The Value of Patient Self-report for Disease Surveillance
- Florence T Bourgeois,
- Stephen C Porter,
- Clarissa Valim,
- Tiffany Jackson,
- E Francis Cook,
- Kenneth D Mandl
- Affiliations of the authors: Division of Emergency Medicine (FTB, SCP, TJ, KDM), Clinical Research Program (CV), Children's Hospital, Boston, MA; Department of Pediatrics (FTB, SCP, KDM), Harvard Medical School, Boston, MA; Department of Biostatistics (CV), Department of Epidemiology (EFC), Harvard School of Public Health, Boston, MA; Children's Hospital Informatics Program at the Harvard-MIT Division of Health Sciences and Technology (SCP, KDM), Cambridge, MA
- Correspondence: Florence T Bourgeois MD, MPH, Division of Emergency Medicine, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115; e-mail: <florence.bourgeois{at}childrens.harvard.edu>
- Received 24 April 2006
- Accepted 14 July 2007
Abstract
Objective To determine the accuracy of self-reported information from patients and families for use in a disease surveillance system.
Design 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.
Measurements 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.
Footnotes
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This paper was presented in part at the Syndromic Surveillance Conference, Seattle, WA, September 14–16, 2005, and at the Pediatric Academic Societies’ Annual Meeting, San Francisco, CA, April 28–May 2, 2006.
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This work was supported by National Research Service Awards 5 T32 HD40128-03 and 5 T32 HD40128-04, by R01LM007970-01 from the National Library of Medicine, National Institutes of Health.
