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第 13 課:死亡、EPISODE 和 EPISODE_EVENT

記錄死亡 (DEATH)、長期疾病過程(EPISODE — 新 CDM 5.4),例如癌症治療,以及發作中的相關事件 (EPISODE_EVENT)。

🏗️ 建築 — 第 13 課 死亡,情節 &EPISODE_EVENT 初學者的 OMOP CDM 5.4 — 從頭到尾了解 第 4 部分:擴展臨床表 亞洲開發網

簡介

臨床資料組中的最後三個表:DEATH 記錄死亡事件,EPISODE(CDM 5.4 中的新增功能)記錄長期臨床/治療進展,EPISODE_EVENT 連結一次發作中的事件。 EPISODE 是 CDM 5.4 中最引人注目的補充,對於癌症研究尤其重要。


1. DEATH — 死亡記錄

1.1。表結構

專欄類型必填說明
person_id整數✅ PK/FK患者(1 筆記錄/患者)
death_date日期✅死亡日期
death_datetime日期時間死亡日期和時間
death_type_concept_id整數✅資料來源
cause_concept_id整數死亡原因 (SNOMED)
cause_source_valueVARCHAR(50)原廠ICD
cause_source_concept_id整數原創概念

1.2。重要特徵

  • 每人 1 個唯一記錄 — 如果有多個來源,請選擇最值得信賴的來源
  • person_id既是PK又是FK→沒有自己的death_id
  • cause_concept_id:使用 SNOMED 作為主要原因

1.3。死亡類型概念 ID

概念 ID來源描述
3281732817電子病歷從 HIS 記錄
32810索賠社保資料
32885死亡證明死亡證明
32886全國死亡指數國家登記冊

1.4。例如

-- BN tử vong do nhồi máu cơ tim cấp
INSERT INTO death (
    person_id, death_date,
    death_type_concept_id,
    cause_concept_id,
    cause_source_value,
    cause_source_concept_id
) VALUES (
    100001, '2024-06-20',
    32885,                        -- Death certificate
    4329847,                      -- SNOMED: AMI
    'I21.9',                      -- ICD-10
    45572161                      -- ICD10CM concept
);

1.5。 SQL分析

-- Top 10 nguyên nhân tử vong
SELECT
    c.concept_name AS cause_of_death,
    COUNT(*) AS death_count,
    ROUND(COUNT(*) * 100.0 / SUM(COUNT(*)) OVER(), 1) AS pct
FROM death d
JOIN concept c ON d.cause_concept_id = c.concept_id
WHERE d.cause_concept_id != 0
GROUP BY c.concept_name
ORDER BY death_count DESC
LIMIT 10;

-- Tỉ lệ tử vong sau nhập viện ICU
SELECT
    ROUND(
        COUNT(DISTINCT d.person_id) * 100.0 /
        NULLIF(COUNT(DISTINCT v.person_id), 0), 1
    ) AS mortality_rate_pct
FROM visit_occurrence v
LEFT JOIN death d ON v.person_id = d.person_id
    AND d.death_date BETWEEN v.visit_start_date
    AND v.visit_start_date + INTERVAL '30 days'
WHERE v.visit_concept_id = 32037;  -- ICU visit

2. 情節 — 病理過程(新 CDM 5.4)

2.1。為什麼我們需要劇集?

在 CDM 5.4 之前,無法表示「癌症治療過程」—事件(診斷、化療、放療、手術)分散在多個表格中。 EPISODE將它們組合成一個完整的「故事」。

  Trước CDM 5.4:

  CONDITION: Ung thư phổi ─────────── (rời rạc)
  PROCEDURE: Sinh thiết phổi ────────── (rời rạc)
  DRUG:      Cisplatin cycle 1 ──────── (rời rạc)
  DRUG:      Cisplatin cycle 2 ──────── (rời rạc)
  PROCEDURE: Phẫu thuật cắt thùy phổi ─ (rời rạc)

  Sau CDM 5.4:

  EPISODE: "Điều trị ung thư phổi giai đoạn 3"
       │
       ├── EPISODE_EVENT → CONDITION (chẩn đoán)
       ├── EPISODE_EVENT → PROCEDURE (sinh thiết)
       ├── EPISODE_EVENT → DRUG (hóa trị cycle 1)
       ├── EPISODE_EVENT → DRUG (hóa trị cycle 2)
       └── EPISODE_EVENT → PROCEDURE (phẫu thuật)

2.2。 EPISODE表結構

專欄類型必填說明
episode_id大智✅ PK唯一ID
person_id整數✅ FK病人
episode_concept_id整數✅劇集類型
episode_start_date日期✅開始日期
episode_start_datetime日期時間
episode_end_date日期結束日期
episode_end_datetime日期時間
episode_parent_id大智劇集父級(層次結構)
episode_number整數序號
episode_object_concept_id整數✅劇集物件
episode_type_concept_id整數✅資料來源
episode_source_valueVARCHAR(50)原始碼
episode_source_concept_id整數

2.3。 Episode_concept_id — 劇集類型

概念 ID剧集类型示例
3252832528疾病首次出現首次發現肺癌
3252932529疾病復發癌症復發
3253132531治療方案順鉑-依托泊苷方案
3253232532治療週期週期 1、週期 2...

2.4。例如:肺癌治療

-- Episode cha: Bệnh ung thư phổi
INSERT INTO episode (
    episode_id, person_id,
    episode_concept_id,
    episode_start_date, episode_end_date,
    episode_parent_id,
    episode_object_concept_id,
    episode_type_concept_id
) VALUES (
    200001, 100001,
    32528,                            -- Disease first occurrence
    '2024-01-15', NULL,               -- Chưa kết thúc
    NULL,                             -- Không có cha
    4311499,                          -- SNOMED: Lung cancer
    32817                             -- EHR
);

-- Episode con: Phác đồ hóa trị
INSERT INTO episode (
    episode_id, person_id,
    episode_concept_id,
    episode_start_date, episode_end_date,
    episode_parent_id,
    episode_number,
    episode_object_concept_id,
    episode_type_concept_id
) VALUES (
    200002, 100001,
    32531,                            -- Treatment regimen
    '2024-02-01', '2024-06-30',
    200001,                           -- Thuộc episode ung thư phổi
    1,
    35804410,                         -- Cisplatin regimen
    32817
);

-- Episode con: Cycle 1
INSERT INTO episode (
    episode_id, person_id,
    episode_concept_id,
    episode_start_date, episode_end_date,
    episode_parent_id,
    episode_number,
    episode_object_concept_id,
    episode_type_concept_id
) VALUES (
    200003, 100001,
    32532,                            -- Treatment cycle
    '2024-02-01', '2024-02-21',
    200002,                           -- Thuộc phác đồ
    1,                                -- Cycle 1
    35804410,
    32817
);

3. EPISODE_EVENT — 事件綁定

3.1。表結構

專欄類型必填說明
episode_id大智✅ FK劇集
event_id大智✅事件 ID
episode_event_field_concept_id整数✅包含事件的表

3.2。 Episode_event_field_concept_id

概念 ID事件表
11471271147127條件發生。條件發生_id
11470941147094 drug_exposure.drug_exposure_id
11470821147082 procedure_occurrence.procedure_occurrence_id
1147138測量.measurement_id
11471651147165 device_exposure.device_exposure_id

3.3。例如:将事件附加到周期 1

-- Chẩn đoán ung thư → Episode chẩn đoán
INSERT INTO episode_event VALUES (
    200001,                           -- Episode: lung cancer
    70010,                            -- condition_occurrence_id
    1147127                           -- condition_occurrence table
);

-- Hóa trị Cisplatin → Episode Cycle 1
INSERT INTO episode_event VALUES (
    200003,                           -- Episode: Cycle 1
    80010,                            -- drug_exposure_id (Cisplatin)
    1147094                           -- drug_exposure table
);

-- XN máu trước hóa trị → Episode Cycle 1
INSERT INTO episode_event VALUES (
    200003,
    110020,                           -- measurement_id (CBC)
    1147138                           -- measurement table
);

4. EPISODE在研究中的应用

-- Tìm BN ung thư phổi có >= 4 cycle hóa trị
SELECT
    e_disease.person_id,
    c_disease.concept_name AS cancer_type,
    COUNT(e_cycle.episode_id) AS total_cycles
FROM episode e_disease
JOIN concept c_disease
    ON e_disease.episode_object_concept_id = c_disease.concept_id
JOIN episode e_regimen
    ON e_disease.episode_id = e_regimen.episode_parent_id
    AND e_regimen.episode_concept_id = 32531  -- Treatment regimen
JOIN episode e_cycle
    ON e_regimen.episode_id = e_cycle.episode_parent_id
    AND e_cycle.episode_concept_id = 32532    -- Treatment cycle
WHERE e_disease.episode_concept_id = 32528    -- First occurrence
  AND c_disease.concept_id = 4311499          -- Lung cancer
GROUP BY e_disease.person_id, c_disease.concept_name
HAVING COUNT(e_cycle.episode_id) >= 4;

-- Timeline điều trị 1 BN
SELECT
    e.episode_number,
    ec.concept_name AS episode_type,
    e.episode_start_date,
    e.episode_end_date,
    oc.concept_name AS episode_object
FROM episode e
JOIN concept ec ON e.episode_concept_id = ec.concept_id
JOIN concept oc ON e.episode_object_concept_id = oc.concept_id
WHERE e.person_id = 100001
ORDER BY e.episode_start_date, e.episode_number;

總結

  1. 死亡:1 筆記錄/人,使用 SNOMED 確定死亡原因
  2. EPISODE(新CDM 5.4):病理/治療過程,親子層次結構支持
  3. EPISODE_EVENT:將多個表中的事件連結到劇集
  4. EPISODE 主要針對腫瘤學設計,但適用於所有慢性疾病
  5. 結構:疾病→治療方案→治療週期→事件

**下一篇:**開始第5部分-標準化詞彙,標準化字典系統。


參考文獻