Performance of Natural Language Processing versus International Classification of Diseases Codes in Building Registries for Patients With Fall Injury: Retrospective Analysis
Bibliographic record
Abstract
Background: Standardized registries, such as the International Classification of Diseases (ICD) codes, are commonly built using administrative codes assigned to patient encounters. However, patients with fall injury are often coded using subsequent injury codes, such as hip fractures. This necessitates manual screening to ensure the accuracy of data registries. Objective: This study aimed to automate the extraction of fall incidents and mechanisms using natural language processing (NLP) and compare this approach with the ICD method. Methods: Clinical notes for patients with fall-induced hip fractures were retrospectively reviewed by medical experts. Fall incidences were detected, annotated, and classified among patients who had a fall-induced hip fracture (case group). The control group included patients with hip fractures without any evidence of falls. NLP models were developed using the annotated notes of the study groups to fulfill two separate tasks: fall occurrence detection and fall mechanism classification. The performances of the models were compared using accuracy, sensitivity, specificity, positive predictive value, negative predictive value, F1-score, and area under the receiver operating characteristic curve. Results: A total of 1769 clinical notes were included in the final analysis for the fall occurrence task, and 783 clinical notes were analyzed for the fall mechanism classification task. The highest F1-score using NLP for fall occurrence was 0.97 (specificity=0.96; sensitivity=0.97), and for fall mechanism classification was 0.61 (specificity=0.56; sensitivity=0.62). Natural language processing could detect up to 98% of the fall occurrences and 65% of the fall mechanisms accurately, compared to 26% and 12%, respectively, by ICD codes. Conclusions: Our findings showed promising performance with higher accuracy of NLP algorithms compared to the conventional method for detecting fall occurrence and mechanism in developing disease registries using clinical notes. Our approach can be introduced to other registries that are based on large data and are in need of accurate annotation and classification.
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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 | 0.023 | 0.074 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.005 | 0.003 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| 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".