Previously submitted to: JMIR Medical Informatics (no longer under consideration since Nov 03, 2026)
Date Submitted: Nov 2, 2026
Open Peer Review Period: Nov 3, 2026 - Nov 3, 2026
(closed for review but you can still tweet)
NOTE: This is an unreviewed Preprint
Warning: This is a unreviewed preprint (What is a preprint?). Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn (a note "no longer under consideration" will appear above).
Peer review me: Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period (in this case, a "Peer Review Me" button to sign up as reviewer is displayed above). All preprints currently open for review are listed here. Outside of the formal open peer-review period we encourage you to tweet about the preprint.
Citation: Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author).
Final version: If our system detects a final peer-reviewed "version of record" (VoR) published in any journal, a link to that VoR will appear below. Readers are then encourage to cite the VoR instead of this preprint.
Settings: If you are the author, you can login and change the preprint display settings, but the preprint URL/DOI is supposed to be stable and citable, so it should not be removed once posted.
Submit: To post your own preprint, simply submit to any JMIR journal, and choose the appropriate settings to expose your submitted version as preprint.
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Recorded Norepinephrine Restart Estimates in Intensive Care Databases: Retrospective Study of Episode Matching and Index Times
ABSTRACT
Background:
Electronic health records contain medication orders and infusion observations with different temporal meanings. Reconstructing a stopping event requires decisions about episode matching and the start of follow-up.
Objective:
To assess how event matching and follow-up origin affect norepinephrine stopping classifications and recorded restart estimates in intensive care databases.
Methods:
In this retrospective methodological study, we audited source-defined labels in MIMIC-IV, eICU and HiRID. We compared reciprocal maximum-overlap and terminal-overlap matching within common eICU stays, decomposed segment and clock contributions, and varied gap thresholds and pair-quality restrictions. Supplementary MIMIC-IV analyses masked pre-landmark stop evidence while keeping patients and follow-up constant. We estimated intervals using clustered bootstrap resampling.
Results:
Excluding single-observation segments and zero-duration overlaps before rematching retained 4,596 eICU stays from 52 hospitals. At the 120-minute threshold, 24-hour order-minus-infusion recorded restart contrasts were −28.18 and −11.23 percentage points under maximum-overlap and terminal-overlap matching. The between-policy change was 16.95 points (95% interval 14.97–18.95). Among 1,207 stays common to four gap thresholds, changes ranged from 2.57 to 24.11 points. In 11,384 MIMIC-IV stays at the 24-hour landmark, 30% episode-hash masking changed label prevalence by −12.47 points and the 28-day death risk-difference contrast by −0.47 points (−1.49 to 0.53).
Conclusions:
Matching and observation clocks changed recorded restart estimates within the same records. Segmentation defined both the index event and subsequent restart; neither policy was a clinical reference standard. Event definitions should specify segment construction, reciprocal matching and observation origin. These comparisons do not verify cessation or estimate withdrawal treatment effects. Changes in mortality estimates were small under the tested masks.
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.