Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Aug;75(8):1821-1829.
doi: 10.1002/acr.25061. Epub 2023 Feb 19.

Development and Validation of an Emergency Department Electronic Medical Record Gout Flare Alert

Lesley E Jackson  1 , Narender Annapureddy  2 , Megan E Hansen  2 , Kenneth G Saag  1 , James Booth  1 , Giovanna Rosas  1 , Phillip J Foster  1 , Amy Mudano  1 , Dongmei Sun  1 , John D Osborne  1 , Tim Bongartz  2 , Erik Hess  2 , Colleen Lawrence  2 , Leah Dunkel  2 , Maria I Danila  3
Affiliations

Development and Validation of an Emergency Department Electronic Medical Record Gout Flare Alert

Lesley E Jackson et al. Arthritis Care Res (Hoboken). 2023 Aug.

Abstract

Objective: Patients with acute gout are frequently treated in the emergency department (ED) and represent a typically underresourced and understudied population. A key limitation for gout research in the ED is the timely ability to identify acute gout patients. Our goal was to refine a multicriteria, electronic medical record alert for gout flares and to determine its diagnostic characteristics in the ED.

Methods: The gout flare alert used electronic medical record data from ED nursing notes and was triggered by the term 'gout' preceding past medical history in the chief complaint, the term 'gout' and a musculoskeletal problem in the chief complaint, or the term 'gout' in the problem list and a musculoskeletal chief complaint. We validated its diagnostic properties to assess presence/absence of gout through manual medical record review using adjudicated expert consensus as the gold standard.

Results: In January 2020, we analyzed 202 patient records from 2 university-based EDs; from these records, 57 patients were identified by our gout flare alert, and 145 were identified by other means as potentially having an acute gout flare. The gout flare alert's positive predictive value was 47% (95% confidence interval [95% CI] 34-60%), negative predictive value was 94% (95% CI 90-98%), sensitivity was 75% (95% CI 61-89%), and specificity was 82% (95% CI 76-88%). The diagnostic properties were similar at both institutions.

Conclusion: Our multicomponent gout flare alert had reasonable sensitivity and specificity, albeit a modest positive predictive value. An electronic gout flare alert may help enable the conduct of gout research in the ED setting.

PubMed Disclaimer

Conflict of interest statement

Declarations of Interests: None

Figures

Figure 1.
Figure 1.
Patient selection for development and validation of electronic medical record (EMR) gout flare alert. All UAB and VUMC Emergency Department (ED) patients from January 2020 were retrospectively screened for the presence of an acute gout flare based on symptoms and other clinical parameters. Following expert medical record review of all charts for determination of acute gout flare, the alert characteristics were calculated. UAB, University of Alabama at Birmingham; VUMC, Vanderbilt University Medical Center; ED, emergency department; Y, yes; N, no. † flare symptoms included the presence of the term ‘gout’ listed prior to the past medical history in the chief complaint, the presence of both the term ‘gout’ and a musculoskeletal location listed anywhere in the chief complaint, or the presence of the term ‘gout’ in the problem list in conjunction with the presence of a musculoskeletal location in the chief complaint or listed in the structured nursing form. *expert medical record review by two rheumatologists represented the gold standard for diagnosis of acute gout flare
See this image and copyright information in PMC

References

    1. Elfishawi MM, Zleik N, Kvrgic Z, Michet CJ Jr., , Crowson CS, Matteson EL, et al. The Rising Incidence of Gout and the Increasing Burden of Comorbidities: A Population-based Study over 20 Years. The Journal of rheumatology. 2018;45(4):574–9. - PMC - PubMed
    1. Pisaniello HL, Lester S, Gonzalez-Chica D, Stocks N, Longo M, Sharplin GR, et al. Gout prevalence and predictors of urate-lowering therapy use: results from a population-based study. Arthritis Res Ther. 2018;20(1):143. - PMC - PubMed
    1. Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007–2008. Arthritis and rheumatism. 2011;63(10):3136–41. - PubMed
    1. Choi HK, Niu J, Neogi T, Chen CA, Chaisson C, Hunter D, et al. Nocturnal risk of gout attacks. Arthritis Rheumatol. 2015;67(2):555–62. - PMC - PubMed
    1. Singh JA, Hodges JS, Toscano JP, Asch SM. Quality of care for gout in the US needs improvement. Arthritis and rheumatism. 2007;57(5):822–9. - PMC - PubMed

Publication types