# Diagnostic performance of essential tremor criteria in electronic health records: a retrospective neurology cohort study

## TL;DR

This study compares how well electronic health records identify essential tremor using two different diagnostic criteria, finding that accuracy improves with more clinical visits.

## Contribution

The study evaluates the diagnostic performance of EHR-based essential tremor coding against adjudicated criteria in real-world neurology practice.

## Key findings

- ET diagnostic coding showed high sensitivity and NPV across both criteria.
- Specificity and PPV improved with multiple clinical encounters.
- The 2018 criteria had lower specificity compared to the 1998 criteria.

## Abstract

The 2018 Movement Disorder Society criteria introduced stricter diagnostic requirements for essential tremor (ET) compared with the 1998 consensus; however, how electronic health record (EHR)–based ET diagnostic coding aligns with chart-adjudicated criteria in routine practice remains unclear. We evaluated the diagnostic performance of EHR-based ET coding relative to chart-adjudicated criteria in a US neurology practice.

We conducted a retrospective study within the Geisinger Health System in Pennsylvania. Patients with neurologist-assigned ET diagnoses were identified and stratified as ET-only or ET with differential diagnostic coding. A stratified random sample underwent manual chart review. Clinical features were mapped to both criteria after one and two visits. Accuracy metrics—sensitivity, specificity, sample-based positive predictive value (PPV), and sample-based negative predictive value (NPV)—were calculated with 95% confidence intervals.

The reviewed sample included 447 ET-only cases and 137 with differential. With one visit, the 1998 criteria yielded sensitivity of 96% (94–98%), specificity of 60% (53–67%), PPV of 82% (78–86%), and NPV of 88% (82–94%). The 2018 criteria demonstrated similar sensitivity (96%, 94–98%) but lower specificity (38%, 32–44%) and PPV of 53% (48–58%), with NPV of 93% (88–98%). With ≥2 visits, specificity increased to 71% (61–81%) and PPV to 85% (80–90%) for the 1998 criteria, and to 51% (43–59%) and 65% (57–71%) for the 2018 criteria.

In this cohort, ET diagnostic coding showed consistently high sensitivity and NPV across frameworks. Specificity and PPV differed by criterion and improved with multiple clinical encounters.