Automated phenotyping of congenital heart disease for dynamic patient aggregation and outcome reporting.

Abstract

Objectives: Accurate characterization of patients with congenital heart disease is fundamental to research, outcomes reporting, quality improvement, and clinical decision-making. Here we present an approach to computing the anatomy of patients with congenital heart disease based on the whole of their diagnostic and surgical codes.

Materials and methods: All diagnostic and procedure codes for patients cared for between 1981 and 2020 at Boston Children's Hospital were extracted from a database containing diagnostic codes from echocardiograms, and procedural codes from surgical and catheterization procedures. The pipeline sequentially (1) mapped each of the 7500 native codes to algorithm codes; (2) computed the parent anatomy for each study using a pre-defined hierarchy; (3) computed the parent anatomy for the patient, based on highest ranking parent anatomy; and (4) computed the subcategories and mandatory co-variate findings for each patient. Thereafter, diagnostic accuracy of 500 unseen patients was adjudicated against clinical documentation by clinical experts.

Results: A total of 514 541 echocardiograms on 161 735 patients were available for this study. Phenotypes of congenital cardiac diseases were assigned in 84 285 patients (52%), and the remainder were computed to have normal anatomy. Clinicians agreed with algorithm assignments in 96.4% (482 of 500 patients), with disagreements most often representing definitional differences. An interactive dashboard enabled by the output of this algorithm is presented.

Conclusions: The computation of detailed congenital heart defect phenotypes from raw diagnostic and procedure codes is possible with a high degree of accuracy and efficiency. This framework may enable tools to support interactive outcomes reporting and clinical decision support.