Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Division of Hospital Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
J Intensive Care Med. 2023 Jul;38(7):630-634. doi: 10.1177/08850666231155397. Epub 2023 Feb 5.
Using History and Physical Examination (H&P) notes, we investigated potential racial differences in documented chief complaints and problems among sepsis patients admitted to the intensive care unit.
Patient records from Medical Information Mart for Intensive Care (MIMIC-III) dataset indicating a diagnosis of sepsis were included. First recorded clinical notes for each hospital admission were assessed; free text information was specifically extracted on (1) chief complaints, and (2) problems recorded in the Assessment & Plan (A&P) section. The top 10 for each were compared between Black and White patients.
In initial H&P notes of 17 434 sepsis patients (n = 1229 Black and n = 9806 White), the top 10 most common chief complaints were somewhat similar between Black and White patients. However, relative differences existed in terms of ranking, specifically for altered mental status which was more commonly reported in Black versus White patients (11.7% vs 7.8% < .001). Among text in the A&P, sepsis was documented significantly less frequently among Black versus White patients: 11.8% versus 14.3%, = .001. Racial differences were not detected in vital signs and laboratory values.
This analysis supports the hypothesis that there may be racial differences in early sepsis presentation and possible provider interpretation of these complaints.
我们通过病史和体格检查（H&P）记录，研究了重症监护病房（ICU）中疑似脓毒症患者记录的主要症状和问题方面可能存在的种族差异。
纳入了 Medical Information Mart for Intensive Care（MIMIC-III）数据集表明患有脓毒症的患者记录。评估了每位患者每次住院的首次记录临床记录；特别从评估与计划（A&P）部分提取了（1）主要症状和（2）记录的问题的自由文本信息。将黑人患者和白人患者的前 10 项进行了比较。
在 17434 例脓毒症患者（n=1229 名黑人患者和 n=9806 名白人患者）的初始 H&P 记录中，黑人患者和白人患者的前 10 种最常见的主要症状有些相似。然而，在排名方面存在相对差异，特别是在意识状态改变方面，黑人患者比白人患者更常见（11.7%比 7.8%，<0.001）。在 A&P 中的文字记录中，脓毒症在黑人患者中的记录明显少于白人患者：11.8%比 14.3%，=0.001。在生命体征和实验室值方面没有发现种族差异。
本分析支持这样一种假设，即早期脓毒症的表现和可能的提供者对这些症状的解释可能存在种族差异。
