Note Texta | Error Assessment |
---|---|
False Positive | |
“Chief Complaint Patient presents with Other weakness Fall” | Chief complaint was in error. Visit was for causes unrelated to a fall (diarrhea and weakness related to c. diff and sepsis). No fall mentioned in the note. |
“He was pulling a frozen chicken package out of freezer when it fell and struck his left lower leg anterior aspect” | Something else fell |
“Had a fall on [DATE] with left knee laceration with minimal blood loss and no other injuries” | Note mentions prior fall (~ 3 weeks before) in HPI section, only as context for reason for visit (low hemoglobin counts) |
“She has had multiple UTIs in the fall 2016” | Refers to the season “Fall”. Algorithm excludes for this, but only when written as “Fall of 20XX” |
“PMH: Past Medical History...- s/p fall - ” | Algorithm mistakenly pulled this from past history section |
“Patient has a known left-sided ovarian mass which her primary care physician and her husband falling.” | Transcription error in note (physician likely meant to write “following”) |
“Pt states she fell apart after her divorce, that there is nothing that makes her happy” | Use of an idiom that contained the word fall |
“The patient is unable to confirm falling”... “Son unaware and unable to confirm if patient fell or not” | Uncertainty about whether fall occurred; phrase “unable to confirm” was not included in algorithm for exclusion |
“Negative for falls” | Negation term not included in algorithm |
“Negative for back pain, falls and neck pain” | Negation term not included in algorithm |
False Negative | |
“...presents to the ED with complaints of left wrist pain sustained after a FOOSH injury earlier today while playing tennis.” | Use of acronym that describes the incident (‘Fall On OutStretched Hand’), rather than the word ‘fall’) |
“Patient reports earlier this morning she was up in her bathroom attempting to use the toilet, sat down, missed the toilet and landed on her right hip.” | Word(s) other than “fall” used to describe fall incident in the note |
“She was noted to have a syncopal event. She went down to the ground and struck her head...”; “...she syncopized at her aerobics class today. She does not remember the events immediately before or after.,, She did hit her head.” | Word(s) other than “fall” used to describe fall incident in the note |
“He says that he intermittently woke up on the floor feeling unusual… it took him several minutes to realize that he had hit his head and that he had a large hematoma on the back left side of his head” | Word(s) other than “fall” used to describe fall incident in the note |
“...presents with CT angiogram showing ‘occlusion’. Patient fell 1 month ago, had wound to her R knee. This opened into a sore, she has been managing this with her physician.” | Fall was not recent, but contributed to the cause of the ED visit. |