Welsh Claire E, Duz Marco, Parkin Timothy D H, Marshall John F
Equine Clinical Sciences Division, Weipers Centre Equine Hospital, School of Veterinary Medicine, University of Glasgow, UK.
School of Veterinary Medicine and Science, University of Nottingham, UK.
Prev Vet Med. 2017 Jan 1;136:11-18. doi: 10.1016/j.prevetmed.2016.11.012. Epub 2016 Nov 22.
Electronic medical records from first opinion equine veterinary practice may represent a unique resource for epidemiologic research. The appropriateness of this resource for risk factor analyses was explored as part of an investigation into clinical and pharmacologic risk factors for laminitis. Amalgamated medical records from seven UK practices were subjected to text mining to identify laminitis episodes, systemic or intra-synovial corticosteroid prescription, diseases known to affect laminitis risk and clinical signs or syndromes likely to lead to corticosteroid use. Cox proportional hazard models and Prentice, Williams, Peterson models for repeated events were used to estimate associations with time to first, or subsequent laminitis episodes, respectively. Over seventy percent of horses that were diagnosed with laminitis suffered at least one recurrence. Risk factors for first and subsequent laminitis episodes were found to vary. Corticosteroid use (prednisolone only) was only significantly associated with subsequent, and not initial laminitis episodes. Electronic medical record use for such analyses is plausible and offers important advantages over more traditional data sources. It does, however, pose challenges and limitations that must be taken into account, and requires a conceptual change to disease diagnosis which should be considered carefully.
初诊马匹兽医诊所的电子病历可能是流行病学研究的独特资源。作为对蹄叶炎临床和药理学风险因素调查的一部分，探讨了该资源用于风险因素分析的适用性。对来自英国七家诊所的合并病历进行文本挖掘，以识别蹄叶炎发作、全身或滑膜内皮质类固醇处方、已知影响蹄叶炎风险的疾病以及可能导致使用皮质类固醇的临床症状或综合征。分别使用Cox比例风险模型和重复事件的Prentice、Williams、Peterson模型来估计与首次或随后蹄叶炎发作时间的关联。超过70%被诊断为蹄叶炎的马匹至少复发过一次。首次和随后蹄叶炎发作的风险因素有所不同。皮质类固醇的使用（仅泼尼松龙）仅与随后的而非初始的蹄叶炎发作显著相关。将电子病历用于此类分析是可行的，并且与更传统的数据源相比具有重要优势。然而，它确实带来了必须考虑的挑战和局限性，并且需要对疾病诊断进行概念上的改变，对此应仔细考虑。
