Generating Consensus Syndrome Case Definitions September 24-25, 2007 Pittsburgh, PA Hosted by Wendy...
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![Page 1: Generating Consensus Syndrome Case Definitions September 24-25, 2007 Pittsburgh, PA Hosted by Wendy Chapman and John DowlingFunded by ISDS.](https://reader036.fdocuments.in/reader036/viewer/2022062422/56649ee45503460f94bf3c44/html5/thumbnails/1.jpg)
Generating Consensus Syndrome Case Definitions
September 24-25, 2007Pittsburgh, PA
Hosted by Wendy Chapman and John Dowling Funded by ISDS
![Page 2: Generating Consensus Syndrome Case Definitions September 24-25, 2007 Pittsburgh, PA Hosted by Wendy Chapman and John DowlingFunded by ISDS.](https://reader036.fdocuments.in/reader036/viewer/2022062422/56649ee45503460f94bf3c44/html5/thumbnails/2.jpg)
ObjectiveGenerate explicit consensus
syndrome definitions based on current syndromic surveillance
practice
RespiratoryGastrointestinal
Fever/Constitutional/ILI
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Overview
• Purpose of meeting
• Baseline consensus syndromes
• Coming to Consensus
• Consensus Definitions
• Future goals
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Clinical Condition experienced by a patient
Complaint Classifier
Syndrome CategoryClinical Condition Concept
(Preprocess)Classify
Cough (C00529)Headache (C00421)
RespiratoryNeurological
Admission complaint
“cough/headache”
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Purpose of Meeting
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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
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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
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Consensus Syndrome Definitions
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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
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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
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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
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18 unique syndromes
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• 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
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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
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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
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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
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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
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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
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Coming to Consensus on Reference Syndrome Definitions
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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
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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
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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?
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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
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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
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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
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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
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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
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32 conditions
12
Constitutional Syndrome
IRRITABLE BABY
FEVER
WEAKNESS
ANOREXIA
VIRAL SYNDROME
FAINTNESS
MALAISE
BODY ACHES
GENERAL ILLNESS
CHILLS
LYMPHADENOPATHY
SWEATING
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17 conditions
12
Influenza-like Illness Syndrome
COUGH
SORE THROAT
FEVER
WEAKNESS
VIRAL SYNDROME
BODY ACHES
BRONCHIOLITIS
PNEUMONIA
UPPER RESPIRATORY INFECTION
MALAISE
CHILLS
INFLUENZA
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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
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Future Goals
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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
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Thank you ISDS