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Evaluation and Validity of Chief Complaints and
Discharge Diagnoses in a Drop-In Syndromic Surveillance System
Aaron T. Fleischauer,1 B.
Silk,2 M. Schumacher,3 K. Komatsu,4 S. Santana,3 V. Vaz,4 M. Wolfe,5 L. Hutwagner,
1 J. Cono,1 R. Berkelman,2 T. Treadwell1
1Bioterrorism Preparedness and Response Program, National Center for Infectious Diseases, CDC; 2Emory University, Atlanta, Georgia;
3Maricopa County Department of Public Health, Phoenix, Arizona;
4Arizona Department of Health Services, Phoenix, Arizona;
5Division of HIV/AIDS Prevention,
National Center for HIV, STD, and TB Prevention, CDC
Corresponding author: Aaron T. Fleischauer, Bioterrorism Preparedness and Response Program, National Center for Infectious Diseases, CDC, 1600 Clifton Rd, MS C-18, Atlanta, GA 30308. Telephone: 404-634-3995; Fax: 404-639-0382; E-mail:
alf6@cdc.gov.
Abstract
Introduction: Syndromic surveillance systems are being explored to determine their capacity to detect
outbreaks, including those caused by biologic or chemical terrorism. However, few systems have been validated.
Objectives: This study evaluated a syndromic surveillance system by comparing syndrome categorization in the emergency department (ED) with medical chart review.
Methods: During October 27--November 18, 2001, a surveillance form was completed for each ED visit at
15 participating Arizona hospitals. One of 10 clinical syndromes or "none" was selected per patient to best represent the patient's primary condition. Medical records were reviewed for a weighted, random sample of 16,886
available forms. ED chief complaints and discharge diagnoses were abstracted as standards to compare with surveillance forms. Clinicians assessed concordance between the selected syndromes and standards.
Results: Of 1,956 patient records from six selected hospitals, 1,646 (85%) indicated either one syndrome or none, and 313 (15%) were blank. Overall, system concordance was 71% and 85% when using chief complaint and
ED discharge diagnosis, respectively. Discharge diagnosis outperformed chief complaint in the overall system (+14%) and within syndromes (range: 0%--65%). Concordance of
respiratory tract infection with fever for chief
complaint was low (27%) compared with its concordance with ED discharge diagnosis (83%). Similarly, concordance of chief complaint was low for sepsis (6%),
rash with fever (24%), and myalgia with
fever (40%).
Conclusions: This ED-based syndromic surveillance system was able to classify patients into an
appropriate syndrome category rapidly and with accuracy. However, syndromic surveillance systems might perform better when based on ED discharge diagnosis in addition to or instead of chief complaint.
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