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| 1 | +# Chartevents timing vs ICU stay windows |
| 2 | + |
| 3 | +Researchers often find `icu.chartevents.charttime` values **after** |
| 4 | +`icu.icustays.outtime` (or occasionally before `intime`). Large absolute counts |
| 5 | +are expected in the raw PhysioNet files and usually do **not** mean a broken |
| 6 | +`stay_id` join. |
| 7 | + |
| 8 | +See [issue #1961](https://github.com/MIT-LCP/mimic-code/issues/1961). |
| 9 | + |
| 10 | +## Why charttime can fall outside `[intime, outtime]` |
| 11 | + |
| 12 | +1. **Late charting.** Nurses and devices often document observations after the |
| 13 | + patient has left the ICU; the row still carries the ICU `stay_id`. |
| 14 | +2. **Device / interface clocks.** Bedside monitors and EHR interfaces may stamp |
| 15 | + times that disagree slightly with ADT `intime`/`outtime`. |
| 16 | +3. **Derived stay boundaries.** `icustays` windows are constructed from |
| 17 | + transfer / careunit logic; charted data is not clipped to those windows in |
| 18 | + the ETL that loads the CSV files. |
| 19 | + |
| 20 | +The public tables do not expose a "manual vs automatic" provenance flag for |
| 21 | +each `charttime`. |
| 22 | + |
| 23 | +## Practical guidance |
| 24 | + |
| 25 | +- Treat `icustays.intime` / `outtime` as the **administrative** ICU window. |
| 26 | +- For "in-ICU only" cohorts, filter explicitly, e.g. |
| 27 | + `charttime >= intime AND charttime <= outtime`, and report how many rows you |
| 28 | + dropped. |
| 29 | +- Prefer a sensitivity analysis that also keeps a short post-`outtime` grace |
| 30 | + period (e.g. 1–6 hours) when studying labs or vitals that are often charted |
| 31 | + late. |
| 32 | +- Do **not** rewrite `outtime` from the latest `charttime` inside the PhysioNet |
| 33 | + loaders — that belongs in a documented derived concept if you need it. |
| 34 | + |
| 35 | +## Related notes |
| 36 | + |
| 37 | +- ED module: `mimic-iv-ed/docs/TIMING_NOTES.md` (`edstays.intime` vs pyxis) |
| 38 | +- Lab / OMR unit caveats: `mimic-iv/buildmimic/TABLE_NOTES.md` when present |
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