UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA 15224, United States.
Department of Biomedical Informatics, University of Pittsburgh School of Medicine, 5607 Baum Boulevard, Pittsburgh, PA 15206, United States.
Epilepsy Behav. 2023 Aug;145:109321. doi: 10.1016/j.yebeh.2023.109321. Epub 2023 Jun 20.
Rationale The American Academy of Neurology (AAN) recommends annual sexual and reproductive health (SRH) counseling for all people with epilepsy of gestational capacity (PWEGC). Child neurologists report discussing SRH concerns infrequently with adolescents. Limited research exists regarding documentation of such counseling.
We retrospectively studied clinical notes using natural language processing to investigate child neurologists' documentation of SRH counseling for adolescent and young adult PWEGC. We segmented notes into sentences and evaluated for references to menstruation, sexual activity, contraception, folic acid, teratogens, and pregnancy. We developed training sets in a labeling application and used machine learning to identify additional counseling instances. We repeated this iteratively until we identified no new relevant sentences. We validated results using external reviewers; after removing sentences reviewers disagreed on (n = 13/400), we calculated Cohen's kappa values between the model and reviewers (>0.98 for all categories). We evaluated labeled texts for each patient per calendar year with descriptive statistics and logistic regression, adjusting for race/ethnicity, age, and teratogen use.
Data comprised 971 PWEGC age 13-21 years with 2277 patient-years and 3663 outpatient child neurology notes. Nearly half of patient-years lacked SRH counseling documentation (49.1%). Among all patients, 38.0% never had SRH counseling documented. Documentation was present regarding menstruation in 26.7% of patient-years, folic acid in 25.0%, contraception in 21.9%, pregnancy in 3.5%, teratogens in 3.0%, and sexual activity in 1.8%. Documentation regarding menstruation and contraception was associated with prescription of antiseizure medications that have a higher risk of teratogenic effects (OR = 1.27, p = 0.020, 95% CI = [1.04,1.54]; OR = 1.27, p = 0.027, 95% CI = [1.03,1.58]). Documentation regarding contraception, folic acid, and sexual activity was increased among older patients (OR = 1.28, p < 0.001, 95% CI = [1.21,1.35]; OR = 1.26, p < 0.001, 95% CI = [1.19,1.32]; OR = 1.26, p = 0.004, 95% CI = [1.08,1.47]). Documentation regarding sexual activity was decreased among patients identifying as White/Non-Hispanic (OR = 0.39, p = 0.007, 95% CI = [0.20,0.78]).
Child neurologists counsel PWEGC on SRH less frequently than recommended by the AAN based on documentation.
美国神经病学学会（AAN）建议所有具有生育能力的癫痫患者（PWEGC）每年进行一次性和生殖健康（SRH）咨询。儿科神经科医生报告称，他们很少与青少年讨论 SRH 问题。关于此类咨询的记录，目前的研究有限。
我们使用自然语言处理技术对临床记录进行了回顾性研究，以调查儿科神经科医生对青少年和年轻 PWEGC 的 SRH 咨询记录。我们将笔记分成句子，并评估了与月经、性行为、避孕、叶酸、致畸剂和妊娠相关的内容。我们在一个标记应用程序中开发了培训集，并使用机器学习来识别其他咨询实例。我们反复进行此操作，直到我们没有发现新的相关句子。我们使用外部审核员对结果进行了验证；在删除审核员不同意的句子（n=400 中的 13 个）后，我们计算了模型和审核员之间的 Cohen's kappa 值（所有类别均>0.98）。我们使用描述性统计和逻辑回归对每个患者的每个日历年度进行了评估，调整了种族/民族、年龄和致畸剂的使用。
数据包括 971 名年龄在 13-21 岁的 PWEGC，随访时间为 2277 患者年和 3663 次儿科神经科门诊记录。近一半的患者年缺乏 SRH 咨询记录（49.1%）。在所有患者中，38.0%从未记录过 SRH 咨询。在 26.7%的患者年中记录了月经情况，25.0%记录了叶酸情况，21.9%记录了避孕情况，3.5%记录了妊娠情况，3.0%记录了致畸剂情况，1.8%记录了性行为情况。记录月经和避孕情况与开具有更高致畸风险的抗癫痫药物有关（比值比[OR]，1.27；p=0.020；95%置信区间[CI]，1.04 至 1.54；OR，1.27；p=0.027；95%CI，1.03 至 1.58）。记录避孕、叶酸和性行为情况与年龄较大的患者有关（OR，1.28；p<0.001；95%CI，1.21 至 1.35；OR，1.26；p<0.001；95%CI，1.19 至 1.32；OR，1.26；p=0.004；95%CI，1.08 至 1.47）。记录性行为情况与白人/非西班牙裔患者较少有关（OR，0.39；p=0.007；95%CI，0.20 至 0.78）。
根据记录，儿科神经科医生对 PWEGC 的 SRH 咨询频率低于 AAN 的建议。
