Natural language processing diagnosed behavioral disturbance vs confusion assessment method for the intensive care unit: prevalence, patient characteristics, overlap, and association with treatment and outcome.

Abstract

To compare the prevalence, characteristics, drug treatment for delirium, and outcomes of patients with Natural Language Processing (NLP) diagnosed behavioral disturbance (NLP-Dx-BD) vs Confusion Assessment Method for intensive care unit (CAM-ICU) positivity. In three combined medical-surgical ICUs, we obtained data on demographics, treatment with antipsychotic medications, and outcomes. We applied NLP to caregiver progress notes to diagnose behavioral disturbance and analyzed simultaneous CAM-ICU. We assessed 2313 patients with a median lowest Richmond Agitation-Sedation Scale (RASS) score of - 2 (- 4.0 to - 1.0) and median highest RASS score of 1 (0 to 1). Overall, 1246 (53.9%) patients were NLP-Dx-BD positive (NLP-Dx-BD^pos) and 578 (25%) were CAM-ICU positive (CAM-ICU^pos). Among NLP-Dx-BD^pos patients, 539 (43.3%) were also CAM-ICU^pos. In contrast, among CAM-ICU^pos patients, 539 (93.3%) were also NLP-Dx-BD^pos. The use of antipsychotic medications was highest in patients in the CAM-ICU^pos and NLP-Dx-BD^pos group (24.3%) followed by the CAM-ICU^neg and NLP-Dx-BD^pos group (10.5%). In NLP-Dx-BD^neg patients, antipsychotic medication use was lower at 5.1% for CAM-ICU^pos and NLP-Dx-BD^neg patients and 2.3% for CAM-ICU^neg and NLP-Dx-BD^neg patients (overall P < 0.001). Regardless of CAM-ICU status, after adjustment and on time-dependent Cox modelling, NLP-Dx-BD was associated with greater antipsychotic medication use. Finally, regardless of CAM-ICU status, NLP-Dx-BD^pos patients had longer duration of ICU and hospital stay and greater hospital mortality (all P < 0.001). More patients were NLP-Dx-BD positive than CAM-ICU positive. NLP-Dx-BD and CAM-ICU assessment describe partly overlapping populations. However, NLP-Dx-BD identifies more patients likely to receive antipsychotic medications. In the absence of NLP-Dx-BD, treatment with antipsychotic medications is rare.