A test of syndromic surveillance using a severe acute respiratory syndrome model.
OBJECTIVE
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.
Wallace
David J
DJ
Department of Internal Medicine, Department of Emergency Medicine, Kings County Hospital Center, Brooklyn, NY, USA. davidjohnwallace@yahoo.com
Arquilla
Bonnie
B
Heffernan
Richard
R
Kramer
Martin
M
Anderson
Todd
T
Bernstein
David
D
Augenbraun
Michael
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004196:Disease Outbreaks / Q000517:prevention & control*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D009096:Multi-Institutional Systems; D009519:New York City / Q000453:epidemiology; D016544:Patient Simulation; D011159:Population Surveillance; D011446:Prospective Studies; D045169:Severe Acute Respiratory Syndrome / Q000453:epidemiology* / Q000517:prevention & control