NICC Creates Pathway to Update Chief Complaint


We are continually updating our processes. The addition of NICCs, which stands for non-informative chief complaints, creates a pathway for ensuring that our systems don't retain non-helpful information when better clinical data become available.

NICC update

Community of Practice Technical Committee tackles a challenging issue

The NSSP Data Dictionary includes the term NICC, which is such a useful part of the NSSP vocabulary that it deserves thorough explanation. NICC stands for non-informative chief complaint. For background, sometimes NSSP receives chief complaint terms that are not informative. By "not informative," we mean that although the chief complaint may have a non-null value, the value itself may add negligible, if any, value to syndromic surveillance. For example, a chief complaint value of "unknown" is not informative.

Early versions of NSSP–ESSENCE would ingest and store the first non-null chief complaint value sent for a visit, regardless of the value of the chief complaint itself. For example, if the first non-null chief complaint was "unknown," then ESSENCE's chiefcomplaintorig and chiefcomplaintparsed columns would retain the value "unknown" despite receiving additional or more informative chief complaint data for that visit.

Further, using the same example, the DD portion of CCDD would also have "unknown." This was problematic because there may have been more informative chief complaint data reported for a visit but not reflected in ESSENCE chief complaint fields (including CCDD) and, thus, not considered in some CCDD categories.

The NSSP Community of Practice Technical Committee compiled a list of commonly used NICC terms. (See NICC Terminology table below.) The Technical Committee recommended that NSSP consider alternate processing rules when ingesting chief complaint data into ESSENCE. These processing rules would account for the possibility of a NICC term being reported as the first non-null chief complaint and the subsequent informative chief complaints not being leveraged. On the basis of this recommendation, the NSSP–ESSENCE ingestion process was modified.

The NSSP ingestion process continues to use the first non-null chief complaint during ingestion, even if the first non-null is a NICC. However, the current processing will "overwrite" a NICC chief complaint when a subsequent informative chief complaint is reported (in other words, a chief complaint value that is not on the NICC list).

Did you know?‎

The history field for chief complaint (chiefcomplaintupdates) will store all chief complaints reported, including those terms considered non-informative, or "NICC." So, you will be able to see those visits that did have a NICC at some point in the history of all chief complaints reported.

Let's take an example of several messages and records associated with the same visit (ESSENCEID). Notice the ChiefComplaintOrig values reflected in the data reported in the messages. The first non-null is a NICC value: "Chief Complaint Not Present." However, other messages following this first message contain chief complaint data that are more informative.

Several messages and records associated with the same visit (ESSENCEID)
rowid messagedatetime ChiefComplaintOrig
94033777 2018-10-15 09:36:39.000 Chief Complaint Not Present
94033774 2018-10-15 09:36:59.000 Chief Complaint Not Present
94647080 2018-10-15 09:59:10.000 NULL
94647082 2018-10-15 09:59:10.000 NULL
94647076 2018-10-15 09:59:50.000 NULL
94647077 2018-10-15 09:59:50.000 NULL
94647079 2018-10-15 11:25:02.000 Kidney Infection
94647083 2018-10-15 11:25:02.000 Kidney Infection
94647078 2018-10-15 11:27:47.000 Kidney Infection
94647081 2018-10-15 11:27:47.000 Kidney Infection
94033776 2018-10-15 16:00:56.000 Chest Pain
94033775 2018-10-15 16:41:36.000 Chest Pain

How ESSENCE processed these data before the enhancement

Here's what a collapsed "one row" of data in ESSENCE looked like with the original processing rules:

ChiefComplaintOrig                ChiefComplaintUpdates                                                                 
Chief Complaint Not Present   {1};Chief Complaint Not Present;|{2};;|{3};Kidney Infection;|{4};Chest Pain

Notice the non-informative value, being the first non-null value, is used as the chief complaint.

How does ESSENCE process these data now?

Here’s what the collapsed “one row” of data in ESSENCE looks like with our new processing rules:

ChiefComplaintOrig                ChiefComplaintUpdates                                                                 
Kidney Infection                      {1};Chief Complaint Not Present;|{2};;|{3};Kidney Infection;|{4};Chest Pain

Notice the non-informative value is now overwritten with the subsequently reported informative value.

NICC Terminology
NICC Terminology
1 “” 12 other 23 Ambulance 34 Sick
2 null 13 xxx 24 EMS/Arrive by 35 Evaluation
3 unknown 14 Evaluation 25 EMS/Ambulance 36 Injury
4 unknown 15 Follow up 26 ; 37 ill
5 n/a 16 medical 27 ;; 38 Eval
6 na 17 illness 28 Triage 39 squad
7 Chief complaint not present 18 General 29 Triage peds 40 referral
8 ed visit 19 General Symptom 30 Triage- 41 Code 1
9 ed visit 20 EMS 31 Triage peds- 42 Code 3
10 er 21 AMR 32 See chief complaint quote
11 Advice only 22 medical 33 See CC quote