Sentiment in nursing notes as an indicator of out-of-hospital mortality in intensive care patients

• Published in: PloS one 2018-06, Vol.13 (6), p.e0198687-e0198687
• Main Authors: Waudby-Smith, Ian E R, Tran, Nam, Dubin, Joel A, Lee, Joon
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Analysis; Beliefs, opinions and attitudes; Biology and Life Sciences; Computer and Information Sciences; Correlation analysis; Critical Care Nursing; Critical Illness - mortality; Critical Illness - therapy; Data mining; Emotions; Female; Handbooks; Health care policy; Humans; Information processing; Intensive care; Intensive Care Units; Kaplan-Meier Estimate; Male; Medical personnel; Medicine and Health Sciences; Middle Aged; Mortality; Natural Language Processing; Nurses; Nursing; Nursing Records; Patients; People and Places; Performance prediction; Physical Sciences; Polarity; Practice; Prediction models; Prognosis; Quartiles; Rank tests; Regression analysis; Regression models; Research and Analysis Methods; Sentiment analysis; Social networks; Survival; Treatment outcome; Unstructured data; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0198687

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. 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. 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). 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.