The value of patient self-report for disease surveillance.
OBJECTIVE
To determine the accuracy of self-reported information from patients and families for use in a disease surveillance system.


METHODS
Patients and their parents presenting to the emergency department (ED) waiting room of an urban, tertiary care children's hospital were asked to use a Self-Report Tool, which consisted of a questionnaire asking questions related to the subjects' current illness.


METHODS
The sensitivity and specificity of three data sources for assigning patients to disease categories was measured: the ED chief complaint, physician diagnostic coding, and the completed Self-Report Tool. The gold standard metric for comparison was a medical record abstraction.


RESULTS
A total of 936 subjects were enrolled. Compared to ED chief complaints, the Self-Report Tool was more than twice as sensitive in identifying respiratory illnesses (Rate ratio [RR]: 2.10, 95% confidence interval [CI] 1.81-2.44), and dermatological problems (RR: 2.23, 95% CI 1.56-3.17), as well as significantly more sensitive in detecting fever (RR: 1.90, 95% CI 1.67-2.17), gastrointestinal problems (RR: 1.10, 95% CI 1.00-1.20), and injuries (RR: 1.16, 95% CI 1.08-1.24). Sensitivities were also significantly higher when the Self-Report Tool performance was compared to diagnostic codes, with a sensitivity rate ratio of 4.42 (95% CI 3.45-5.68) for fever, 1.70 (95% CI 1.49-1.93) for respiratory problems, 1.15 (95% CI 1.04-1.27) for gastrointestinal problems, 2.02 (95% CI 1.42-2.87) for dermatologic problems, and 1.06 (95% CI 1.01-1.11) for injuries.


CONCLUSIONS
Disease category assignment based on patient-reported information was significantly more sensitive in correctly identifying a disease category than data currently used by national and regional disease surveillance systems.
Bourgeois
Florence T
FT
Division of Emergency Medicine, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA. florence.bourgeois@childrens.harvard.edu
Porter
Stephen C
SC
Valim
Clarissa
C
Jackson
Tiffany
T
Cook
E Francis
EF
Mandl
Kenneth D
KD
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003625:Data Collection; D003663:Decision Trees; D004194:Disease / Q000145:classification*; D004636:Emergency Service, Hospital; D006801:Humans; D007223:Infant; D008487:Medical History Taking / Q000379:methods; D011159:Population Surveillance / Q000379:methods*; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires
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