Summary
Background: The development and validation of automated electronic medical record (EMR) search
strategies are important in identifying emergent endotracheal intubations in the intensive
care unit (ICU).
Objective: To develop and validate an automated search algorithm (strategy) for emergent endotracheal
intubation in the critically ill patient.
Methods: The EMR search algorithm was created through sequential steps with keywords applied
to an institutional EMR database. The search strategy was derived retrospectively
through a secondary analysis of a 450-patient subset from the 2,684 patients admitted
to either a medical or surgical ICU from January 1, 2010, through December 31, 2011.
This search algorithm was validated against an additional 450 randomly selected patients.
Sensitivity, specificity, and negative and positive predictive values of the automated
search algorithm were compared with a manual medical record review (the reference
standard) for data extraction of emergent endotracheal intubations. Results: In the derivation subset, the automated electronic note search strategy achieved
a sensitivity of 74% (95% CI, 69%-79%) and a specificity of 98% (95% CI, 92%-100%).
With refinements in the search algorithm, sensitivity increased to 95% (95% CI, 91%-97%)
and specificity decreased to 96% (95% CI, 92%-98%) in this subset. After validation
of the algorithm through a separate patient subset, the final reported sensitivity
and specificity were 95% (95% CI, 86%-99%) and 100% (95% CI, 98%-100%).
Conclusions: Use of electronic search algorithms allows for correct extraction of emergent endotracheal
intubations in the ICU, with high degrees of sensitivity and specificity. Such search
algorithms are a reliable alternative to manual chart review for identification of
emergent endotracheal intubations.
Keywords
Electronic medical record - emergent - endotracheal intubation - intensive care unit
- search algorithm
