Physician's Choice of Charting Template Versus ICD-9 Code --- Agreement Between Two Syndromic Surveillance Methods Using Emergency Department Electronic Medical Records

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Dennis G. Cochrane,^1,2 J. Allegra,^1,2 J. Rothman^{2

1}Morristown Memorial Hospital Residency in Emergency Medicine, Morristown, New Jersey; ²Emergency Medical Associates of New Jersey Research Foundation, Livingston, New Jersey

Corresponding author: Dennis G. Cochrane, Morristown Memorial Hospital Residence in Emergency Medicine, Morristown, NJ 07962. Telephone: 973-971-8919; E-mail: cochraned@verizon.net.

Abstract

Introduction: Although syndromic surveillance is often performed by tracking patterns of International Classification of Diseases, Ninth Revision (ICD-9) codes, ICD-9 codes are frequently not available in real time. In certain practice settings, the physician's choice of charting template (PCCT) is available in real time and therefore might have an advantage for use in syndromic surveillance.

Objectives: This study quantified the level of overlap among patients selected by PCCT and ICD-9 code.

Methods: A retrospective analysis was conducted of a database of patient visits in 15 New Jersey emergency departments during January 1999--October 2002. Two investigators reviewed all ICD-9 codes and PCCTs used during this period and chose by consensus those relevant to each of nine syndromes. For each syndrome, counts were generated of patient visits selected by ICD-9 code and by PCCT. The kappa statistic was then used to characterize the level of agreement between the two techniques. Sensitivity and specificity of the PCCT method were calculated by using the ICD-9 code as a criterion standard.

Results: The database contained 1,729,866 patient visits. Kappa calculations indicated near perfect agreement for asthma (0.82), chest pain (0.81), and headache (0.82) syndromes (Table). Excellent agreement was determined for skin (0.6), any gastrointestinal (0.74), and diarrhea (0.69) syndromes. Calculations indicated moderate agreement for respiratory (0.52) and fever (0.49) syndromes and only fair agreement for weak (0.34) syndrome.

Conclusions: Moderate to near perfect agreement between ICD-9 code and PCCT was determined for eight of the nine syndromes examined. PCCT might be useful for real-time syndromic surveillance using electronic medical records.

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