Annotated Clinical Texts from MIMIC
Adv. / Metastatic Cancer: Cancers with very high or imminent mortality (pancreas, esophagus, stomach, cholangiocarcinoma, brain); mention of distant or multi-organ metastasis, where palliative care would be considered (prognosis < 6 months).
Example: "h/o cholangiocarcinoma dx in [DATE] s/p resection, with recent CT showing met cholangiocarcinoma"
Adv. Heart Disease: Any consideration for needing a heart transplant; description of severe aortic stenosis (aortic valve area < 1.0cm^2, severe cardiomyopathy, Left Ventricular Ejection Fraction (LVEF) <= 30%. Not sufficient to have a medical history of congestive heart failure (CHF) or myocardial infarction (MI) with stent or coronary artery bypass graft (CABG).
Example: echo in [DATE] showed EF 30%
Adv. Lung Disease: Severe chronic obstructive pulmonary disease (COPD) defined as Gold Stage III-IV, or with a forced expiratory volume during first breath (FEV1) < 50% of normal, or forced vital capacity (FVC) <70%, or severe interstitial lung disease (ILD), or Idiopathic pulmonary fibrosis (IPF).
Example: Pt has significant obstructive and restrictive pulmonary disease, on home oxygen.
Alcohol Abuse: Current/recent alcohol abuse history; still an active problem at time of admission (may or may not be the cause of it).
Example: past medical history of alcohol abuse who was diagnosed with alcoholic cirrhosis on this admission.
Chronic Neurologic Dystrophies: Any chronic central nervous system (CNS) or spinal cord diseases, included/not limited to: Multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), myasthenia gravis, Parkinson’s Disease, epilepsy, history of stroke/cerebrovascular accident (CVA) with residual deficits, and various neuromuscular diseases/dystrophies.
Example: 58 yo m w/ multiple sclerosis and seizure disorder
Chronic Pain: Any etiology of chronic pain, including fibromyalgia, requiring long-term opioid/narcotic analgesic medication to control.
Example: started on a fentanyl patch and continued on prn oxycodone for pain control
Dementia: Alzheimer's, alcohol-associated, and other forms of dementia mentioned in the text.
Example: pmh sig for Alzheimer's dementia
Depression: Diagnosis of depression; prescription of anti-depressant medication; or any description of intentional drug overdose, suicide or self-harm attempts.
Example: Citalopram restarted once taking POs
Developmental Delay: Includes congenital, genetic and idiopathic disabilities.
Example: history of Down's syndrome
Non Adherence: Temporary or permanent discontinuation of a treatment, including pharmaceuticals or appointments, without consulting a physician prior to doing so. This includes skipping dialysis appointments or leaving the hospital against medical advice. A patient who sees a physician to discuss adverse events associated with a medication may or may not constitute non-adherence depending on whether or not the treatment was ceased without the physician's consultation.
Example: in setting of missing dialysis for the past week
Obesity & Clinical obesity: BMI > 30. Previous history of or being considered for gastric bypass. Insufficient to have abdominal obesity mentioned in physical exam.
Example: past medical history of morbid obesity with weight greater than 300 pounds
Psychiatric disorders: All psychiatric disorders in DSM-5 classification, including schizophrenia, bipolar and anxiety disorders, other than depression.
Example: schizophrenia, on effexor and risperdal
Substance Abuse: Include any intravenous drug abuse (IVDU), accidental overdose of psychoactive or narcotic medications, (prescribed or not). Admitting to marijuana use in history is not sufficient.
Example: toxicology screen was positive for ETOH, benzos, and cocaine