{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T19:35:07Z","timestamp":1783020907950,"version":"3.54.6"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To develop and evaluate an internally validated natural language processing (NLP) model to determine guideline adherence of antibiotic decisions in the emergency department (ED) for skin and soft tissue infections (SSTIs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This cross-sectional pilot study developed and applied a random forest (RF)\/NLP model to classify clinical narratives of patients with skin infections as requiring either methicillin-resistant\n                      <jats:italic toggle=\"yes\">Staphylococcus aureus<\/jats:italic>\n                      (MRSA) or non-MRSA antibiotic coverage. Conducted at a quaternary care children\u2019s hospital with an annual volume of 50,000 ED visits, our study included patients aged 1 to 18 years presenting for SSTIs to the ED from July 1, 2018, through June 30, 2023. Main outcomes included the NLP model\u2019s sensitivity, specificity, and receiver operator characteristic (ROC) curve compared to gold standard manual physician review of the medical records.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 1588 patients were part of the training data set, with an additional 423 patients utilized for validation. The RF model achieved an area under the curve (AUC) of 0.99, 97.0% sensitivity, and 94.9% specificity. In the validation data set, the model achieved 96.6% sensitivity and 90.1% specificity. Performance remained strong despite absent\/missing patient history in certain narratives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The NLP model demonstrated that automated analysis of clinical narratives for determining guideline adherence is feasible. Despite missing data in narratives, the model\u2019s high performance suggests potential for broader application. Given the rise in antibiotic-resistant infections and the role of judicious antibiotic use, developing automated systems through NLP can significantly contribute to health care delivery and patient safety. The methodology of this study provides a feasible, sustainable path for similar applications in the emergency setting.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/pec.0000000000003576","type":"journal-article","created":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T05:00:15Z","timestamp":1772168415000},"page":"491-498","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating Guideline-Adherent Antibiotic Use for Skin Infections Using Natural Language Processing"],"prefix":"10.1097","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5448-2645","authenticated-orcid":false,"given":"James R.","family":"Rudloff","sequence":"first","affiliation":[{"name":"Department of Pediatrics"},{"name":"Institute for Informatics, Data Science, and Biostatistics, Washington University in St. Louis, St. Louis, MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie A.","family":"Fritz","sequence":"additional","affiliation":[{"name":"Department of Pediatrics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"Lai","sequence":"additional","affiliation":[{"name":"Institute for Informatics, Data Science, and Biostatistics, Washington University in St. Louis, St. Louis, MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir A.","family":"Kimia","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Connecticut Children\u2019s Hospital, Hartford, CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Assaf","family":"Landschaft","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Harvard University, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rakesh D.","family":"Mistry","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Yale University School of Medicine, New Haven, CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason G.","family":"Newland","sequence":"additional","affiliation":[{"name":"Department of Pediatrics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fahd A.","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Department of Pediatrics"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,2,27]]},"reference":[{"key":"R1-20260702","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.annemergmed.2012.09.002","article-title":"A call to action for antimicrobial stewardship in the emergency department: approaches and strategies","volume":"62","author":"May","year":"2013","journal-title":"Ann Emerg Med"},{"key":"R2-20260702","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1001\/jamapediatrics.2015.79","article-title":"The battle against antimicrobial resistance: time for the emergency department to join the fight","volume":"169","author":"Mistry","year":"2015","journal-title":"JAMA Pediatr"},{"key":"R3-20260702","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1086\/502278","article-title":"Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years","volume":"24","author":"Carling","year":"2003","journal-title":"Infect Control Hosp Epidemiol"},{"key":"R4-20260702","doi-asserted-by":"crossref","first-page":"1864","DOI":"10.1001\/jama.2016.4151","article-title":"Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011","volume":"315","author":"Fleming-Dutra","year":"2016","journal-title":"JAMA"},{"key":"R5-20260702","doi-asserted-by":"crossref","first-page":"e51","DOI":"10.1093\/cid\/ciw118","article-title":"Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America","volume":"62","author":"Barlam","year":"2016","journal-title":"Clin Infect Dis"},{"key":"R6-20260702","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1017\/ice.2017.3","article-title":"Current state of antimicrobial stewardship in children\u2019s hospital emergency departments","volume":"38","author":"Mistry","year":"2017","journal-title":"Infect Control Hosp Epidemiol"},{"key":"R7-20260702","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2021-053197","article-title":"Optimizing antibiotic treatment of skin infections in pediatric emergency and urgent care centers","volume":"150","author":"Wiltrakis","year":"2022","journal-title":"Pediatrics"},{"key":"R8-20260702","doi-asserted-by":"crossref","first-page":"e1063","DOI":"10.1097\/PEC.0000000000002667","article-title":"Aligning provider prescribing with guidelines for soft tissue infections","volume":"38","author":"Kovaleski","year":"2022","journal-title":"Pediatr Emerg Care"},{"key":"R9-20260702","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1016\/j.jemermed.2015.02.007","article-title":"Failure of emergency department observation unit treatment for skin and soft tissue infections","volume":"49","author":"Mistry","year":"2015","journal-title":"J Emerg Med"},{"key":"R10-20260702","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1097\/PEC.0b013e318203ca1c","article-title":"Emergency department treatment failures for skin infections in the era of community-acquired methicillin-resistant Staphylococcus aureus","volume":"27","author":"Mistry","year":"2011","journal-title":"Pediatr Emerg Care"},{"key":"R11-20260702","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1093\/aje\/kwt441","article-title":"Using natural language processing to improve efficiency of manual chart abstraction in research: the case of breast cancer recurrence","volume":"179","author":"Carrell","year":"2014","journal-title":"Am J Epidemiol"},{"key":"R12-20260702","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1016\/j.jbi.2009.09.001","article-title":"Current issues in biomedical text mining and natural language processing","volume":"42","author":"Chapman","year":"2009","journal-title":"J Biomed Inform"},{"key":"R13-20260702","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1136\/amiajnl-2011-000464","article-title":"Natural language processing: an introduction","volume":"18","author":"Nadkarni","year":"2011","journal-title":"J Am Med Inform Assoc"},{"key":"R14-20260702","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.jbi.2018.10.005","article-title":"Using clinical Natural Language Processing for health outcomes research: overview and actionable suggestions for future advances","volume":"88","author":"Velupillai","year":"2018","journal-title":"J Biomed Inform"},{"key":"R15-20260702","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2022-059504","article-title":"Bacteremia in children with fever and acute lower extremity pain","volume":"151","author":"El Helou","year":"2023","journal-title":"Pediatrics"},{"key":"R16-20260702","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1097\/PEC.0000000000000484","article-title":"An introduction to natural language processing: how you can get more from those electronic notes you are generating","volume":"31","author":"Kimia","year":"2015","journal-title":"Pediatr Emerg Care"},{"key":"R17-20260702","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1542\/peds.2009-2741","article-title":"Yield of lumbar puncture among children who present with their first complex febrile seizure","volume":"126","author":"Kimia","year":"2010","journal-title":"Pediatrics"},{"key":"R18-20260702","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2023-064095","article-title":"Bacteremia in patients with fever and acute lower extremity pain in a non-lyme endemic region","volume":"153","author":"Rudloff","year":"2024","journal-title":"Pediatrics"},{"key":"R19-20260702","doi-asserted-by":"crossref","first-page":"106090","DOI":"10.1016\/j.chiabu.2023.106090","article-title":"Using natural language processing to identify child maltreatment in health systems","volume":"138","author":"Negriff","year":"2023","journal-title":"Child Abuse Negl"},{"key":"R20-20260702","doi-asserted-by":"crossref","first-page":"2326","DOI":"10.1016\/j.jpedsurg.2021.03.007","article-title":"Using deep learning and natural language processing models to detect child physical abuse","volume":"56","author":"Shahi","year":"2021","journal-title":"J Pediatr Surg"},{"key":"R21-20260702","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1136\/amiajnl-2014-002887","article-title":"Automated clinical trial eligibility prescreening: increasing the efficiency of patient identification for clinical trials in the emergency department","volume":"22","author":"Ni","year":"2015","journal-title":"J Am Med Inform Assoc"},{"key":"R23-20260702","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"370","author":"von Elm","year":"2007","journal-title":"Lancet"},{"key":"R24-20260702","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1542\/hpeds.2019-0317","article-title":"Variation in proportion of blood cultures obtained for children with skin and soft tissue infections","volume":"10","author":"Stephens","year":"2020","journal-title":"Hosp Pediatr"},{"key":"R25-20260702","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1093\/cid\/ciu444","article-title":"Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America","volume":"59","author":"Stevens","year":"2014","journal-title":"Clin Infect Dis"},{"key":"R26-20260702","doi-asserted-by":"crossref","first-page":"14604582221132429","DOI":"10.1177\/14604582221132429","article-title":"Electronic surveillance of patient safety events using natural language processing","volume":"28","author":"Ozonoff","year":"2022","journal-title":"Health Informatics J"},{"key":"R27-20260702","doi-asserted-by":"crossref","first-page":"159","DOI":"10.2307\/2529310","article-title":"The measurement of observer agreement for categorical data","volume":"33","author":"Landis","year":"1977","journal-title":"Biometrics"},{"key":"R28-20260702","doi-asserted-by":"crossref","first-page":"936","DOI":"10.2214\/AJR.15.14677","article-title":"Effects of performance feedback reports on adherence to evidence-based guidelines in use of CT for evaluation of pulmonary embolism in the emergency department: a randomized trial","volume":"205","author":"Raja","year":"2015","journal-title":"AJR Am J Roentgenol"},{"key":"R29-20260702","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1016\/j.ajem.2020.10.017","article-title":"A multifaceted intervention improves antibiotic stewardship for skin and soft tissues infections","volume":"46","author":"May","year":"2021","journal-title":"Am J Emerg Med"},{"key":"R30-20260702","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1111\/acem.13873","article-title":"An implementation science approach to antibiotic stewardship in emergency departments and urgent care centers","volume":"27","author":"Yadav","year":"2020","journal-title":"Acad Emerg Med"}],"container-title":["Pediatric Emergency Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/PEC.0000000000003576","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T18:20:01Z","timestamp":1783016401000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/PEC.0000000000003576"}},"subtitle":["A Pilot Study"],"short-title":[],"issued":{"date-parts":[[2026,2,27]]},"references-count":29,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.1097\/pec.0000000000003576","relation":{},"ISSN":["0749-5161","1535-1815"],"issn-type":[{"value":"0749-5161","type":"print"},{"value":"1535-1815","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,27]]},"assertion":[{"value":"2025-06-02","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-06","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}