Detection of pneumonia using free-text radiology reports in the BioSense system

Objective: Near real-time disease detection using electronic data sources is a public health priority. Detecting pneumonia is particularly important because it is the manifesting disease of several bioterrorism agents as well as a complication of influenza, including avian and novel H1N1 strains. Text radiology reports are available earlier than physician diagnoses and so could be integral to rapid detection of pneumonia. We performed a pilot study to determine which keywords present in text radiology reports are most highly associated with pneumonia diagnosis. Design: Electronic radiology text reports from 11 hospitals from February 1, 2006 through December 31, 2007 were used. We created a computerized algorithm that searched for selected keywords (" airspace disease" , " consolidation" , " density" , " infiltrate" , " opacity" , and " pneumonia" ), differentiated between clinical history and radiographic findings, and accounted for negations and double negations; this algorithm was tested on a sample of 350 radiology reports. We used the algorithm to study 189,246 chest radiographs, searching for the keywords and determining their association with a final International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis of pneumonia. Measurements: Performance of the search algorithm in finding keywords, and association of the keywords with a pneumonia diagnosis. Results: In the sample of 350 radiographs, the search algorithm was highly successful in identifying the selected keywords (sensitivity 98.5%, specificity 100%). Analysis of the 189,246 radiographs showed that the keyword " pneumonia" was the strongest predictor of an ICD-9-CM diagnosis of pneumonia (adjusted odds ratio 11.8) while " density" was the weakest (adjusted odds ratio 1.5). In general, the most highly associated keyword present in the report, regardless of whether a less highly associated keyword was also present, was the best predictor of a diagnosis of pneumonia. Conclusion: Empirical methods may assist in finding radiology report keywords that are most highly predictive of a pneumonia diagnosis.