Disaster and Terrorism/Brief Research Report
Syndromic analysis of computerized emergency department patients' chief complaints: An opportunity for bioterrorism and influenza surveillance*,**,*

Presented at the Society for Academic Emergency Medicine annual meeting, St. Louis, MO, May 2002.
https://doi.org/10.1067/mem.2003.104Get rights and content

Abstract

Study objective: Emergency department computerized triage logs might be useful for automated ED surveillance and potentially for early identification of bioterrorism events. We describe a Web-based surveillance program and its feasibility for surveillance. Methods: A Web-based surveillance program that receives computerized chief complaint data daily from a large academic urban teaching hospital and performs syndromic analysis on these data was developed. On the basis of preset limits, the Web-based surveillance program sends an alert e-mail message when the syndromic analysis reveals an increase in the number of patients in predefined symptom groups. The feasibility of this system was tested by using historical data during an influenza outbreak (December 1999 to January 2000) and applying the anthrax symptom group. Results: The Web-based surveillance program identified the influenza outbreak in the first week. Conclusion: Computerized triage logs might be a feasible method for bioterrorism and influenza surveillance. The Web-based nature of the surveillance program creates the opportunity for other hospitals to contribute data, potentially resulting in an automated network of ED computerized triage log surveillance. [Ann Emerg Med. 2003;41:447-452.]

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.

Section snippets

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.

Figure. Anthrax chief complaint group and influenza outbreak from 1999 to 2000. Stars signify an alert on December 7, 1999, and a false alert on February 27, 2000. The dotted line signifies the approximate duration of the influenza outbreak.

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.

**

Supported by a grant from the St. John Hospital and Medical Center Biomedical Investigation Committee.

*

Reprints not available from the authors.

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