Abstract 2650: Reliability and Validity of Retrospective Extraction of the ABCD 2 Score From Medical Records

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Koto Ishida ◽  
Jonathan M Raser ◽  
Christina A Wilson ◽  
Scott E Kasner ◽  
Michael T Mullen ◽  
...  
Keyword(s):  
Clinical Features ◽  
Medical Records ◽  
Interrater Reliability ◽  
Chart Review ◽  
Reliability And Validity ◽  
Interrater Agreement ◽  
Risk Category ◽  
Kappa Statistics ◽  
Retrospective Assessment ◽  
Record Review

Background and Purpose: The ABCD 2 score is increasingly used for risk stratification of TIA patients. Many of the studies assessing the utility of the ABCD 2 score have retrospectively extracted the score from medical records, but the reliability of estimation based on chart review has not been reported. We sought to determine whether the ABCD 2 score can be estimated retrospectively from medical records. Methods: We compared ABCD 2 scores that were prospectively determined by a board certified vascular neurologist to scores determined retrospectively from medical record review. All ED records and initial neurology consult resident notes were abstracted with explicit ABCD 2 scoring redacted. ABCD 2 scores were then estimated by two independent blinded trained raters using these records. Estimated component, total scores, and ABCD 2 risk category (0-3, 4-5, 6-7), were compared both between raters and with the prospectively obtained scores. Reliability was assessed using unweighted kappa statistics. Results: Records were analyzed for 55 consecutive TIA patients. For the two raters of retrospective ABCD 2 scores, interrater reliability was good with 75% exact agreement in total score between raters (κ=0.68) and 84% agreement for ABCD 2 category (κ=0.74). Interrater agreement on individual items was greatest for age and diabetes, and poorest for clinical features and duration. Retrospectively estimated total ABCD 2 scores were identical to prospective scores in 52% of patients. Agreement between raters and the prospectively obtained score was >90% for age, blood pressure, and diabetes, but was only ∼70% for clinical features and duration. Retrospectively estimated ABCD 2 category was identical to the prospective category in 64% of patients ( Table ). Dichotomizing at an ABCD 2 score ≥4, retrospective assessment had a sensitivity of 83% (CI 70-95%) and specificity of 67% (CI 40-95%) compared to the prospective score. Conclusions: The ABCD 2 score can be abstracted from medical records with good interrater reliability but limited validity, which may lead to misclassification of risk category in over one-third of patients.

scholarly journals Medical Record Review to Differentiate between Idiopathic Parkinson’s Disease and Parkinsonism: A Danish Record Linkage Study with 10 Years of Follow-Up

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Lene Wermuth ◽  
Xin Cui ◽  
Naomi Greene ◽  
Eva Schernhammer ◽  
Beate Ritz
Keyword(s):  
Medical Record ◽  
Electronic Medical Records ◽  
Clinical Features ◽  
Medical Records ◽  
Chart Review ◽  
Large Population ◽  
Area Under The Curve ◽  
Medical Record Review ◽  
Record Review

Background. The electronic medical records provide new and unprecedented opportunities for large population-based and clinical studies if valid and reliable diagnoses can be obtained, to determine what information is needed to distinguish idiopathic PD from Parkinsonism in electronic medical records.Methods. Chart review of complete medical records of 2,446 patients with a hospital discharge diagnosis of PD, who, between 1996 and 2009, were registered in the Danish National Hospital Register as idiopathic PD. All patients were examined in neurology departments. Clinical features were abstracted from charts to determine Parkinsonian phenotypes and disease course, using predefined criteria for idiopathic PD.Results. Chart review verified that 2,068 (84.5%) patients met criteria for idiopathic PD. The most distinguishing features of idiopathic PD patients were asymmetric onset, and fewer atypical features at onset or follow-up compared to Parkinsonism, and the area under the curve (AUC) for these items alone is moderate (0.74–0.77) and the highest AUC (0.91) was achieved when using all clinical features recorded in addition to PD medication use and a follow-up of 5 years or more.Conclusion. To reduce disease misclassification, information extracted from medical record review with at least 5 years of follow-up after first diagnosis was key to improve diagnostic accuracy.

Abstract P270: Automating Processes to Expedite Medical Record Review in Research

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
K M Reeder ◽  
Edward Ellerbeck ◽  
Marilyn Werkowitch ◽  
N. Nazir ◽  
B. Waltrip ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Emergency Room ◽  
Medical Record ◽  
Medical Records ◽  
Chart Review ◽  
Medical Record Review ◽  
Automated System ◽  
Emergency Room Visits ◽  
Automated Method ◽  
Record Review

Problem. Heart failure (HF) clinical trials often use medical record review data to determine HF related hospital events, such as emergency room visits and readmissions. However, reviewing medical records for each hospital event can be daunting. The purpose of this project was to expedite medical record review processes using an automated method for identifying potential HF related hospital events. Methods. A stepwise procedure was developed for obtaining electronic information of all consented HF clinical trial participants' hospital events. First, an electronic list of all study participants was generated from a study data base and electronically sent to the Medical Records department each month. Next, a list of all emergency room visits and hospitalizations, including admission and discharge dates, discharge disposition, and diagnosis and procedure codes was electronically generated by the Medical Records department. A trained cardiovascular research nurse reviewed the abstracted coding and billing data for each hospital event and identified specific codes potentially related to HF. Last, hospital events identified as meeting specific criteria were included in the medical record review. Results. Using the automated system, a total of 294 hospital events for 125 subjects were obtained from the Medical Records department during the initial 2 years of the clinical trial. Of these, 85 (29%) hospital events were identified as needing to undergo chart review. Thirty-three (39%) of the 85 charts that underwent blinded review were identified as being HF related hospital events. Conclusions. Automating procedures for obtaining hospital event information expedited both the systematic data review and chart review processes. In this study, combined use of automated processes for obtaining hospital event data and nurse review reduced the number of charts requiring blinded review by nearly 60%.

Telemedicine in General Neurology: Interrater Reliability of Clinical Neurological Examination Via Audio-Visual Telemedicine

2018 ◽  
Vol 80 (5-6) ◽  
pp. 289-294 ◽  
Author(s):  
Mohamed Awadallah ◽  
Frank Janssen ◽  
Barbara Körber ◽  
Lorenz Breuer ◽  
Mateusz Scibor ◽  
...  
Keyword(s):  
Emergency Room ◽  
Neurological Examination ◽  
Interrater Reliability ◽  
Muscle Tone ◽  
Reliability And Validity ◽  
Observer Agreement ◽  
Kappa Statistics ◽  
Clinical Neurological Examination ◽  
Academic Teaching Hospital ◽  
Acute Patients

Introduction: While there are several studies on reliability of telemedicine in assessing stroke scales, little is known about the validity of a general neurological examination performed via telemedicine. Therefore, we sought to test the agreement between bedside and remote examination in acute patients of the emergency room. Methods: Acute patients at the emergency room of a 450-bed academic teaching hospital were included in this study. A clinical neurological examination consisting of 22 items was performed at bedside and also remotely via an audio-visual link by a different neurologist; both were experienced clinicians at the consultant level. Kappa statistics were calculated for each item of the examination. Results: Forty three patients completed both examinations (mean age 58.3 years, 56% female). Patients were seen between 8 and 72 min after admission (mean 36.3 min). Total time for remote examination was 12.6 min (8–21 min) and 8.9 min (5–18 min) for bedside examination. K-coefficients ranged from 0.32 (muscle tone) – 0.82 (language) indicating a fair to excellent agreement in most items. Conclusions: Remote examination via an audio-visual link produces comparable results to bedside performance even in acute patients of the emergency room. Compared to the scarce data available, inter-observer agreement is about the same as that between 2 examiners at bedside. However, more studies on reliability and validity of clinical neurological examination are required.

scholarly journals Withdrawal Symptoms Following Discontinuation of Vortioxetine—Retrospective Chart Review

2021 ◽  
Vol 14 (5) ◽  
pp. 451
Author(s):  
Marcin Siwek ◽  
Adrian Andrzej Chrobak ◽  
Aleksandra Gorostowicz ◽  
Anna Julia Krupa ◽  
Dominika Dudek
Keyword(s):  
Clinical Features ◽  
Medical Records ◽  
Chart Review ◽  
Depressive Disorders ◽  
Clinical Presentation ◽  
Retrospective Chart Review ◽  
Medical Consultation ◽  
Withdrawal Symptoms ◽  
Drug Discontinuation ◽  
Emotional Lability

The efficacy of vortioxetine has been proven in many studies, but data concerning discontinuation symptoms (DS) after vortioxetine withdrawal is scarce. The aim of our study is to systematically evaluate the prevalence, determinants, and clinical features of vortioxetine DS in a retrospective chart review. Data were obtained from medical records of 263 adult patients with depressive disorders who discontinued former vortioxetine treatment. DS were observed in eight (3%) patients after 71–375 days (median 272) of treatment. DS emerged after median three days following vortioxetine withdrawal and lasted for median seven days. The clinical presentation of DS involved: emotional lability (100% of patients), irritability (75%), sudden worsening of mood (75%), nervousness (37.5%), and agitation (37.5%). Median DESS score was four (range of four to six). DS were significantly more prevalent after accidental vs. planned discontinuation (adjusted p = 0.011) and were less frequent after switching to a different antidepressant vs. ceasing pharmacotherapy (adjusted p = 0.0165). DS appeared more often if patients discontinued therapy without medical consultation (adjusted p = 0.033). The occurrence of DS was not associated with the dose and way of drug discontinuation (sudden vs. gradual). In sum, our results show that clinicians should be aware that vortioxetine withdrawal is associated with the possibility of DS.

Reliability Assessment and Validation of the Skin Hyperpigmentation Index Compared to the Physician Global Assessment Score

Dermatology ◽  
2021 ◽  
pp. 1-4
Author(s):  
Simon Bossart ◽  
Simone Cazzaniga ◽  
Torsten Willenberg ◽  
Albert-Adrien Ramelet ◽  
Kristine Heidemeyer ◽  
...  
Keyword(s):  
Interrater Reliability ◽  
Global Assessment ◽  
Reliability Assessment ◽  
Reliability And Validity ◽  
Interrater Agreement ◽  
Physician Global Assessment ◽  
Skin Hyperpigmentation ◽  
Computer Measurement ◽  
Reliable Instrument ◽  
Nonphysician Clinicians

<b><i>Background:</i></b> The skin hyperpigmentation index (SHI), a new objective method for measuring skin hyperpigmentation, needs validation. <b><i>Objective:</i></b> To gain evidence of the reliability and validity of the SHI. <b><i>Methods:</i></b> Fifteen raters were divided into 3 groups (5 dermatologists, 5 nondermatologist physicians, and 5 nonphysician clinicians). Each rated 5 pigmented mole lesions with mild-to-severe hyperpigmentation to determine intra- and interrater reliability. All raters photographed the lesions and rated them using the subjective Physician Global Assessment (PGA) score. The same photographs were then assessed based on automatic computer measurement software using the online SHI tool (https://shi.skinimageanalysis.com). <b><i>Results:</i></b> The SHI reliability was excellent for all intra- and interrater assessments, while most PGA assessments showed good intra- and interrater agreement. Between-group reliability was excellent for SHI, while moderate-to-good for PGA evaluations. Concordance between the SHI and PGA assessments was strong across all groups of assessors. <b><i>Conclusion:</i></b> There is evidence that the SHI is a reliable instrument for measuring skin hyperpigmentation, and can be used by nonexperienced clinicians.

scholarly journals Clinical characteristics of inpatients with coronavirus disease 2019 (COVID-19) in Sichuan province

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wen Wang ◽  
Lei Chen ◽  
Qiao He ◽  
Mingqi Wang ◽  
Mei Liu ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Clinical Features ◽  
Medical Records ◽  
Clinical Characteristics ◽  
Sichuan Province ◽  
Chest Ct ◽  
Shortness Of Breath ◽  
Course Of Disease ◽  
West China ◽  
Radiologic Abnormality

Abstract Background The outbreak of COVID-19 has resulted in serious concerns in China and abroad. To investigate clinical features of confirmed and suspected patients with COVID-19 in west China, and to examine differences between severe versus non-severe patients. Methods Patients admitted for COVID-19 between January 21 and February 11 from fifteen hospitals in Sichuan Province, China were included. Experienced clinicians trained with methods abstracted data from medical records using pre-defined, pilot-tested forms. Clinical characteristics between severe and non-severe patients were compared. Results Of the 169 patients included, 147 were laboratory-confirmed, 22 were suspected. For confirmed cases, the most common symptoms from onset to admission were cough (70·7%), fever (70·5%) and sputum (33·3%), and the most common chest CT patterns were patchy or stripes shadowing (78·0%); throughout the course of disease, 19·0% had no fever, and 12·4% had no radiologic abnormality; twelve (8·2%) received mechanical ventilation, four (2·7%) were transferred to ICU, and no death occurred. Compared to non-severe cases, severe ones were more likely to have underlying comorbidities (62·5% vs 26·2%, P = 0·001), to present with cough (92·0% vs 66·4%, P = 0·02), sputum (60·0% vs 27·9%, P = 0·004) and shortness of breath (40·0% vs 8·2%, P <  0·0001), and to have more frequent lymphopenia (79·2% vs 43·7%, P = 0·003) and eosinopenia (84·2% vs 57·0%, P = 0·046). Conclusions The symptoms of patients in west China were relatively mild, and an appreciable proportion of infected cases had no fever, warranting special attention.

Development and Initial Validation of a Project-Based Rubric to Assess the Systems-Based Practice Competency of Residents in the Clinical Chemistry Rotation of a Pathology Residency

2014 ◽  
Vol 138 (6) ◽  
pp. 809-813
Author(s):  
Carolyn R. Vitek ◽  
Jane C. Dale ◽  
Henry A. Homburger ◽  
Sandra C. Bryant ◽  
Amy K. Saenger ◽  
...  
Keyword(s):  
Critical Thinking ◽  
Interrater Reliability ◽  
Clinical Chemistry ◽  
Core Competencies ◽  
Intraclass Correlation ◽  
Reliability And Validity ◽  
Correlation Coefficients ◽  
Thinking Skills ◽  
Project Evaluation ◽  
Critical Thinking Skills

Context.— Systems-based practice (SBP) is 1 of 6 core competencies required in all resident training programs accredited by the Accreditation Council for Graduate Medical Education. Reliable methods of assessing resident competency in SBP have not been described in the medical literature. Objective.— To develop and validate an analytic grading rubric to assess pathology residents' analyses of SBP problems in clinical chemistry. Design.— Residents were assigned an SBP project based upon unmet clinical needs in the clinical chemistry laboratories. Using an iterative method, we created an analytic grading rubric based on critical thinking principles. Four faculty raters used the SBP project evaluation rubric to independently grade 11 residents' projects during their clinical chemistry rotations. Interrater reliability and Cronbach α were calculated to determine the reliability and validity of the rubric. Project mean scores and range were also assessed to determine whether the rubric differentiated resident critical thinking skills related to the SBP projects. Results.— Overall project scores ranged from 6.56 to 16.50 out of a possible 20 points. Cronbach α ranged from 0.91 to 0.96, indicating that the 4 rubric categories were internally consistent without significant overlap. Intraclass correlation coefficients ranged from 0.63 to 0.81, indicating moderate to strong interrater reliability. Conclusions.— We report development and statistical analysis of a novel SBP project evaluation rubric. The results indicate the rubric can be used to reliably assess pathology residents' critical thinking skills in SBP.

Clinical features of pharyngeal cancer: a retrospective study of 258 consecutive patients

2001 ◽  
Vol 115 (2) ◽  
pp. 112-118 ◽  
Author(s):  
A. Escribano Uzcudun ◽  
P. Bravo Fernández ◽  
J. J. Sánchez ◽  
A. García Grande ◽  
I. Rabanal Retolaza ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Head And Neck ◽  
Clinical Features ◽  
Medical Records ◽  
Performance Status ◽  
Nasopharyngeal Cancer ◽  
University Hospital ◽  
Premalignant Lesions ◽  
Pharyngeal Cancer ◽  
Presenting Symptoms

Pharyngeal cancer still presents an unsatisfactory mortality (30-40 per cent in most series, with a slightly better prognosis for nasopharyngeal cancer relative to both oropharyngeal and hypophyarngeal cancers) despite advances in treatment. Therefore, it is critical to know the clinical features of pharyngeal cancer. The purpose of this study was to investigate the most relevant clinical features of pharyngeal cancer (oropharyngeal, hypopharyngeal, and nasopharyngeal) in order to improve knowledge of this malignancy with the aim of ameliorating diagnosis and treatment.The retrospective study was based on a review of medical records from 258 consecutive patients with pharyngeal cancer (oropharyngeal, hypopharyngeal and nasopharyngeal) diagnosed at La Paz University Hospital, Madrid, Spain, between January 1 1991 and and December 31 1995. Medical records were provided by the Departments of Otorhinolaryngology, Head and Neck Surgery, Radiation Oncology, and Medical Oncology.All medical records were analysed for the following clinical variables: 1) incidence, 2) sociodemographics, 3) sites (oropharynx, hypopharynx, nasopharynx) and subsites, 4) clinical and histological staging, 5) pathlogy, 6) presenting symptoms, 7) time to diagnosis, 8) patients’ general performance status at diagnosis, 9) personal cancer history and synchronous head and neck tumours, 10) premalignant lesions, and 11) paediatric cases.Our most outstanding finding was the excessively long time that elapsed between first clinical manifestation appearance and conclusive diagnosis of pharyngeal cancer (4.7 months for pharynx, 4.5 for oropharynx, 4.4 for hypopharynx and 6.5 for nasopharynx cancers). It was found that nasopharyngeal cancer was quite different from both oropharyngeal and hypopharyngeal cancers with respect to its potential aetiology, risk factors and clinical presentation. In addition it has a better prognosis.

Measuring Mobility of the Metacarpophalangeal Joints II, III, IV, and V in the Dorso-Volar Plane

1984 ◽  
Vol 13 (1) ◽  
pp. 15-20 ◽  
Author(s):  
C Wagner ◽  
D Drescher
Keyword(s):  
Healthy Subjects ◽  
Reliability And Validity ◽  
Repeated Measurements ◽  
Interrater Agreement ◽  
Range Of Movement ◽  
Men And Women ◽  
Examination Method ◽  
Total Range ◽  
Flexion And Extension

An electronic gravity goniometer was developed for determining the passive range of movement of the MCP joints II, III, IV, and V in the dorso-volar plane by the use of preset torques. Test–retest measurements on 23 healthy subjects between the ages of 18 and 57 demonstrated high intrarater and interrater agreement for determining the total range. In the determination of the amounts of flexion and extension the measurement of the flexion was less reliable. There was overall evidence of a declining tendency of reliability from MCP joint II to MCP joint V, probably caused by different reactions of the joints to repeated measurements. The higher total range of the MCP joints in women was principally caused by a higher range of extension. In the case of men and women the range of MCP joint V was noticeably greater than that of the other three joints. The mobility of the four MCP joints correlates relatively closely as a whole, however, in the case of the non-adjacent joints less closely than with the adjacent joints. Reliability and validity of the examination method were balanced against one another with regard to testing of the biomechanical pre-conditions for manual dexterity.

Reliability and Validity Analyses of the Youth Level of Service/Case Management Inventory

2005 ◽  
Vol 32 (3) ◽  
pp. 329-344 ◽  
Author(s):  
Fred Schmidt ◽  
Robert D. Hoge ◽  
Lezlie Gomes
Keyword(s):  
Juvenile Offenders ◽  
Case Management ◽  
Interrater Reliability ◽  
Assessment Tool ◽  
Reliability And Validity ◽  
Level Of Service ◽  
Risk Level ◽  
Criminogenic Needs ◽  
Health Assessments ◽  
Males And Females

The Youth Level of Service/Case Management Inventory (YLS/CMI) is a structured assessment tool designed to facilitate the effective intervention and rehabilitation of juvenile offenders by assessing each youth’s risk level and criminogenic needs. The present study examined the YLS/CMI’s reliability and validity in a sample of 107 juvenile offenders who were court-referred for mental health assessments. Results demonstrated the YLS/CMI’s internal consistency and interrater reliability. Moreover, the instrument’s predictive validity was substantiated on a number of recidivism measures for both males and females. Limitations of the current findings are discussed.

Sign in / Sign up

Export Citation Format

Share Document