title: Enabling Precision Medicine With Digital Case Classification at the Point-of-Care.
abstract: Infectious and inflammatory diseases of the central nervous system are difficult to identify early. Case definitions for aseptic meningitis, encephalitis, myelitis, and acute disseminated encephalomyelitis (ADEM) are available, but rarely put to use. The VACC-Tool (Vienna Vaccine Safety Initiative Automated Case Classification-Tool) is a mobile application enabling immediate case ascertainment based on consensus criteria at the point-of-care. The VACC-Tool was validated in a quality management program in collaboration with the Robert-Koch-Institute. Results were compared to ICD-10 coding and retrospective analysis of electronic health records using the same case criteria. Of 68,921 patients attending the emergency room in 10/2010-06/2013, 11,575 were hospitalized, with 521 eligible patients (mean age: 7.6 years) entering the quality management program. Using the VACC-Tool at the point-of-care, 180/521 cases were classified successfully and 194/521 ruled out with certainty. Of the 180 confirmed cases, 116 had been missed by ICD-10 coding, 38 misclassified. By retrospective application of the same case criteria, 33 cases were missed. Encephalitis and ADEM cases were most likely missed or misclassified. The VACC-Tool enables physicians to ask the right questions at the right time, thereby classifying cases consistently and accurately, facilitating translational research. Future applications will alert physicians when additional diagnostic procedures are required.
authors.affiliation: Department of Pediatrics, Charité University Medical Center Berlin, Germany; Vienna Vaccine Safety Initiative, Berlin, Germany.
authors.forename: Patrick
authors.initials: P
authors.lastname: Obermeier
authors.affiliation: Department of Pediatrics, Charité University Medical Center Berlin, Germany; Vienna Vaccine Safety Initiative, Berlin, Germany.
authors.forename: Susann
authors.initials: S
authors.lastname: Muehlhans
authors.affiliation: Department of Pediatrics, Charité University Medical Center Berlin, Germany; Vienna Vaccine Safety Initiative, Berlin, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Hoppe
authors.affiliation: Department of Pediatrics, Charité University Medical Center Berlin, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Karsch
authors.affiliation: Department of Pediatrics, Charité University Medical Center Berlin, Germany; Vienna Vaccine Safety Initiative, Berlin, Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Tief
authors.affiliation: Department of Pediatrics, Charité University Medical Center Berlin, Germany; Vienna Vaccine Safety Initiative, Berlin, Germany.
authors.forename: Lea
authors.initials: L
authors.lastname: Seeber
authors.affiliation: Department of Pediatrics, Charité University Medical Center Berlin, Germany; Vienna Vaccine Safety Initiative, Berlin, Germany.
authors.forename: Xi
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Mathematics and Computer Sciences, Free University Berlin, Germany.
authors.forename: Tim
authors.initials: T
authors.lastname: Conrad
authors.affiliation: National Reference Centre for Poliomyelitis and Enteroviruses, Robert Koch Institute, Berlin, Germany.
authors.forename: Sindy
authors.initials: S
authors.lastname: Boettcher
authors.affiliation: National Reference Centre for Poliomyelitis and Enteroviruses, Robert Koch Institute, Berlin, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Diedrich
authors.affiliation: Department of Pediatrics, Charité University Medical Center Berlin, Germany; Vienna Vaccine Safety Initiative, Berlin, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Rath
mesh_terms: D006801:Humans; D008499:Medical Records / Q000145:classification*; D016347:Medical Records Systems, Computerized; D019095:Point-of-Care Systems; D057285:Precision Medicine / Q000379:methods*; D012984:Software
keywords: ADEM; Data standards; Encephalitis; Meningitis; Mobile health; Surveillance