Retrospective derivation and validation of a search algorithm to identify extubation failure in the intensive care unit

BACKGROUND: Development and validation of automated electronic medical record (EMR) search strategies is important in identifying extubation failure in the intensive care unit (ICU). We developed and validated an automated search algorithm (strategy) for extubation failure in critically ill patients. 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 secondary analysis of a 100-patient subset from the 978 patient cohort admitted to a neurological ICU from January 1, 2002, through December 31, 2011(derivation subset). It was, then, validated against an additional 100-patient subset (validation subset). Sensitivity, specificity, 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 extubation failure. RESULTS: In the derivation subset of 100 random patients, the initial automated electronic search strategy achieved a sensitivity of 85% (95% CI, 56%-97%) and a specificity of 95% (95% CI, 87%-98%). With refinements in the search algorithm, the final sensitivity was 93% (95% CI, 64%-99%) and specificity increased to 100% (95% CI, 95%-100%) in this subset. In validation of the algorithm through a separate 100 random patient subset, the reported sensitivity and specificity were 94% (95% CI, 69%-99%) and 98% (95% CI, 92%-99%) respectively. CONCLUSIONS: Use of electronic search algorithms allows for correct extraction of extubation failure in the ICU, with high degrees of sensitivity and specificity. Such search algorithms are a reliable alternative to manual chart review for identification of extubation failure

Weight-bearing in ankle fractures: An audit of UK practice.

INTRODUCTION: The purpose of this national study was to audit the weight-bearing practice of orthopaedic services in the National Health Service (NHS) in the treatment of operatively and non-operatively treated ankle fractures. METHODS: A multicentre prospective two-week audit of all adult ankle fractures was conducted between July 3rd 2017 and July 17th 2017. Fractures were classified using the AO/OTA classification. Fractures fixed with syndesmosis screws or unstable fractures (>1 malleolus fractured or talar shift present) treated conservatively were excluded. No outcome data were collected. In line with NICE (The National Institute for Health and Care Excellence) criteria, "early" weight-bearing was defined as unrestricted weight-bearing on the affected leg within 3 weeks of injury or surgery and "delayed" weight-bearing as unrestricted weight-bearing permitted after 3 weeks. RESULTS: 251 collaborators from 81 NHS hospitals collected data: 531 patients were managed non-operatively and 276 operatively. The mean age was 52.6 years and 50.5 respectively. 81% of non-operatively managed patients were instructed for early weight-bearing as recommended by NICE. In contrast, only 21% of operatively managed patients were instructed for early weight-bearing. DISCUSSION: The majority of patients with uni-malleolar ankle fractures which are managed non-operatively are treated in accordance with NICE guidance. There is notable variability amongst and within NHS hospitals in the weight-bearing instructions given to patients with operatively managed ankle fractures. CONCLUSION: This study demonstrates community equipoise and suggests that the randomized study to determine the most effective strategy for postoperative weight-bearing in ankle fractures described in the NICE research recommendation is feasible