Ascertaining instances of neuroleptic malignant syndrome in a secondary mental healthcare electronic medical records database: the SLAM BRC Case Register
Ascertaining instances of neuroleptic malignant syndrome in a secondary mental healthcare electronic medical records database: the SLAM BRC Case Register
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DOI：
10.1177/2045125312438215
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发表时间：
2012-04-01
影响因子：
4.2
通讯作者：
Stewart, Robert
中科院分区：
文献类型：
--
作者：
Chang, Chin-Kuo;Harrison, Simon;Stewart, Robert
目的：抗精神病药物恶性综合征（NMS）是抗精神病药物治疗的一种罕见但可能致命的并发症。然而，没有单一的诊断测试和各种重叠的标准存在。我们使用伦敦东南部二级精神卫生保健的大型病例登记册，旨在识别疑似病例并量化先前发表的六种不同诊断标准之间的一致性水平。方法：利用最近开发的病例登记册，该登记册来源于完整但匿名的电子医疗记录（南伦敦和莫兹利NHS基金会信托），我们应用文本字符串搜索来识别已经采取行动进行调查或治疗的疑似NMS病例。结果：病例登记分析显示183例疑似NMS病例，其中43例符合至少一套诊断标准。标准之间的一致性较差（。= 0.35（所有组合一致性; 95%置信区间0.31-0.39），只有1例病例符合所有6项诊断标准。然而，在符合任何诊断标准的病例中，发热、锥体外系症状、意识改变、自主神经症状和CK浓度升高明显比不符合诊断标准的病例更常见（p < 0.01）。在进一步分析中，这些特征中的两个或更多个的存在显著区分了符合标准的病例与不符合标准的病例（p < 0.01）。个别症状也报告了疑似病例NMS，不符合任何诊断标准。结论：在一个大样本的NMS病例记录在医疗记录中，相对较差的协议，发现在公布的诊断标准NMS。然而，NMS的核心特征在符合诊断标准的病例中更常见。在不符合诊断标准的疑似病例中也描述了个别症状。这些研究结果表明，继续需要对NMS的标准标准达成共识。
Objectives: Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal complication of antipsychotic treatment. However, there is no single diagnostic test and a variety of overlapping criteria exist. Using a large case register of secondary mental healthcare in Southeast London, we aimed to identify suspected cases and quantify the levels of agreement between six different diagnostic criteria previously published.Methods: Taking advantage of a recently developed case register sourced from full but anonymized electronic medical records (the South London and Maudsley NHS Foundation Trust), we applied text string searching to identify suspected NMS cases for which action had been taken to investigate or treat. Three psychiatrists manually reviewed case records for clinical data to compare diagnostic criteria.Results: Analysis of the case register revealed 183 suspected NMS cases, of which 43 fulfilled at least one set of the six diagnostic criteria. Agreement between criteria was poor (. = 0.35 for all combined agreement; 95% confidence interval 0.31-0.39) and only one case fulfilled all six diagnostic criteria. However, among cases meeting any diagnostic criteria, pyrexia, extrapyramidal symptoms, altered consciousness, autonomic symptoms, and elevated CK concentrations were significantly more common than in cases not meeting diagnostic criteria (p < 0.01). On further analyses, the presence of two or more of these features significantly distinguished cases meeting criteria from those that did not (p < 0.01). Individual symptoms were also reported in suspected cases of NMS that did not fulfil any diagnostic criteria.Conclusions: In a large sample of NMS cases recorded in medical records, relatively poor agreement was found among published diagnostic criteria for NMS. However, core features of NMS were observed significantly more often among cases meeting diagnostic criteria. Individual symptoms were also described in suspected cases that did not meet diagnostic criteria. These findings suggest a continued need for consensus on standard criteria for NMS.