Disaster and Terrorism/Brief Research ReportSyndromic analysis of computerized emergency department patients' chief complaints: An opportunity for bioterrorism and influenza surveillance*,**,*
Introduction
Even before the events of September 11, 2001, there were concerns about our ability to detect and respond to bioterrorism events in our homeland.1 Current surveillance systems that rely on laboratory reporting do not provide the daily surveillance that is necessary to quickly identify a bioterrorism event. In the ideal surveillance system, data would be collected and evaluated the same day. Early detection of any bioterrorism event is imperative to respond quickly and appropriately and to maximize survivors.
Syndromic analysis of computerized emergency department patients' chief complaints might be a cost-effective method of surveillance. It would offer the advantage of rapid implementation (all hospitals are required to keep a triage log and could computerize data entry) and would have the potential to expand into a regional system of surveillance.
To investigate the potential of syndromic analysis of computerized ED patients' chief complaints for terrorism surveillance, we developed and tested such a program. The objective of this study is to describe this surveillance system and to evaluate its effectiveness for bioterrorism surveillance.
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Materials and methods
This study was conducted at a large urban teaching hospital with 78,000 annual visits. The study was ruled exempt by our institutional review board. It was conducted in 2 phases: First was the program development phase, and second was a feasibility test for using this type of surveillance.
The Web-based surveillance program (St. John Surveillance System, Charles Irvin, MD, St. John Hospital, Detroit, MI) was written with Java and SQL on the Linux open source operating system (www.linux.com ). It
Results
The Figure reveals the results of applying the anthrax chief complaint group to the time period of September 15, 1999, to March 15, 2000.Although only the absolute number of patients seen in the anthrax chief complaint groups was used in the analysis, the
Discussion
Evaluating the potential of using EDs for public health surveillance is not new.8 The ED is recognized as being on the front line for terrorism detection and surveillance.8 Previously evaluated methods have problems ranging from lack of cost effectiveness (manual data extraction9) to lack of timeliness (using billing data requires time before the chart is coded for billing purpose10).
Use of ED patients' chief complaints might be a means for surveillance. All hospitals are required by law to
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The authors report they have no financial interest in the products described in the article or the companies that produce them.
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Supported by a grant from the St. John Hospital and Medical Center Biomedical Investigation Committee.
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Reprints not available from the authors.