{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T02:31:34Z","timestamp":1784255494447,"version":"3.55.0"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T00:00:00Z","timestamp":1770681600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The 2018 Movement Disorder Society criteria introduced stricter diagnostic requirements for essential tremor (ET) compared with the 1998 consensus; however, how electronic health record (EHR)\u2013based ET diagnostic coding aligns with chart-adjudicated criteria in routine practice remains unclear. We evaluated the diagnostic performance of EHR-based ET coding relative to chart-adjudicated criteria in a US neurology practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective study within the Geisinger Health System in Pennsylvania. Patients with neurologist-assigned ET diagnoses were identified and stratified as ET-only or ET with differential diagnostic coding. A stratified random sample underwent manual chart review. Clinical features were mapped to both criteria after one and two visits. Accuracy metrics\u2014sensitivity, specificity, sample-based positive predictive value (PPV), and sample-based negative predictive value (NPV)\u2014were calculated with 95% confidence intervals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The reviewed sample included 447 ET-only cases and 137 with differential. With one visit, the 1998 criteria yielded sensitivity of 96% (94\u201398%), specificity of 60% (53\u201367%), PPV of 82% (78\u201386%), and NPV of 88% (82\u201394%). The 2018 criteria demonstrated similar sensitivity (96%, 94\u201398%) but lower specificity (38%, 32\u201344%) and PPV of 53% (48\u201358%), with NPV of 93% (88\u201398%). With \u22652 visits, specificity increased to 71% (61\u201381%) and PPV to 85% (80\u201390%) for the 1998 criteria, and to 51% (43\u201359%) and 65% (57\u201371%) for the 2018 criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this cohort, ET diagnostic coding showed consistently high sensitivity and NPV across frameworks. Specificity and PPV differed by criterion and improved with multiple clinical encounters.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1744336","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T05:30:20Z","timestamp":1770701420000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Diagnostic performance of essential tremor criteria in electronic health records: a retrospective neurology cohort study"],"prefix":"10.3389","volume":"17","author":[{"given":"Haydn P.","family":"Swackhamer","sequence":"first","affiliation":[{"name":"Department of Neurology, Geisinger Medical Center","place":["Danville, PA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"Stoica","sequence":"additional","affiliation":[{"name":"Department of Neurology, Geisinger Medical Center","place":["Danville, PA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikki","family":"Sapkota","sequence":"additional","affiliation":[{"name":"Department of Neurology, Conemaugh Health System","place":["Johnstown, PA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oluwaseyi I.","family":"Olulana","sequence":"additional","affiliation":[{"name":"Department of Neurology, MedStar Health\u2014Georgetown University Hospital","place":["Washington, DC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahdi","family":"Taye","sequence":"additional","affiliation":[{"name":"Geisinger Commonwealth School of Medicine","place":["Scranton, PA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akshay C.","family":"Patel","sequence":"additional","affiliation":[{"name":"Geisinger Commonwealth School of Medicine","place":["Scranton, PA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alyssa M.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Neurology, Geisinger Medical Center","place":["Danville, PA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iqra C.","family":"Mian","sequence":"additional","affiliation":[{"name":"Department of Neurology, Wright State University Boonshoft School of Medicine","place":["Dayton, OH, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mudit","family":"Gupta","sequence":"additional","affiliation":[{"name":"Healthcare Data Analyst Team Lead, Geisinger Medical Center","place":["Danville, PA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alia C.","family":"Stanciu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Geisinger Medical Center","place":["Danville, PA, United States"]},{"name":"Freeman College of Management, Bucknell University","place":["Lewisburg, PA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Cosmin","family":"Sandulescu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Geisinger Medical Center","place":["Danville, PA, United States"]},{"name":"Geisinger Commonwealth School of Medicine","place":["Scranton, PA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,10]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.5334\/tohm.632","article-title":"How common is essential tremor? Update on the worldwide prevalence of essential tremor","volume":"11","author":"Louis","year":"2021","journal-title":"Tremor Other Hyperkinet Mov"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jns.2022.120191","article-title":"The MDS consensus tremor classification: the best way to classify patients with tremor at present","volume":"435","author":"Latorre","year":"2022","journal-title":"J Neurol Sci"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1002\/mds.27121","article-title":"Consensus statement on the classification of tremors. From the task force on tremor of the International Parkinson and Movement Disorder Society","volume":"33","author":"Bhatia","year":"2018","journal-title":"Mov Disord"},{"key":"ref4","article-title":"Consensus statement of the Movement Disorder Society on tremor","author":"Deuschl","year":"1998","journal-title":"Mov Disord"},{"key":"ref5","first-page":"208","article-title":"Use of an electronic health record to optimize site performance in ran domized clinical trials","volume-title":"J Clin Trials","author":"Yvette","year":"2014"},{"key":"ref6","article-title":"The Geisinger MyCode community health initiative: an electronic health record-linked biobank for precision medicine research","author":"Samantha","year":"2015","journal-title":"Genet Med"},{"key":"ref7","first-page":"1100","article-title":"Common misdiagnosis of a common neurological disorder how are we misdiagnosing essential tremor?","volume-title":"Arch Neurol","author":"Jain","year":"2006"},{"key":"ref8","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2020.00172","article-title":"Essential tremor as a \u201cwaste basket\u201d diagnosis: diagnosing essential tremor remains a challenge","volume":"11","author":"Amlang","year":"2020","journal-title":"Front Neurol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"34","DOI":"10.5334\/tohm.905","article-title":"Validation of the international classification of diseases, tenth revision-clinical modification diagnostic code for essential tremor","volume":"14","author":"Howard","year":"2024","journal-title":"Tremor Other Hyperkinet Mov (NY)"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1159\/000104096","article-title":"ICD-9 CM code 333.1 as an identifier of patients with essential tremor: a study of the positive predictive value of this code","volume":"28","author":"Louis","year":"2007","journal-title":"Neuroepidemiology"},{"key":"ref11","volume-title":"Epic diagnosis groupers","year":"2025"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"e0148991","DOI":"10.1371\/journal.pone.0148991","article-title":"The effectiveness of electronic differential diagnoses (DDX) generator s: a systematic review and Meta-analysis","volume":"11","author":"Riches","year":"2016","journal-title":"PLoS One"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1016\/S1474-4422(12)70325-3","article-title":"Essential tremor: a unique diagnostic code in ICD-10-CM","volume":"12","author":"Louis","year":"2013","journal-title":"Lancet Neurol"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1212\/WNL.41.2_Part_1.234","article-title":"Essential tremor","volume":"2","author":"Lou","year":"1991","journal-title":"Neurology"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1159\/000111584","article-title":"Does age of onset in essential tremor have a bimodal distribution? 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data","author":"Stevenson","year":"2024"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)\u2014a metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009","journal-title":"J Biomed Inform"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"103208","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap consortium: building an international community of software platform partners","volume":"95","author":"Harris","year":"2019","journal-title":"J Biomed Inform"},{"key":"ref22","volume-title":"Create \u2018Table 1\u2019 to describe baseline characteristics with or without propensity score weights","author":"Yoshida","year":"2022"},{"key":"ref23","doi-asserted-by":"crossref","DOI":"10.1212\/CPJ.0000000000001100","article-title":"Mixed motor disorder","volume":"11","author":"Louis","year":"2021","journal-title":"Neurol Clin Pract"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1212\/wnl.47.1.264","article-title":"Accuracy of reported family histories of essential tremor","volume":"47","author":"Busenbark","year":"1996","journal-title":"Neurology"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1136\/jnnp.25.2.122","article-title":"Observations on essential tremor","volume":"25","author":"Marshall","year":"1962","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1093\/brain\/99.4.659","article-title":"Essential tremor in Papua New Guinea","volume":"99","author":"Hornabrook","year":"1976","journal-title":"Brain"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1136\/jnnp.47.5.466","article-title":"Essential tremor in Rochester, Minnesota: a 45-year study","volume":"47","author":"Rajput","year":"1984","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1212\/WNL.34.3.361","article-title":"Hereditary neurodegenerative disorders in Nigerian Africans","volume":"34","author":"Aiyesimoju","year":"1984","journal-title":"Neurology"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1002\/ana.410350613","article-title":"The relationship of essential tremor to other movement disorders: repo rt on 678 patients","volume":"35","author":"Koller","year":"1994","journal-title":"Ann Neurol"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1002\/mds.870090212","article-title":"Gait abnormality in essential tremor","volume":"9","author":"Singer","year":"1994","journal-title":"Mov Disord"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2023.998205","article-title":"Prevalence and risk factors for abnormal tandem gait in patients with essential tremor syndrome: a cross-sectional study in Southwest China","volume":"14","author":"Huang","year":"2023","journal-title":"Front Neurol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1016\/j.parkreldis.2022.07.018","article-title":"Distribution of rest tremor in patients with essential tremor: does it lateralize with simple kinetic, postural, or intention tremors?","volume":"102","author":"Delgado","year":"2022","journal-title":"Parkinsonism Relat Disord"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1001\/ARCHNEUR.60.3.405","article-title":"Rest tremor in patients with essential tremor","volume":"60","author":"Cohen","year":"2003","journal-title":"Arch Neurol"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1212\/01.wnl.0000192393.05850.ec","article-title":"Population-based case-control study of cognitive function in essential 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