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Shock etiology was abstracted using regular expression\u00a0from clinician notes in the electronic health record then\u00a0was made into a 9-dimensional vector representing 9 different\u00a0shock etiologies. Inter-clinician diagnostic agreement of these vectors was calculated for each patient using Cosine Similarity Scores. Measure of agreement was based on cosine similarity of etiology vectors, not clinical adjudication. Patients without complete inter-clinician diagnostic agreement (Cosine Similarity Score\u2009&lt;\u20091) were compared to patients with diagnostic agreement. Machine learning models were tested to predict patients without complete inter-clinician diagnostic agreement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 7302 patients, 1327 (18.2%) never had complete inter-clinician diagnostic agreement. Patients without diagnostic agreement were more often Black (20.5 vs 16.2%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.011), with more comorbidities (Elixhauser Comorbidity Index\u2009&gt;\u200910; 39.1 vs 31.6%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and Sequential Organ Failure Assessment (SOFA) score\u2009&gt;\u200915 (12.1 vs 7.6%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Patients without diagnostic agreement less frequently had improvements in SOFA scores between ICU days 0 and 4 (34.7 vs 41.9%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and more often died in-hospital (41.5 vs. 27.6%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Machine learning models that\u00a0most accurately predicted patients without diagnostic agreement were logistic regression (Accuracy: 0.8597, F1-Score: 0.9117, AUC-ROC: 0.9257), random forest (Accuracy: 0.8658, F1-Score: 0.9201, AUC-ROC: 0.9255), and gradient boosting (Accuracy: 0.8515, F1-Score: 0.9138, AUC-ROC: 0.9227).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients without complete inter-clinician diagnostic agreement of shock etiology can be successfully predicted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s13755-025-00423-w","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T18:28:14Z","timestamp":1768242494000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Inter-clinician diagnostic agreement of shock etiology: a multicenter observational study"],"prefix":"10.1007","volume":"14","author":[{"given":"Lauren M.","family":"Janczewski","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolyn J.","family":"Hu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tiannan","family":"Zhan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ravi","family":"Garg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Slocum","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Al\u2019ona","family":"Furmanchuk","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Berry","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nandita","family":"Nadig","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeff","family":"Huml","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laeeq","family":"Shamshuddin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuriy","family":"Moklyak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura J.","family":"Davidson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sherry","family":"Chou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abbas","family":"AlQamari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emilie","family":"Powell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruce","family":"Ankenman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jane L.","family":"Holl","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8334-0304","authenticated-orcid":false,"given":"Anne","family":"Stey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"423_CR1","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1186\/s13049-016-0280-x","volume":"24","author":"JG Holler","year":"2016","unstructured":"Holler JG, Henriksen DP, Mikkelsen S, et al. 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