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 Dowling Funded
by ISDS
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ObjectiveGenerate explicit consensus syndrome
definitions based on current syndromic
surveillance practiceRespiratoryGastrointestina
lFever/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
Admission complaint
cough/headache
(Preprocess)Classify
Complaint Classifier
Syndrome Category
Clinical Condition Concept
Respiratory Neurological
Cough (C00529) Headache (C00421)
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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
Before the meeting

• 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

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Characterize Currently Used Syndromic Definitions

• 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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• 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

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• 18 unique syndromes

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Inclusion Criteria for Clinical Conditions

• Conditions can be signs, symptoms, findings, or
  diagnoses
• Conditions should comprise a single problem
• Coughnot 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

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• 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

Why Signs, symptoms not in CCC-EDS General
diagnoses
Added Bronchitis Influenza Chills Pleural
effusion
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• 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 Crohns Disease
Diverticulitis Pulmonary Infection
Why Specific diagnoses Broad bins
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(No Transcript)
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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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• 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 Scholer
• John Dowling
• Rebecca Noe
• Peter Elkin
• Wendy Chapman

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Who are we to generate reference definitions?
Will we accomplish anything or just argue?
Will one person be headstrong and not agree with
the rest?
Am I overlooking anybody?
Will they like Pittsburgh?
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Syndrome Definition purpose

• To 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

Respiratory
Resp Upper Lower Asthma Cold 10 1 1 2 1
Gastrointestinal
GI Abd Pain Bloody Diarrhea Diarrhea Vomiting 9 1
1 2 2
Constitutional
Const Febrile ILI FeverFlu Sepsis 4 4 2 1 1
Neurological
Neurological Meningoencephalitis Shock_coma 8 3
1
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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
Clinical Condition Sens Spec

• 48 conditions
• 26 16
• 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
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GI Syndrome
Clinical Condition Sens Spec

• 25 conditions
• 6 3
• Sensitive Specific

ABDOMINAL PAIN 1 0 DIARRHEA 1 1 VOMITING 1 1 NAU
SEA 1 0 GASTROENTERITIS 1 1 DEHYDRATION 1 0
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Constitutional Syndrome
IRRITABLE BABY FEVER WEAKNESS ANOREXIA VIRAL
SYNDROME FAINTNESS MALAISE BODY ACHES GENERAL
ILLNESS CHILLS LYMPHADENOPATHY SWEATING

• 32 conditions
• 12

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Influenza-like Illness Syndrome
COUGH SORE THROAT FEVER WEAKNESS VIRAL
SYNDROME BODY ACHES BRONCHIOLITIS PNEUMONIA UPPER
RESPIRATORY INFECTION MALAISE CHILLS INFLUENZA

• 17 conditions
• 12

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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