Association between antipsychotic drug dose and length of clinical notes: a proxy of disease severity?

Background Most structured clinical data, such as diagnosis codes, are not sufficient to obtain precise phenotypes and assess disease burden. Text mining of clinical notes could provide a basis for detailed profiles of phenotypic traits. The objective of the current study was to determine whether drug dose, regardless of polypharmacy, is associated with the length of clinical notes, and to determine the frequency of adverse events per word in clinical notes. Methods In this observational study, we utilized restricted-access data from an electronic patient record system. Using three methods (defined daily dose, olanzapine equivalents, and chlorpromazine equivalents) we calculated antipsychotic dose equivalents and compared these with the number of words recorded per treatment day. For each normalization method, the frequencies of adverse events per word in manually curated samples were compared to dose intervals. Results The length of clinical notes per treatment day was positively associated with the prescribed dose for all normalization methods. The number of adverse events per word was stable over the analyzed dose spectrum. Conclusions Assuming that drug dose increases with the severity of disease, the length of clinical notes can serve as a proxy for disease severity. Due to the near-linear relationship, correction of daily word count is unnecessary when text mining for potential adverse drug reactions.