Background

Survival in pancreatic ductal adenocarcinoma (PDAC) remains poor due to late diagnosis. Electronic Health Records (EHRs) can be used to study this rare disease, but validated algorithms to identify PDAC in the United States EHRs do not currently exist.

Aims

To develop and validate an algorithm using Veterans Health Administration (VHA) EHR data for the identification of patients with PDAC.

Methods

We developed two algorithms to identify patients with PDAC in the VHA from 2002 to 2023. The algorithms required diagnosis of exocrine pancreatic cancer in either ≥ 1 or ≥ 2 of the following domains: (i) the VA national cancer registry, (ii) an inpatient encounter, or (iii) an outpatient encounter in an oncology setting. Among individuals identified with ≥ 1 of the above criteria, a random sample of 100 were reviewed by three gastroenterologists to adjudicate PDAC status. We also adjudicated fifty patients not qualifying for either algorithm. These patients died as inpatients and had alkaline phosphatase values within the interquartile range of patients who met ≥ 2 of the above criteria for PDAC. These expert adjudications allowed us to calculate the positive and negative predictive value of the algorithms.

Results

Of 10.8 million individuals, 25,533 met ≥ 1 criteria (PPV 83.0%, kappa statistic 0.93) and 13,693 individuals met ≥ 2 criteria (PPV 95.2%, kappa statistic 1.00). The NPV for PDAC was 100%.

Conclusions

An algorithm incorporating readily available EHR data elements to identify patients with PDAC achieved excellent PPV and NPV. This algorithm is likely to enable future epidemiologic studies of PDAC.

Graphic Abstract

中文翻译：

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退伍军人健康管理局用于识别胰腺癌的病例发现算法的开发和验证

背景

由于诊断较晚，胰腺导管腺癌 (PDAC) 的生存率仍然很低。电子健康记录 (EHR) 可用于研究这种罕见疾病，但美国 EHR 中目前不存在用于识别 PDAC 的经过验证的算法。

目标

使用退伍军人健康管理局 (VHA) EHR 数据开发和验证算法来识别 PDAC 患者。

方法

我们开发了两种算法来识别 2002 年至 2023 年 VHA 中的 PDAC 患者。这些算法需要在以下领域 ≥ 1 或 ≥ 2 中诊断出外分泌胰腺癌：(i) VA 国家癌症登记处，(ii)住院患者，或 (iii) 肿瘤科门诊患者。在符合 ≥ 1 个上述标准的个体中，三位胃肠病学家随机抽取 100 名样本进行审查，以判定 PDAC 状态。我们还裁定了 50 名不符合任一算法资格的患者。这些患者在住院期间死亡，碱性磷酸酶值在满足≥ 2 上述 PDAC 标准的患者的四分位范围内。这些专家裁决使我们能够计算算法的阳性和阴性预测值。

结果

在 1080 万人中，有 25,533 人满足 ≥ 1 个标准（PPV 83.0%，kappa 统计量 0.93），13,693 人满足 ≥ 2 个标准（PPV 95.2%，kappa 统计量 1.00）。PDAC 的 NPV 为 100%。

结论

结合现成 EHR 数据元素来识别 PDAC 患者的算法实现了出色的 PPV 和 NPV。该算法可能有助于未来 PDAC 的流行病学研究。

图文摘要