Identifying Acute Low Back Pain Episodes in Primary Care Practice from Clinical Notes

Acute and chronic low back pain (LBP) are different conditions with different treatments. However, they are coded in electronic health records with the same ICD-10 code (M54.5) and can be differentiated only by retrospective chart reviews. This prevents efficient definition of data driven guidelines for billing and therapy recommendations, such as return to-work options. To solve this issue, we evaluate the feasibility of automatically distinguishing acute LBP episodes by analyzing free text clinical notes. We used a dataset of 17,409 clinical notes from different primary care practices; of these, 891 documents were manually annotated as "acute LBP" and 2,973 were generally associated with LBP via the recorded ICD-10 code. We compared different supervised and unsupervised strategies for automated identification: keyword search; topic modeling; logistic regression with bag-of-n-grams and manual features; and deep learning (ConvNet). We trained the supervised models using either manual annotations or ICD-10 codes as positive labels. ConvNet trained using manual annotations obtained the best results with an AUC-ROC of 0.97 and F-score of 0.72. ConvNet9s results were also robust to reduction of the number of manually annotated documents. In the absence of manual annotations, topic models performed better than methods trained using ICD-10 codes, which were unsatisfactory for identifying LBP acuity. This study uses clinical notes to delineate a potential path toward systematic learning of therapeutic strategies, billing guidelines, and management options for acute LBP at the point of care.