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Generating a reliable reference standard set for syndromic case classification.

Wendy W Chapman1, John N Dowling, Michael M Wagner

  • 1RODS Laboratory, Center for Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA 15213-2582, USA. chapman@cbmi.pitt.edu

Journal of the American Medical Informatics Association : JAMIA
|July 29, 2005
PubMed
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This study developed reliable reference standards for biosurveillance syndromic definitions. Most definitions showed high prevalence and rater agreement, enabling comparison with automated classifiers.

Area of Science:

  • Public Health
  • Infectious Disease Epidemiology
  • Health Informatics

Background:

  • Biosurveillance relies on syndromic definitions for early detection of public health threats.
  • Developing reliable reference standards is crucial for validating automated syndromic classifiers.

Purpose of the Study:

  • To generate and assess the reliability of reference standard case definitions for biosurveillance.
  • To evaluate the performance of ICD-9 codes for identifying syndromic cases.

Main Methods:

  • Classified 527,228 patients using ICD-9 codes for seven broad syndromic definitions.
  • Physicians reviewed a subset of charts, assigning values to 14 variables.
  • Assessed positive predictive value, prevalence, inter-rater agreement (kappa, Finn's r), and reliability (generalizability coefficients).

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Main Results:

  • Positive predictive value of ICD-9 codes varied (0.33-0.86).
  • High inter-rater agreement (kappa > 0.70) and reliability (generalizability coefficients > 0.70) were observed for most variables.
  • 21 of 27 generated syndromic definitions met criteria for reference standards.

Conclusions:

  • A robust set of reference standard syndromic definitions was established for biosurveillance.
  • Specific syndromes (e.g., botulism, rash, certain gastrointestinal/respiratory syndromes) showed limitations in prevalence or agreement.
  • The generated standards can be used to evaluate automated biosurveillance systems.