generating consensus syndrome case definitions
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Generating Consensus Syndrome Case Definitions. September 24-25, 2007 Pittsburgh, PA. Hosted by Wendy Chapman and John DowlingFunded by ISDS. - PowerPoint PPT PresentationTRANSCRIPT
Generating Consensus Syndrome Case Definitions
September 24-25, 2007Pittsburgh, PA
Hosted by Wendy Chapman and John Dowling Funded by ISDS
ObjectiveGenerate explicit consensus
syndrome definitions based on current syndromic surveillance
practice
RespiratoryGastrointestinal
Fever/Constitutional/ILI
Overview
• Purpose of meeting
• Baseline consensus syndromes
• Coming to Consensus
• Consensus Definitions
• Future goals
Clinical Condition experienced by a patient
Complaint Classifier
Syndrome CategoryClinical Condition Concept
(Preprocess)Classify
Cough (C00529)Headache (C00421)
RespiratoryNeurological
Admission complaint
“cough/headache”
Purpose of Meeting
Purpose of Meeting
Aim 1
• Catalogue and characterize existing chief complaint classifiers and the syndromic categories they map to
Aim 2
• Develop consensus syndrome categories and definitions, using the catalogue of existing definitions as a starting point
Possible Uses for Standardized Consensus Syndromic Definitions
Research
• Compare chief complaint classifiers against each other using standard definitions
• Generate a list of clinical conditions important for surveillance– Target for NLP systems to extract from reports
• Generate a standardized list of conditions that can be validated for predictive power
• Develop a set of chief complaints with standardized annotations for research and development
Public Health
• Provide a catalogue of what real systems across the country are surveilling
• Provide a benchmark for comparing different syndrome definitions against each other
– Examination
– Research/validation studies
Consensus Syndrome Definitions
Generating Consensus Syndromes
• Compiled syndrome definitions from ten surveillance systems
– Clinical conditions mapped to syndromes
• Counted how many times each condition occurred with each syndrome
• Removed conditions that did not meet inclusion criteria
• Discussed
– which syndromes to include in reference
– which clinical conditions comprise each syndrome
Before the meeting
Characterize Currently Used Syndromic Definitions
1. Collated condition-syndrome maps for 10 syndromic surveillance systems– RODS– BioPortal (Arizona)– Seattle, King County– Biosense– NCDetect– Aegis (Harvard)– Essence– New York State– Boston Public Health Dept– New York City
2. Created a union of all syndromes(Respiratory, GI, Fever/Constitutional/ILI, Neurological)
• Merged identical syndromes together
System 1: Respiratory
System 2: Respiratory, Upper Resp, Lower Resp
System 3: Respiratory
Resp U Resp L Resp
18 unique syndromes
• Conditions can be signs, symptoms, findings, or diagnoses
• Conditions should comprise a single problem
– Cough—not cough/SOB
• Conditions should be those that a patient may present with at an acute care visit
• Conditions should be reasonably described in admit complaints
• Conditions should be directly related to the organ system
Inclusion Criteria for Clinical Conditions
3. Filtered and sorted clinical conditions indicating each syndrome
• From an initial list of 91 conditionsCCC-EDS (Thompson)• If anyone used condition
• Keep the condition in current list
• For additional conditions• If condition did not exist in current list
• Add new condition OR• Leave condition out
Added: BronchitisInfluenzaChillsPleural effusion
Why: Signs, symptoms not in CCC-EDSGeneral diagnoses
3. Filtered and sorted clinical conditions indicating each syndrome
• Created an initial list of 91 conditionsCCC-EDS (Thompson)• If anyone used condition
• Keep the condition in current list
• For additional conditions• If condition did not exist in current list
• Add new condition OR• Leave condition out
Not Added: Crohn’s Disease
DiverticulitisPulmonaryInfection
Why: Specific diagnosesBroad bins
Title Resp U Resp L Resp
APNEA 2
ASTHMA ATTACK 2 1
BREATHING DIFFICULTY (DYSPNEA) 2 1
BRUISE
CARDIORESPIRATORY ARREST 2 1
CHEST PAIN 1
COUGH 3 1
COUGHING UP BLOOD (HEMOPTYSIS) 3 1
CROUP 3 1
59 of 91 CCC-EDS conditions were used
78 new conditions added
31 conditions considered synonyms (not added)
36 additional conditions not added
136 total conditions
4. Counted frequency of each condition for each syndrome in combined list
Maximum Frequency
10 – Respiratorycough, breathing difficulty, coughing up
blood
Number of Singletons
128
Coming to Consensus on Reference Syndrome Definitions
Pittsburgh MeetingSeptember 24-25, 2007
• 18 participants
– 13 attended
• Set guidelines for syndrome definition generation
– purpose for syndrome definitions
• Viewed baseline syndromes
• Argued about
– Which syndromes to include
– Which conditions to include
Participants
• Craig Hales• Carol Sniegoski• Karen Olson• Jeremy Espino• Cathy Larson• Mikaela Keller• Lori Hutwagner• David Thompson• Dennis Cochrane
• Marc Paladini• Julia Gunn• Atar Baer• Bill Lober• Matt Schoeler• John Dowling• Rebecca Noe• Peter Elkin• Wendy Chapman
Will we accomplish
anything or just argue?
Will one person be
headstrong and not agree with the rest?
Who are we to generate reference
definitions?
Will they like Pittsburgh?
Am I overlooking anybody?
Syndrome Definition purposeTo assist public health in monitoring, characterizing, detecting, and responding to changes in population health based on patients’ initial clinical presentation of acute outbreaks and exposures
What Syndromes Do People Use?Ten surveillance systems
Resp Upper Lower Asthma Cold10 1 1 2 1
Respiratory
GI Abd Pain Bloody Diarrhea Diarrhea Vomiting9 1 1 2 2
Gastrointestinal
Const Febrile ILI FeverFlu Sepsis4 4 2 1 1
Constitutional
Neurological Meningoencephalitis Shock_coma8 3 1
Neurological
Reference Syndrome Definitions
• Focused on three syndromes– Respiratory– GI– Constitutional/ILI
• Solution to many arguments– Create a sensitive and a specific syndrome
• Respiratory (sensitive, specific)• GI (sensitive, specific)
– Create two syndromes (similar to sens and spec)• Constitutional• ILI
6 consensus reference syndrome definitions
Respiratory Syndrome
48 conditions
2616
Sensitive Specific
BREATHING DIFFICULTY 1 1
COUGH 1 1
HEMOPTYSIS 1 1
ASTHMA ATTACK 1 1
CROUP 1 1
PNEUMONIA 1 1
WHEEZING 1 1
RUNNY OR STUFFY NOSE 1 0
PLEURITIC PAIN 1 0
SORE THROAT 1 0
URI 1 0
…
Clinical Condition Sens Spec
25 conditions
6 3
Sensitive Specific
Clinical Condition Sens Spec
ABDOMINAL PAIN 1 0
DIARRHEA 1 1
VOMITING 1 1
NAUSEA 1 0
GASTROENTERITIS 1 1
DEHYDRATION 1 0
GI Syndrome
32 conditions
12
Constitutional Syndrome
IRRITABLE BABY
FEVER
WEAKNESS
ANOREXIA
VIRAL SYNDROME
FAINTNESS
MALAISE
BODY ACHES
GENERAL ILLNESS
CHILLS
LYMPHADENOPATHY
SWEATING
17 conditions
12
Influenza-like Illness Syndrome
COUGH
SORE THROAT
FEVER
WEAKNESS
VIRAL SYNDROME
BODY ACHES
BRONCHIOLITIS
PNEUMONIA
UPPER RESPIRATORY INFECTION
MALAISE
CHILLS
INFLUENZA
Reasons for Excluding a Condition• Not specific to the organ system
– Fever in Respiratory
• Not systemic
– Headache in Constitutional
• Not specific enough to a disease of interest
– Abdominal Pain in Specific Gastrointestinal
• Not the primary presentation of a significant illness
– Earache in Specific Respiratory
• A related concept or synonym to another concept
– LLQ Abdominal pain
Future Goals
Future
• Post syndrome definitions on ISDS Wiki
Add
– Related concepts/synonyms
– Localized textual variants
– Linguistic variants
• Write paper on the meeting and on the definitions
• Begin collaborative research studies
– Anyone want to collaborate?
• Generate repository of chief complaints
– Generate annotations into syndrome definitions
Thank you ISDS