Performance en classification de données textuelles des passages aux urgences des modèles BERT pour le français

National audienceContextualized language models based on the Transformer architecture such as BERT (Bidirectional Encoder Representations from Transformers) have achieved remarkable performances in various language processing tasks. CamemBERT and FlauBERT are pre-trained versions for French.We used these two models to automatically classify free clinical notes from emergency department visits following a trauma. Their performances were compared to the TF-IDF (Term-Frequency - Inverse Document Frequency) method associated with the SVM (Support Vector Machine) classifier on 22481 clinical notes from the emergency department of the Bordeaux University Hospital. CamemBERT and FlauBERT obtained slightly better results than the TF-IDF/SVM couple for the micro F1-score. These encouraging results allow us to consider further developments in the use of transformers in the automation of emergency department data processing in order to consider the implementation of a national observatory of trauma in France.Les modèles de langue contextualisés basés sur l'architecture Transformer tels que BERT (Bidirectional Encoder Representations from Transformers) ont atteint des performances remarquables dans des diverses tâches de traitement de la langue. CamemBERT et FlauBERT en sont des versions pré-entraînées pour le français. Nous avons utilisé ces deux modèles afin de classer automatiquement des notes cliniques libres issues de visites aux urgences à la suite d'un traumatisme. Leurs performances ont été comparées à la méthode TF-IDF (Term-Frequency-Inverse Document Frequency) associé au classifieur SVM (Support Vector Machine) sur 22481 notes cliniques provenant du service des urgences du CHU de Bordeaux. CamemBERT et FlauBERT ont obtenu des résultats légèrement supérieurs à ceux du couple TF-IDF/SVM pour le micro F1-score. Ces résultats encourageants permettent d'envisager l'utilisation des transformers pour automatiser le traitement des données des urgences dans le cadre de la mise en place d'un observatoire national du traumatisme en France

Trends in reasons for emergency calls during the COVID-19 crisis in the department of Gironde, France using artificial neural network for natural language classification

Abstract Objectives During periods such as the COVID-19 crisis, there is a need for responsive public health surveillance indicators in order to monitor both the epidemic growth and potential public health consequences of preventative measures such as lockdown. We assessed whether the automatic classification of the content of calls to emergency medical communication centers could provide relevant and responsive indicators. Methods We retrieved all 796,209 free-text call reports from the emergency medical communication center of the Gironde department, France, between 2018 and 2020. We trained a natural language processing neural network model with a mixed unsupervised/supervised method to classify all reasons for calls in 2020. Validation and parameter adjustment were performed using a sample of 39,907 manually-coded free-text reports. Results The number of daily calls for flu-like symptoms began to increase from February 21, 2020 and reached an unprecedented level by February 28, 2020 and peaked on March 14, 2020, 3 days before lockdown. It was strongly correlated with daily emergency room admissions, with a delay of 14 days. Calls for chest pain and stress and anxiety, peaked 12 days later. Calls for malaises with loss of consciousness, non-voluntary injuries and alcohol intoxications sharply decreased, starting one month before lockdown. No noticeable trends in relation to lockdown was found for other groups of reasons including gastroenteritis and abdominal pain, stroke, suicide and self-harm, pregnancy and delivery problems. Discussion The first wave of the COVID-19 crisis came along with increased levels of stress and anxiety but no increase in alcohol intoxication and violence. As expected, call related to road traffic crashes sharply decreased. The sharp decrease in the number of calls for malaise was more surprising. Conclusion The content of calls to emergency medical communication centers is an efficient epidemiological surveillance data source that provides insights into the societal upheavals induced by a health crisis. The use of an automatic classification system using artificial intelligence makes it possible to free itself from the context that could influence a human coder, especially in a crisis situation. The COVID-19 crisis and/or lockdown induced deep modifications in the population health profile.Surveillance épidémiologique de la période pandémique covid-19 par classification automatique en temps réel des notes cliniques des centres d'appels d'urgence du 15 à l'aide de réseaux de neurones artificiels de type Transformer

Development and Validation of Deep Learning Transformer Models for Building a Comprehensive and Real-time Trauma Observatory

BACKGROUND In order to study the feasibility of setting up a national trauma observatory in France, OBJECTIVE we compared the performance of several automatic language processing methods on a multi-class classification task of unstructured clinical notes. METHODS A total of 69,110 free-text clinical notes related to visits to the emergency departments of the University Hospital of Bordeaux, France, between 2012 and 2019 were manually annotated. Among those clinical notes 22,481 were traumas. We trained 4 transformer models (deep learning models that encompass attention mechanism) and compared them with the TF-IDF (Term- Frequency - Inverse Document Frequency) associated with SVM (Support Vector Machine) method. RESULTS The transformer models consistently performed better than TF-IDF/SVM. Among the transformers, the GPTanam model pre-trained with a French corpus with an additional auto-supervised learning step on 306,368 unlabeled clinical notes showed the best performance with a micro F1-score of 0.969. CONCLUSIONS The transformers proved efficient multi-class classification task on narrative and medical data. Further steps for improvement should focus on abbreviations expansion and multiple outputs multi-class classification

Artificial Intelligence in Emergency Medicine: Viewpoint of Current Applications and Foreseeable Opportunities and Challenges

International audienceEmergency medicine and its services have reached a breaking point during the COVID-19 pandemic. This pandemic has highlighted the failures of a system that needs to be reconsidered, and novel approaches need to be considered. Artificial intelligence (AI) has matured to the point where it is poised to fundamentally transform health care, and applications within the emergency field are particularly promising. In this viewpoint, we first attempt to depict the landscape of AI-based applications currently in use in the daily emergency field. We review the existing AI systems; their algorithms; and their derivation, validation, and impact studies. We also propose future directions and perspectives. Second, we examine the ethics and risk specificities of the use of AI in the emergency field

Performance en classification de données textuelles des passages aux urgences des modèles BERT pour le français

National audienceContextualized language models based on the Transformer architecture such as BERT (Bidirectional Encoder Representations from Transformers) have achieved remarkable performances in various language processing tasks. CamemBERT and FlauBERT are pre-trained versions for French.We used these two models to automatically classify free clinical notes from emergency department visits following a trauma. Their performances were compared to the TF-IDF (Term-Frequency - Inverse Document Frequency) method associated with the SVM (Support Vector Machine) classifier on 22481 clinical notes from the emergency department of the Bordeaux University Hospital. CamemBERT and FlauBERT obtained slightly better results than the TF-IDF/SVM couple for the micro F1-score. These encouraging results allow us to consider further developments in the use of transformers in the automation of emergency department data processing in order to consider the implementation of a national observatory of trauma in France.Les modèles de langue contextualisés basés sur l'architecture Transformer tels que BERT (Bidirectional Encoder Representations from Transformers) ont atteint des performances remarquables dans des diverses tâches de traitement de la langue. CamemBERT et FlauBERT en sont des versions pré-entraînées pour le français. Nous avons utilisé ces deux modèles afin de classer automatiquement des notes cliniques libres issues de visites aux urgences à la suite d'un traumatisme. Leurs performances ont été comparées à la méthode TF-IDF (Term-Frequency-Inverse Document Frequency) associé au classifieur SVM (Support Vector Machine) sur 22481 notes cliniques provenant du service des urgences du CHU de Bordeaux. CamemBERT et FlauBERT ont obtenu des résultats légèrement supérieurs à ceux du couple TF-IDF/SVM pour le micro F1-score. Ces résultats encourageants permettent d'envisager l'utilisation des transformers pour automatiser le traitement des données des urgences dans le cadre de la mise en place d'un observatoire national du traumatisme en France

De-identification of Emergency Medical Records in French: Survey and Comparison of State-of-the-Art Automated Systems

International audienceIn France, structured data from emergency room (ER) visits are aggregated at the national level to build a syndromic surveillance system for several health events. For visits motivated by a traumatic event, information on the causes are stored in free-text clinical notes. To exploit these data, an automated de-identification system guaranteeing protection of privacy is required.In this study we review available de-identification tools to de-identify free-text clinical documents in French. A key point is how to overcome the resource barrier that hampers NLP applications in languages other than English. We compare rule-based, named entity recognition, new Transformer-based deep learning and hybrid systems using, when required, a fine-tuning set of 30,000 unlabeled clinical notes. The evaluation is performed on a test set of 3,000 manually annotated notes.Hybrid systems, combining capabilities in complementary tasks, show the best performance. This work is a first step in the foundation of a national surveillance system based on the exhaustive collection of ER visits reports for automated trauma monitoring

Surg Endosc

Laparoscopic adrenalectomy (LA) is the gold standard for the resection of most adrenal lesions. A precise delineation of factors influencing its outcomes is lacking. The aim of this study was to assess factors associated with intraoperative complications, postoperative complications, and prolonged length of stay (LOS) after LA. Patients who underwent LA from 1999 to 2021 in a single-academic-institution were included. Patient and disease-specific data, intraoperative complications, postoperative complications according to Dindo-Clavien (DC) scale, and LOS were recorded. Predictive factors of complications and prolonged LOS were determined by logistic regression. We identified 530 patients who underwent 547 LA. Intraoperative complications occurred in 33 patients (6.0%). Postoperative complications ≥  DC grade 2 occurred in 73 patients (13.35%); severe postoperative complications ≥ DC grade 3 in 14 patients (2.56%). Postoperative complications were positively associated with age ≥ 72 (OR 1.14 [95% CI 1.02-1.29]), intraoperative complications (OR 1.36 [95% CI 1.14-1.63]), and negatively associated with non functional adenomas (OR 0.88 [95% CI 0.7-0.99]), and right adrenalectomy (OR 0.91 [95% CI 0.86-0.97]). Severe postoperative complications were positively associated with chronic obstructive pulmonary disease (COPD, OR 1.08 [95% CI 1.00-1.17]), and negatively associated with right adrenalectomy (OR 0.97 [95% CI 0.92-0.99]). Prolonged LOS was associated with age ≥ 72 (OR 1.21 [95% CI 1.05-1.41]), and COPD (OR 1.20 [95% CI 1.01-1.44]). LA remains safe when performed by surgeons with expertise. Right adrenalectomy resulted in less postoperative overall and severe complications. The risk-benefit equation should be carefully assessed before left LA in older patients with COPD

Surveillance of COVID-19 using a keyword search for symptoms in reports from emergency medical communication centers in Gironde, France: a 15 year retrospective cross-sectional study

During periods such as the COVID-19 crisis, there is a need for responsive public health surveillance indicators related to the epidemic. To determine the performance of keyword-search algorithm in call reports to emergency medical communication centers (EMCC) to describe trends in symptoms during the COVID-19 crisis. We retrospectively retrieved all free text call reports from the EMCC of the Gironde department (SAMU 33), France, between 2005 and 2020 and classified them with a simple keyword-based algorithm to identify symptoms relevant to COVID-19. A validation was performed using a sample of manually coded call reports. The six selected symptoms were fever, cough, muscle soreness, dyspnea, ageusia and anosmia. We retrieved 38,08,243 call reports from January 2005 to October 2020. A total of 8539 reports were manually coded for validation and Cohen's kappa statistics ranged from 75 (keyword anosmia) to 59% (keyword dyspnea). There was an unprecedented peak in the number of daily calls mentioning fever, cough, muscle soreness, anosmia, ageusia, and dyspnea during the COVID-19 epidemic, compared to the past 15 years. Calls mentioning cough, fever and muscle soreness began to increase from February 21, 2020. The number of daily calls reporting cough reached 208 on March 3, 2020, a level higher than any in the previous 15 years, and peaked on March 15, 2020, 2 days before lockdown. Calls referring to dyspnea, anosmia and ageusia peaked 12 days later and were concomitant with the daily number of emergency room admissions. Trends in symptoms cited in calls to EMCC during the COVID-19 crisis provide insights into the natural history of COVID-19. The content of calls to EMCC is an efficient epidemiological surveillance data source and should be integrated into the national surveillance system.Surveillance épidémiologique de la période pandémique covid-19 par classification automatique en temps réel des notes cliniques des centres d'appels d'urgence du 15 à l'aide de réseaux de neurones artificiels de type Transformer

Scand J Trauma Resusc Emerg Med

Objectives During periods such as the COVID-19 crisis, there is a need for responsive public health surveillance indicators related to the epidemic and to preventative measures such as lockdown. The automatic classification of the content of calls to emergency medical communication centers could provide relevant and responsive indicators. Methods We retrieved all 796,209 free-text call reports from the emergency medical communication center of the Gironde department, France, between 2018 and 2020. We trained a natural language processing neural network model with a mixed unsupervised/supervised method to classify all reasons for calls in 2020. Validation and parameter adjustment were performed using a sample of 20,000 manually-coded free-text reports. Results The number of daily calls for flu-like symptoms began to increase from February 21, 2020 and reached an unprecedented level by February 28, 2020 and peaked on March 14, 2020, 3 days before lockdown. It was strongly correlated with daily emergency room admissions, with a delay of 14 days. Calls for chest pain, stress, but also those mentioning dyspnea, ageusia and anosmia peaked 12 days later. Calls for malaises with loss of consciousness, non-voluntary injuries and alcohol intoxications sharply decreased, starting one month before lockdown. Discussion This example of the COVID-19 crisis shows how the availability of reliable and unbiased surveillance platforms can be useful for a timely and relevant monitoring of all events with public health consequences. The use of an automatic classification system using artificial intelligence makes it possible to free itself from the context that could influence a human coder, especially in a crisis situation. Conclusion The content of calls to emergency medical communication centers is an efficient epidemiological surveillance data source that provides insights into the societal upheavals induced by a health crisis

Trends in reasons for emergency calls during the COVID-19 crisis in the department of Gironde, France using artificial neural network for natural language classification

International audienceAbstract Objectives During periods such as the COVID-19 crisis, there is a need for responsive public health surveillance indicators in order to monitor both the epidemic growth and potential public health consequences of preventative measures such as lockdown. We assessed whether the automatic classification of the content of calls to emergency medical communication centers could provide relevant and responsive indicators. Methods We retrieved all 796,209 free-text call reports from the emergency medical communication center of the Gironde department, France, between 2018 and 2020. We trained a natural language processing neural network model with a mixed unsupervised/supervised method to classify all reasons for calls in 2020. Validation and parameter adjustment were performed using a sample of 39,907 manually-coded free-text reports. Results The number of daily calls for flu-like symptoms began to increase from February 21, 2020 and reached an unprecedented level by February 28, 2020 and peaked on March 14, 2020, 3 days before lockdown. It was strongly correlated with daily emergency room admissions, with a delay of 14 days. Calls for chest pain and stress and anxiety, peaked 12 days later. Calls for malaises with loss of consciousness, non-voluntary injuries and alcohol intoxications sharply decreased, starting one month before lockdown. No noticeable trends in relation to lockdown was found for other groups of reasons including gastroenteritis and abdominal pain, stroke, suicide and self-harm, pregnancy and delivery problems. Discussion The first wave of the COVID-19 crisis came along with increased levels of stress and anxiety but no increase in alcohol intoxication and violence. As expected, call related to road traffic crashes sharply decreased. The sharp decrease in the number of calls for malaise was more surprising. Conclusion The content of calls to emergency medical communication centers is an efficient epidemiological surveillance data source that provides insights into the societal upheavals induced by a health crisis. The use of an automatic classification system using artificial intelligence makes it possible to free itself from the context that could influence a human coder, especially in a crisis situation. The COVID-19 crisis and/or lockdown induced deep modifications in the population health profile