# Presentation: 326706

## Rapid Identification of Pneumonias in BioSense Data Using Radiology Text ReportsArmen Asatryan, MD, MPH,1 Haobo Ma, MD, MS,1 Roseanne English, BS,2 Jerome Tokars, MD, MPH21Science Applications International Corporation, 2National Center for Public Health Informatics, Centers for Disease Control and Prevention, Atlanta, GA

***Background and Objective***
**BioSense is designed to conduct near real-time biosurveillance**
**Currently, more than 360 hospitals send data to BioSense**
**Data elements received by BioSense:**
** ****Demographics (age, gender)**
** ****Chief complaint free text**
** ****ICD-9 discharge codes**
** ****ER triage notes, including vital signs**
** ****Radiology (chest and bone films) orders and text reports**
** ****Pharmacy orders**
** ****Microbiology laboratory orders and results**
** ****Influenza, anthrax, plague, tularemia can manifest clinically as pneumonia**
** ****Considerable delay in getting (up to 2-3 weeks) and inaccuracy of ICD-9 codes in diagnosing pneumonia, but radiology reports may be received in 1-2 days**
** ****What is the utility of radiology reports for the early diagnosis of pneumonia syndrome?**

***Methods***
* ***Data: **
** ****67,714 reports of chest X-rays**
** ****42,510 hospital visits**
** ****34,882 patients**
** ****13 hospital facilities**
** ****From February 2006 to January 2007**
** ****All patient classes included (inpatient, outpatient, emergency)**
** ****Sample of chest X-ray report from BioSense:**
** ****CHEST, 2 VIEWS   Indication:    Fever.  Findings:   There is consolidation in the right middle lobe with some volume loss compatible with right middle lobe pneumonia and possible atelectasis. Followup to resolution is recommended.   IMPRESSION:    Right middle lobe pneumonia.**
** ****Keyword-based text parsing SAS program:**
** ****Search terms: density, opacity, consolidation, infiltrate (DOCI terms)**
** ****Program is designed to account for negations and double negations (e.g. (“presence of infiltrate cannot be excluded”)**
** ****Test data set:**
** ****Total 400 reports of chest X-rays comprised of:**
**Physician review of the chest X-ray reports and calculation of kappa statistic**

***Results***
** ****Keyword program performance on 400 reports: **
** ****Pneumonia identification: Sn 98.6%, Sp 98.8%**
** ****DOCI identification: Sn and Sp 98.4%**
** ****Demographics of the population:**
** ****Male : Female = 1.1**
** ****Age: range from newborn to 105 years old, mean 55 years old, mode 81 years old**
** ****Of 67,714 radiology reports, 8,631 occurred in patients with a final ICD-9 diagnosis of pneumonia**
** ****ICD-9 code of pneumonia (480--486) was present in 3,677 (9%) visits, of which 1,420 had a chest X-ray parsed as pneumonia, 2,323 – parsed as DOCI only**
** **
** ****Kappa statistic:**
** ****Pneumonia by X-ray vs. ICD-9 code 0.38**
** ****DOCI, not pneumonia by X-ray vs. ICD9code 0.2**
** ****Logistic regression showed 5 keywords independently associated with a final ICD-9 diagnosis of pneumonia:**
** ****One or more of these 5 keywords was found in 72% of reports from patients with a diagnosis of pneumonia vs. 31% without (sensitivity 72%, specificity 69%, kappa=0.23)**

***Conclusions***
** ****Simple keyword based text parsing programs can successfully parse text reports of chest X-rays for identification of words suggestive of pneumonia**
** ****Readings classified as probable or possible pneumonia are less common than readings classified as having DOCI terms only**
** ****Five radiology report text keywords (infiltrate, pneumonia, airspace, consolidation, and opacity) were independently associated with a diagnosis of pneumonia**
** ****Low kappa value reflects low concordance between radiology reports and final ICD-9 diagnostic codes**
** ****Either a radiology report or a final diagnosis may indicate pneumonia, but neither is definitive**
** ****Access to full patient medical record is necessary for further research on clarifying the role of radiology reports for early diagnosis of pneumonia**

***Background image: chest X-ray of a patient with inhalational anthrax; source: US Armed Forces Institute of Pathology, http://anthrax.radpath.org/Case1.html.***
***Note mediastinal widening and opacities at the right lung base.  ***