Academic Journal
Validation of a Natural Language Processing-Assisted Chart Review Method for Identifying Advance Care Planning Documentation in Pediatric Critical Illness.
| Τίτλος: | Validation of a Natural Language Processing-Assisted Chart Review Method for Identifying Advance Care Planning Documentation in Pediatric Critical Illness. |
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| Συγγραφείς: | Upham EJ; Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital, Boston, MA.; Department of Supportive Oncology, Dana-Farber Cancer Institute, Boston, MA., Gouda SR; Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital, Boston, MA.; Department of Supportive Oncology, Dana-Farber Cancer Institute, Boston, MA.; Harvard Medical School, Boston, MA., Lindvall C; Department of Supportive Oncology, Dana-Farber Cancer Institute, Boston, MA.; Harvard Medical School, Boston, MA., DeCourcey DD; Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital, Boston, MA.; Harvard Medical School, Boston, MA. |
| Πηγή: | Critical care explorations [Crit Care Explor] 2026 Sep 25; Vol. 8 (10), pp. e1494. Date of Electronic Publication: 2026 Sep 25 (Print Publication: 2026). |
| Τύπος έκδοσης: | Journal Article; Validation Study |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Wolters Kluwer Health Country of Publication: United States NLM ID: 101746347 Publication Model: eCollection Cited Medium: Internet ISSN: 2639-8028 (Electronic) Linking ISSN: 26398028 NLM ISO Abbreviation: Crit Care Explor Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Philadelphia, PA : Wolters Kluwer Health, [2019]- |
| Ιατρικοί όροι (MeSH): | Advance Care Planning*/standards , Advance Care Planning*/statistics & numerical data , Critical Illness*/therapy , Documentation*/methods , Documentation*/standards , Natural Language Processing*, Humans ; Retrospective Studies ; Electronic Health Records ; Child ; Female ; Male ; Adolescent ; Child, Preschool ; Intensive Care Units, Pediatric ; Infant |
| Περίληψη: | Objectives: Reliable measurement of advance care planning (ACP) is essential for evaluating both communication practices and quality of care in pediatric critical illness. However, most ACP documentation is embedded in free-text clinical notes and cannot be captured using administrative data, while manual chart review is time-intensive and difficult to scale. We sought to validate a rule-based natural language processing (NLP) approach to identify ACP documentation in the electronic health record (EHR) compared with manual chart review. Design: Retrospective cohort study. Setting: Single-center, quaternary PICU. Patients: Children younger than 21 years admitted to the PICU for greater than 24 hours following out-of-hospital cardiac arrest (OHCA) from 2012 to 2024. Interventions: None. Measurements and Main Results: A rule-based NLP approach incorporating semi-automated chart review was developed through iterative refinement of previously validated keyword libraries to identify ACP documentation across prespecified domains in the EHR. In the validation cohort (n = 95), NLP-assisted chart review showed complete agreement with manual chart review (F1 = 1.0) while substantially reducing abstraction time, enabling analysis of over 31,479 clinical notes in 3 days compared with 6 months for manual review of 43,179 notes. Among 125 children with OHCA, 65% had documented ACP discussions (n = 81). Goals-of-care conversations were most common (99%), followed by limitations of life-sustaining treatment (78%), subspecialty palliative care involvement (28%), preferred location of death (9%), and hospice discussions (7%). Conclusions: NLP-assisted chart review can efficiently and accurately identify ACP documentation in pediatric critical illness for retrospective research and quality improvement efforts. This semi-automated workflow substantially reduced manual abstraction burden while maintaining excellent agreement with manual chart review, enabling effective abstraction of communication processes not captured in structured data. (Copyright © 2026 The Authors. Published by Wolters Kluwer Health, LLC. on behalf of the Society of Critical Care Medicine.) |
| Competing Interests: | The authors have disclosed that they do not have any potential conflicts of interest. |
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| Contributed Indexing: | Keywords: advance care planning; critical care; natural language processing; out-of-hospital cardiac arrest; pediatrics |
| Entry Date(s): | Date Created: 20260925 Date Completed: 20260925 Latest Revision: 20260925 |
| Update Code: | 20260926 |
| DOI: | 10.1097/CCE.0000000000001494 |
| PMID: | 42789538 |
| Βάση Δεδομένων: | MEDLINE |
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