⚡ STEAM Clinical Assertion

Find your clinical terms in a note and classify each mention's assertion status.

How it works — two steps

① Find the terms — word-anchored matching (~O(n)). Every term is located in a single linear pass over the note. Tokens are clinical-aware, so 1.5, p.o., mg/dl, and covid-19 stay intact and a term only matches whole tokens.

② Classify — STEAM BERT. Each located mention is then classified by the BERT model on five assertion axes (negated · certainty · realis · experiencer · temporality), which roll up to a single i2b2 assertion label.

i2b2 labels:

present absent possible hypothetical associated with someone else

① Clinical note (type or paste)

ADMISSION DATE: 03/14/2025
DISCHARGE DATE: 03/19/2025

CHIEF COMPLAINT: Chest pain and shortness of breath.

HISTORY OF PRESENT ILLNESS:
The patient is a 68-year-old man with a history of hypertension, hyperlipidemia, and type 2 diabetes mellitus who presented with substernal chest pressure radiating to the left arm, associated with diaphoresis and dyspnea on exertion. He denies syncope, palpitations, or lower extremity edema. Symptoms began approximately three hours prior to arrival while climbing stairs.

PAST MEDICAL HISTORY:
1. Hypertension.
2. Hyperlipidemia.
3. Type 2 diabetes mellitus.
4. Status post appendectomy.

FAMILY HISTORY:
Father died of myocardial infarction at age 60. Mother with breast cancer. No family history of stroke.

SOCIAL HISTORY:
Former smoker, quit 10 years ago. Denies alcohol or illicit drug use.

ALLERGIES: Penicillin (rash).

MEDICATIONS ON ADMISSION: Lisinopril, atorvastatin, metformin, aspirin.

PHYSICAL EXAMINATION:
Afebrile, blood pressure 158/92, heart rate 96. No jugular venous distention. Lungs clear to auscultation. Regular rate and rhythm without murmurs. No peripheral edema.

LABORATORY AND STUDIES:
Troponin elevated at 0.8. ECG with ST depressions in the lateral leads. Chest x-ray without acute infiltrate or pulmonary edema. Echocardiogram showed mild left ventricular hypertrophy and an ejection fraction of 50%.

HOSPITAL COURSE:
The patient was admitted with a non-ST elevation myocardial infarction. He was started on heparin and underwent cardiac catheterization, which revealed a 90% stenosis of the left anterior descending artery. A drug-eluting stent was placed and he was transitioned to clopidogrel. There was no evidence of heart failure during the admission.

DISCHARGE DIAGNOSIS: Non-ST elevation myocardial infarction.

DISCHARGE INSTRUCTIONS:
Return to the emergency department if you develop recurrent chest pain, shortness of breath, or palpitations. Start insulin if home glucose readings remain above 250.

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② Terms of interest

⚡ STEAM Clinical Assertion

How it works — two steps

Classified terms