Clinical Orthopaedics and Related Research®最新文献

{"title":"De Novo Natural Language Processing Algorithm Accurately Identifies Myxofibrosarcoma From Pathology Reports.","authors":"Sarah E Lindsay, Cecelia J Madison, Duncan C Ramsey, Yee-Cheen Doung, Kenneth R Gundle","doi":"10.1097/CORR.0000000000003270","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003270","url":null,"abstract":"<p><strong>Background: </strong>Available codes in the ICD-10 do not accurately reflect soft tissue sarcoma diagnoses, and this can result in an underrepresentation of soft tissue sarcoma in databases. The National VA Database provides a unique opportunity for soft tissue sarcoma investigation because of the availability of all clinical results and pathology reports. In the setting of soft tissue sarcoma, natural language processing (NLP) has the potential to be applied to clinical documents such as pathology reports to identify soft tissue sarcoma independent of ICD codes, allowing sarcoma researchers to build more comprehensive databases capable of answering a myriad of research questions.</p><p><strong>Questions/purposes: </strong>(1) What proportion of patients with myxofibrosarcoma within the National VA Database would be missed by searching only by soft tissue sarcoma ICD codes? (2) Is a de novo NLP algorithm capable of analyzing pathology reports to accurately identify patients with myxofibrosarcoma?</p><p><strong>Methods: </strong>All pathology reports (10.7 million) in the national VA corporate data warehouse were identified from 2003 to 2022. Using the word-search functionality, reports from 403 veterans were found to contain the term \"myxofibrosarcoma.\" The resulting pathology reports were manually reviewed to develop a gold-standard cohort that contained only those veterans with pathologist-confirmed myxofibrosarcoma diagnoses. The cohort had a mean ± SD age of 70 ± 12 years, and 96% (287 of 300) were men. Diagnosis codes were abstracted, and differences in appropriate ICD coding were compared. An NLP algorithm was iteratively refined and tested using confounders, negation, and emphasis terms for myxofibrosarcoma. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for the NLP-generated cohorts through comparison with the manually reviewed gold-standard cohorts.</p><p><strong>Results: </strong>The records of 27% (81 of 300) of myxofibrosarcoma patients within the VA database were missing a sarcoma ICD code. A de novo NLP algorithm more accurately (92% [276 of 300]) identified patients with myxofibrosarcoma compared with ICD codes (73% [219 of 300]) or basic word searches (74% [300 of 403]) (p < 0.001). Three final algorithm models were generated with accuracies ranging from 92% to 100%.</p><p><strong>Conclusion: </strong>An NLP algorithm can identify patients with myxofibrosarcoma from pathology reports with high accuracy, which is an improvement over ICD-based cohort creation and simple word search. This algorithm is freely available on GitHub (https://github.com/sarcoma-shark/myxofibrosarcoma-shark) and is available to facilitate external validation and improvement through testing in other cohorts.</p><p><strong>Level of evidence: </strong>Level II, diagnostic study.</p>","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: What Is the Association Between Agency and Levels of Capability and Comfort in Musculoskeletal Care? A Systematic Review.","authors":"Julia Blackburn","doi":"10.1097/CORR.0000000000003060","DOIUrl":"10.1097/CORR.0000000000003060","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"1777-1778"},"PeriodicalIF":4.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11419529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140305029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do Hounsfield Units From Intraoperative CT Scans Correlate With Preoperative Values?","authors":"Brendan M Striano, Alexander M Crawford, Harry M Lightsey, Chierika Ukogu, Jose I Acosta Julbe, Daniel C Gabriel, Andrew J Schoenfeld, Andrew K Simpson","doi":"10.1097/CORR.0000000000003122","DOIUrl":"10.1097/CORR.0000000000003122","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;There is increasing interest in forecasting postoperative complications using bone density metrics. Vertebral Hounsfield unit measurements obtained from CT scans performed for surgical planning or other purposes, known as opportunistic CTs, have shown promise for their ease of measurement and the ability to target density measurement to a particular region of interest. Concomitant with the rising interest in prognostic bone density measurement use has been the increasing adoption of intraoperative advanced imaging techniques. Despite the interest in both outcome prognostication and intraoperative advanced imaging, there is little information regarding the use of CT-based intraoperative imaging as a means to measure bone density.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Questions/purposes: &lt;/strong&gt;(1) Can vertebral Hounsfield units be reliably measured by physician reviewers from CT scans obtained intraoperatively? (2) Do Hounsfield units measured from intraoperative studies correlate with values measured from preoperative CT scans?&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;To be eligible for this retrospective study, patients had to have been treated with the use of an intraoperative CT scan for instrumented spinal fusion for either degenerative conditions or traumatic injuries between January 2015 and December 2022. Importantly, patients without a preoperative CT scan of the fused levels within 180 days before surgery or who were indicated for surgery because of infection, metastatic disease, or who were having revision surgery after prior instrumentation were excluded from the query. Of the 285 patients meeting these inclusion criteria, 53% (151) were initially excluded for the following reasons: 36% (102) had intraoperative CT scans obtained after placement of instrumentation, 16% (47) had undergone intraoperative CT scans but the studies were not accessible for Hounsfield unit measurement, and 0.7% (2) had prior kyphoplasty wherein the cement prevented Hounsfield unit measurement. Finally, an additional 19% (53) of patients were excluded because the preoperative CT and intraoperative CT were obtained at different peak voltages, which can influence Hounsfield unit measurement. This yielded a final population of 81 patients from whom 276 preoperative and 276 intraoperative vertebral Hounsfield unit measurements were taken. Hounsfield unit data were abstracted from the same vertebra(e) from both preoperative and intraoperative studies by two physician reviewers (one PGY3 and one PGY5 orthopaedic surgery resident, both pursuing spine surgery fellowships). For a small, representative subset of patients, measurements were taken by both reviewers. The feasibility and reliability of Hounsfield unit measurement were then assessed with interrater reliability of values measured from the same vertebra by the two different reviewers. To compare Hounsfield unit values from intraoperative CT scans with preoperative CT studies, an intraclass correlation using a ","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"1885-1892"},"PeriodicalIF":4.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11419555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140904398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: Do Hounsfield Units From Intraoperative CT Scans Correlate With Preoperative Values?","authors":"Hollis G Potter","doi":"10.1097/CORR.0000000000003176","DOIUrl":"10.1097/CORR.0000000000003176","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"1893-1895"},"PeriodicalIF":4.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11419491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: Congress is AWOL and the Public is Polarized-Is There a Sensible Middle Path for Orthopaedic Surgeons Who Want to Reduce Gun-related Injuries and Deaths?","authors":"Julia H Silver","doi":"10.1097/CORR.0000000000003166","DOIUrl":"10.1097/CORR.0000000000003166","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"1912-1914"},"PeriodicalIF":4.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11419439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141436340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: Can Patient-centered Education and Pain Management Delivered by Coaches Improve Pain Outcomes After Orthopaedic Trauma? A Randomized Trial.","authors":"Alexander S Rascoe","doi":"10.1097/CORR.0000000000003160","DOIUrl":"10.1097/CORR.0000000000003160","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"1870-1872"},"PeriodicalIF":4.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11419485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141436335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: Composite Reconstruction With Irradiated Autograft Plus Total Hip Replacement After Type II Pelvic Resections for Tumors Is Feasible but Fraught With Complications.","authors":"John H Healey","doi":"10.1097/CORR.0000000000003153","DOIUrl":"10.1097/CORR.0000000000003153","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"1836-1838"},"PeriodicalIF":4.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11419560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141757522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editor's Spotlight/Take 5: What Is the Patient-reported Outcome and Complication Incidence After Operative Versus Nonoperative Treatment of Minimally Displaced Tibial Plateau Fractures?","authors":"Seth S Leopold","doi":"10.1097/CORR.0000000000003237","DOIUrl":"10.1097/CORR.0000000000003237","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"1741-1743"},"PeriodicalIF":4.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11419530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: Static Versus Articulating Spacer: Does Infectious Pathogen Type Affect Treatment Success?","authors":"Michael Alexiades","doi":"10.1097/CORR.0000000000003154","DOIUrl":"10.1097/CORR.0000000000003154","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"1856-1857"},"PeriodicalIF":4.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11419541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141436338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR® Curriculum-Orthopaedic Education: Artificial Intelligence and Surgical Assessment.","authors":"Paul J Dougherty, Pamela Andreatta","doi":"10.1097/CORR.0000000000003235","DOIUrl":"10.1097/CORR.0000000000003235","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"1760-1762"},"PeriodicalIF":4.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11419475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}