Syndrome Definitions Group 2-11-15
Meetings occur monthly on the second Wednesday of the month, 12pm eastern time
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Functional requirements gathering – ranking of priority issues to be fixed
o http://communityforum.syndromic.org/group/biosense-usergroup/forum/topic/show?id=4480672%3ATopic%3A25035&xg_source=msg
Syndrome Definitions Purpose: Discuss data processing for syndrome operation and review
current syndromes
Governance Group suggested objectives
Recommendations about
changes to how the system
manages and analyzes the fields
used to define syndromes
Regarding syndrome construction and query function: Query both by chief
complaint and diagnosis, as well as both fields in combination. Flexibility to
design own query using operators (and/or)
 Looking at chief complaint and diagnosis independently is desirable.
Mixing the two together may water things down. The two fields can
be queried for different purposes.
 Utility in retaining the ability to combine the fields. Useful for
casting a wide net (such as codes and chief complaint for injury/non
specific syndromes). Would want to keep fields separate but query
both and de-duplicate results.
 For those diseases that do not have definitive diagnosis at ED visits,
such as meningitis, it may be necessary to create a query of visits
with chief complaints or diagnosis of fever, headache, and neck
pain. The best data source for a query depends on how the facility
provides information.
Regarding chief complaint construction: Triage notes can be useful, but they
are a long string. It requires a lot of exclusions to extract something
significant. If this were to be used in the syndromes, it would complicate
developing syndrome criteria. Having triage notes as a field to query
independently would be a better option.
Creation of criteria for
syndrome group qualification
and/or a list of recommended
priority syndromes with
definitions
ACTION ITEM: Participants to review the current syndromes and
recommend those that are priority to keep or need to be added.
ACTION ITEM: Develop criteria for syndrome group qualification
 Syndromes that are too broad: They include too many visits, do not
have clear follow up, and the reviewer misses things because they
cannot sift through it all
 Syndromes with low volume of visits – not correctly capturing visits,
debatable utility
 Syndromes with a high propensity for misclassification (such as
hemorrhagic illness including any visit mentioning bleeding)
 Keep those that are used daily (ILI, GI, injury), reportable
conditions, conditions of interest (Ebola, MERS, anthrax), weather
and seasonal (cold, heat, CO exposure), and emergency (chemical
exposure)
Recommended methods for
determination of the sensitivity
and specificity of syndromes and
criteria for selection.
ACTION ITEM: Participants to suggest sensitivity and specificity criteria for
syndromes
 Gold standard – observe diagnosis code that validates the chief
complaint. Look for codes that meet the criteria of text value. For
example when validating acute respiratory illness (ARI) want to
confirm that visits captured by the syndrome show a diagnosis of
fever or cough.
 Reference literature to validate changes to inclusion/exclusion
criteria. Again in the example of ARI, it has been noted that
bronchitis lab results are connected to cases of flu. This lends
support to including bronchitis as a chief complaint or diagnosis
term in an ARI syndrome.
If completed by the working
group, finalized syndromes for
change or incorporation within
BioSense Platform.
Participants are needed to address the Governance Group objectives and action items above. Please
sign up to work on at least one topic. Work group members who do not volunteer by the next call on
March 11th will be assigned a topic.
Please reach out with any revisions to the notes, or questions or comments.
Contact information:
Amanda Wahnich
Amanda.wahnich@vdh.virginia.gov
804-864-7760