Characterizing shared and distinct symptom clusters in common chronic conditions through natural language processing of nursing notes.

The study only used nursing notes, so symptoms documented by physicians, therapists, structured checklists, labs, or medications were not included. A symptom was counted as absent if it was not documented or was negated, so missing notes may mean the symptom was not assessed, not that the patient did not have it. The natural language tool made labeling errors, especially with negation, and the team corrected some of these after the fact. The analysis recorded only whether a symptom was documented at least once in a calendar year, not how severe, frequent, distressing, or persistent it was. Patients could have more than one chronic condition, and comorbidities and sociodemographic factors were not controlled. Pediatric, obstetric, and operating room notes were excluded, and some low-frequency or education-focused notes were removed.

The authors declared no conflicts of interest. The paper is listed as receiving NIH extramural research support.

Do not treat a symptom as absent because it is not documented in a nursing note. The study counted only symptoms written in nursing notes, and some symptoms may have been unreported, unassessed, or documented elsewhere.