Sentiment in nursing notes as an indicator of out-of-hospital mortality in intensive care patients
Bibliographic record
Abstract
BACKGROUND: Nursing notes have not been widely used in prediction models for clinical outcomes, despite containing rich information. Advances in natural language processing have made it possible to extract information from large scale unstructured data like nursing notes. This study extracted the sentiment-impressions and attitudes-of nurses, and examined how sentiment relates to 30-day mortality and survival. METHODS: This study applied a sentiment analysis algorithm to nursing notes extracted from MIMIC-III, a public intensive care unit (ICU) database. A multiple logistic regression model was fitted to the data to correlate measured sentiment with 30-day mortality while controlling for gender, type of ICU, and SAPS-II score. The association between measured sentiment and 30-day mortality was further examined in assessing the predictive performance of sentiment score as a feature in a classifier, and in a survival analysis for different levels of measured sentiment. RESULTS: Nursing notes from 27,477 ICU patients, with an overall 30-day mortality of 11.02%, were extracted. In the presence of known predictors of 30-day mortality, mean sentiment polarity was a highly significant predictor in a multiple logistic regression model (Adjusted OR = 0.4626, p < 0.001, 95% CI: [0.4244, 0.5041]) and led to improved predictive accuracy (AUROC = 0.8189 versus 0.8092, 95% BCI of difference: [0.0070, 0.0126]). The Kaplan Meier survival curves showed that mean sentiment polarity quartiles are positively correlated with patient survival (log-rank test: p < 0.001). CONCLUSIONS: This study showed that quantitative measures of unstructured clinical notes, such as sentiment of clinicians, correlate with 30-day mortality and survival, thus can also serve as a predictor of patient outcomes in the ICU. Therefore, further research is warranted to study and make use of the wealth of data that clinical notes have to offer.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".