A test of syndromic surveillance using a severe acute respiratory syndrome model☆
Received 4 January 2008; received in revised form 6 March 2008; accepted 13 March 2008.
Abstract
Objectives
We describe a field simulation that was conducted using volunteers to assess the ability of 3 hospitals in a network to manage a large influx of patients with a potentially communicable disease. This drill provided the opportunity to evaluate the ability of the New York City Department of Health and Mental Hygiene's (NYC-DOHMH) emergency department chief complaint syndromic surveillance system to detect a cluster of patients with febrile respiratory illness.
Methods
The evaluation was a prospective simulation. The clinical picture was modeled on severe acute respiratory syndrome symptoms. Forty-four volunteers participated in the drill as mock patients.
Results
Records from 42 patients (95%) were successfully transmitted to the NYC-DOHMH. The electronic chief complaint for 24 (57%) of these patients indicated febrile or respiratory illness. The drill did not generate a statistical signal in the NYC-DOHMH SaTScan analysis. The 42 drill patients were classified in 8 hierarchical categories based on chief complaints: sepsis (2), cold (3), diarrhea (2), respiratory (20), fever/flu (4), vomit (3), and other (8). The number of respiratory visits, while elevated on the day of the drill, did not appear particularly unusual when compared with the 14-day baseline period used for spatial analyses.
Conclusions
This drill with a cluster of patients with febrile respiratory illness failed to trigger a signal from the NYC-DOHMH emergency department chief complaint syndromic surveillance system. This highlighted several limitations and challenges to syndromic surveillance monitoring.
aDepartment of Internal Medicine, Department of Emergency Medicine, Kings County Hospital Center, Brooklyn, NY, USA
bDepartment of Emergency Medicine, Kings County Hospital Center, Brooklyn, NY 11203, USA
cData Analysis Unit, Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, New York, NY, USA
dDepartment of Internal Medicine, Kings County Hospital Center, Brooklyn, NY, USA
Corresponding author. Fax: +1 917 270 9483.
☆ Supported by grant number U3RMC01315 from the Health Resources and Services Administration (HRSA).
Presented as a poster at the General Assembly of American College of Emergency Physicians (ACEP) in Seattle, Washington, October 2007.
ABSTRACT