The validity of chief complaint and discharge diagnosis in emergency department-based syndromic surveillance.
Acad Emerg Med
; 11(12): 1262-7, 2004 Dec.
Article
em En
| MEDLINE
| ID: mdl-15576514
ABSTRACT
OBJECTIVE:
Emergency department (ED)-based syndromic surveillance systems are being used by public health departments to monitor for outbreaks of infectious diseases, including bioterrorism; however, few systems have been validated. The authors evaluated a "drop-in" syndromic surveillance system by comparing syndrome categorization in the ED with chief complaints and ED discharge diagnoses from medical record review.METHODS:
A surveillance form was completed for each ED visit at 15 participating Arizona hospitals between October 27 and November 18, 2001. Each patient visit was assigned one of ten clinical syndromes or "none." For six of 15 EDs, kappa statistics were used to compare syndrome agreement between surveillance forms and syndrome categorization with chief complaint and ED discharge diagnosis from medical record review.RESULTS:
Overall, agreement between surveillance forms and ED discharge diagnoses (kappa = 0.55; 95% confidence interval [CI] = 0.52 to 0.59) was significantly higher than between surveillance forms and chief complaints (kappa = 0.48; 95% CI = 0.44 to 0.52). Agreement between chief complaints and ED discharge diagnoses was poor for respiratory tract infection with fever (kappa = 0.33; 95% CI = 0.27 to 0.39). Furthermore, pediatric chief complaints showed lower agreement for respiratory tract infection with fever when compared with adults (kappa = 0.34 [95% CI = 0.20 to 0.47] vs. kappa = 0.44 [95% CI = 0.28 to 0.59], respectively).CONCLUSIONS:
In general, this syndromic surveillance system classified patients into appropriate syndrome categories with fair to good agreement compared with chief complaints and discharge diagnoses. The present findings suggest that use of ED discharge diagnoses, in addition to or instead of chief complaints, may increase surveillance validity for both automated and drop-in syndromic surveillance systems.
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Base de dados:
MEDLINE
Assunto principal:
Alta do Paciente
/
Vigilância da População
/
Doenças Transmissíveis
/
Serviço Hospitalar de Emergência
Tipo de estudo:
Diagnostic_studies
/
Evaluation_studies
/
Screening_studies
Limite:
Adult
/
Child
/
Humans
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Acad Emerg Med
Assunto da revista:
MEDICINA DE EMERGENCIA
Ano de publicação:
2004
Tipo de documento:
Article
País de afiliação:
Estados Unidos