, 2.2x higher than the DFU population (p&amp;lt;0.05). Additionally, divorced individuals represented 2% of all individuals with DFU but accounted for 5% of those who developed DFU infection. This was disproportionate to other marriage statuses. These data strongly support the need to incorporate SDOH into updated DFU standard of care guidelines. Moreover, we clearly demonstrate that SDOH, more specifically geolocation data, can be used to identify individuals who are more likely to develop DFU infection. Thus, it is essential that SDOH are included in patient risk stratification to prevent severe diabetic foot complications. Disclosure B.M.Schmidt: None. A.Burant: None. N.Baker: None. A.Katona: None. C.Martin: Advisory Panel; Nevro Corp. C.M.Holmes: None. R.Busui: Board Member; American Diabetes Association, Consultant; Averitas Pharma, Inc., Lexicon Pharmaceuticals, Inc., Nevro Corp., Novo Nordisk, Roche Diagnostics, Procter &amp; Gamble, Research Support; Novo Nordisk, Medtronic, National Institutes of Health. Funding National Institute of Diabetes and Digestive and Kidney Diseases (1K23DK131261-01A1, 5U01DK119083-05)

Analysis of tumor progression among patients with glioma after COVID-19 infection.

2041 Background: As of January 2023, there have been 6.7 million worldwide deaths attributed to SARS-CoV-2 COVID-19, which has impacted outcomes and medical care for all patients. Relatively little is known about the direct effects mediated by the virus on CNS tumor biology, despite the fact that viral neurotropism is well described, various coronavirus receptors have been observed in glioblastoma (GBM) tissues, and differential monocytic infiltration has been proposed to dysregulate the immune microenvironment. We detected a trend of rapid progression following COVID-19 infection among several patients with primary brain tumor patients and sought to systematically evaluate the pace of progression among infected patients in our institution. Methods: A single-institutional database of COVID-19 patients and an electronic medical record (EMR) search tool were used to identify a total cohort of 67 patients with glioma for retrospective analysis. This included 38 GBMs, 18 IDH-mutant gliomas, 5 ependymomas, 2 pilocytic astrocytomas, 1 diffuse midline glioma, 1 diffuse hemispheric glioma, and 1 ganglioglioma patients, each of whom had a documented COVID-19 infection between June 2020-December 2022. Hyperprogression was defined as tumor increase ≥40% compared to previous scan using RECIST size criteria. Results: Thirty-nine (58%) patients experienced tumor progression following COVID-19 infection at a median of 34 days (range=1-734 days) after testing positive for COVID-19. Twenty-two (56%) had received COVID-19 vaccine before their infection and 5 (13%) had asymptomatic infections. Twenty-two patients had measurably increased tumor area by a median of 63% (range=10-2,900%), 18 of which constituted hyperprogression;16 patients developed multifocal disease, 8 developed new nodular enhancement, 3 developed leptomeningeal disease (LMD), and 2 experienced increased infiltrative disease alone. Ten patients’ presentation with new glioma was preceded by COVID-19 infection by a median of 31 days. GBM patients represented the majority of progression events, among whom 59% progressed within 60 days of documented infection (median 25 days). This subgroup of GBM with rapid progression within 60 days had a mOS from infection of 5.2 months; 89% had TERT promotor mutations and 42% had MGMT promoter methylation. Conclusions: Glioma patients appear to have disease progression at an accelerated pace in the first two months after COVID-19 infection. This suggests that glioma patients should continue observing strict precautions to prevent infection and should be clinically monitored vigilantly after infection, with consideration for short interval imaging during treatment. These preliminary data warrant further investigation exploring changes of immune cell infiltration in the tumor microenvironment and the possible correlation between tumor progression and COVID-19.

(281) Pelvic Floor Dysfunction in Premenopausal Women with Recurrent Urinary Tract Infections

Abstract Introduction Urinary tract infections (UTI) are the most common outpatient infections in the United States. Recurrent urinary tract infections (rUTI) are 30 times more common in women than men, suggesting differences in genitourinary anatomy and physiologic factors exist that could explain an increased susceptibility in females. One in three women are diagnosed with a UTI by age 24, with a recurrence rate of approximately 2.6 infections/year. A bidirectional relationship exists between rUTI and pelvic floor dysfunction (PFD) in women, however, little is known about the role of pelvic floor dysfunction in the pathogenesis of UTI in premenopausal women. Objective We aimed to document the occurrence of PFD among a group of premenopausal women with rUTI to further understand the relationship and identify factors associated with pelvic pain and dyspareunia. We hypothesize PFD will have a high prevalence in this population. Methods The Electronic Medical Record Search Engine (EMERSE) database for a single institution was utilize to identify eligible patients. Inclusion criteria included women aged 18-49 with an ICD code for UTI, who still have their ovaries, and who have who have seen a urologist, gynecologist, or urogynecologist within the past 5 years. A total of 610 eligible patients were identified and contacted via email and asked to participate in our survey study. The survey included queries on demographics, medical history, personal experience with UTI symptoms, diagnosis, and treatment. Survey responses were analyzed using chi-squared tests to analyze factors associated with dyspareunia. Pelvic floor dysfunction was defined as baseline pelvic pain outside of the context of UTI or dyspareunia. Internal Review Board approval was obtained for this study (STUDY20211407). Results Of the 610 women contacted, 65 (10.7%) responded. Outside the context of UTI, 52 (80%) women reported some degree of pelvic pain (Figure 1) and 40 (62%) women reported dyspareunia. The presence of pelvic pain was significantly associated with dyspareunia (90% with dyspareunia vs 64% without, p&amp;lt;0.05). On multivariable analysis, patients with pelvic pain were more likely to have dyspareunia (aOR 6.6). There was no association between degree of dyspareunia and duration, number, or severity of UTI. Conclusions PFD is highly prevalent among premenopausal women with rUTI, and screening for pelvic pain and dyspareunia should be performed in this population. Patients who report pelvic pain are more likely to have dyspareunia. Further investigation is needed to evaluate causation between PFD and rUTI in premenopausal women. Disclosure No

Real-world evaluation of linezolid-associated serotonin toxicity with and without concurrent serotonergic agents

The risk of linezolid-associated serotonin toxicity remains unclear. This study sought to evaluate the incidence of serotonin toxicity among hospitalized patients who received linezolid with or without concurrent serotonergic agents (SAs). Secondary outcomes were to assess the dose, agent selection and number of SAs. A single-centre, retrospective cohort study of hospitalized patients aged ≥18 years who received at least one dose of linezolid with or without SAs between 1 January 2014 and 30 June 2021 was performed. Patients were excluded if they were aged <18 years, had linezolid ordered but not administered, were pregnant or were incarcerated. Up to five concurrent SAs were assessed, and dose category was classed as low, moderate or high (dose <33%, 33-66% or >66% of maximum daily dose, respectively). Serotonin toxicity was identified by searching patients' electronic medical records. If identified, the Sternbach criteria and Hunter criteria were applied. Of 2022 patients screened, 1743 were included in this study. Mean age, weight and linezolid duration were 58.5 years, 90.7 kg and 3.8 days, respectively. Approximately 67% (1168/1743) of patients received linezolid with at least one SA, and several patients received multiple SAs. Most patients (53.8%; 616/1144) received moderate- and/or high-dose SAs. Only two patients (0.11%) were identified as possible cases of serotonin toxicity based on the electronic medical record search. However, the incidence of serotonin toxicity was 0.06% (1/1743) based on the Sternbach criteria and 0% (0/1743) based on the Hunter criteria. Serotonin toxicity among hospitalized patients who received linezolid with or without SAs was exceedingly rare, even among those who received multiple and high-dose SAs.