Modest performance of text mining to extract health outcomes may be almost sufficient for high-quality prognostic model development

Background: Across medicine, prognostic models are used to estimate patient risk of certain future health outcomes (e.g., cardiovascular or mortality risk). To develop (or train) prognostic models, historic patient-level training data is needed containing both the predictive factors (i.e., features) and the relevant health outcomes (i.e., labels). Sometimes, when the health outcomes are not recorded in structured data, these are first extracted from textual notes using text mining techniques. Because there exist many studies utilizing text mining to obtain outcome data for prognostic model development, our aim is to study the impact of the text mining quality on downstream prognostic model performance. Methods: We conducted a simulation study charting the relationship between text mining quality and prognostic model performance using an illustrative case study about in-hospital mortality prediction in intensive care unit patients. We repeatedly developed and evaluated a prognostic model for in-hospital mortality, using outcome data extracted by multiple text mining models of varying quality. Results: Interestingly, we found in our case study that a relatively low-quality text mining model (F1 score ≈ 0.50) could already be used to train a prognostic model with quite good discrimination (area under the receiver operating characteristic curve of around 0.80). The calibration of the risks estimated by the prognostic model seemed unreliable across the majority of settings, even when text mining models were of relatively high quality (F1 ≈ 0.80). Discussion: Developing prognostic models on text-extracted outcomes using imperfect text mining models seems promising. However, it is likely that prognostic models developed using this approach may not produce well-calibrated risk estimates, and require recalibration in (possibly a smaller amount of) manually extracted outcome data.