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Using 48,536 patients hospitalized in an ICU, we describe each hospital course as an \u2018alphabet\u2019 of 23 physician actions (\u2018events\u2019) in temporal order. We analyze these as <jats:italic>k<\/jats:italic>\u2010mers of length 3\u201312 events and apply a Bayesian model of (cumulative) relative risk (RR). The log2\u2010transformed RR (median=0.248, mean=0.226) supported the conclusion that the events selected were individually associated with increased risk of infection. Selecting from all possible cutoffs of maximum gain (MG), MG&gt;0.0244 predicts administration of antibiotics with PPV 82.0\u2009%, NPV 44.4\u2009%, and AUC 0.706. Our approach holds value for retrospective analysis of other clinical syndromes for which time\u2010of\u2010onset is critical to analysis but poorly marked in EHRs, including delirium and decompensation.<\/jats:p>","DOI":"10.1002\/cbdv.202200657","type":"journal-article","created":{"date-parts":[[2022,10,11]],"date-time":"2022-10-11T01:46:06Z","timestamp":1665452766000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sequences of Events from the Electronic Medical Record and the Onset of Infection"],"prefix":"10.1002","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8414-4279","authenticated-orcid":false,"given":"Caitlin E.","family":"Coombes","sequence":"first","affiliation":[{"name":"Department of Anesthesiology Stanford University  300 Pasteur Dr. Palo Alto CA 94305 USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7630-2123","authenticated-orcid":false,"given":"Kevin R.","family":"Coombes","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences Medical College of Georgia  1420 Laney Walker Blvd Augusta GA 30912 USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naleef","family":"Fareed","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics The Ohio State University College of Medicine  370\u2005W 9<sup>th<\/sup> Ave Columbus OH 43210 USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,10,10]]},"reference":[{"key":"e_1_2_8_1_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-020-06106-2"},{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/jamia\/ocz106"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.2196\/28781"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmpb.2019.06.010"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12911-020-01245-4"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41597-019-0103-9"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.2196\/13719"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCE.0000000000000010"},{"key":"e_1_2_8_9_1","article-title":"\u2018Prediction of Bacteremia Based on 12-Year Medical Data Using a Machine Learning Approach: Effect of Medical Data by Extraction Time\u2019","volume":"12","author":"Lee K. 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