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1.
J Biomed Inform ; 66: 180-193, 2017 02.
Article in English | MEDLINE | ID: mdl-28057565

ABSTRACT

Awareness of a patient's clinical status during hospitalization is a primary responsibility for hospital providers. One tool to assess status is the Rothman Index (RI), a validated measure of patient condition for adults, based on empirically derived relationships between 1-year post-discharge mortality and each of 26 clinical measurements available in the electronic medical record. However, such an approach cannot be used for pediatrics, where the relationships between risk and clinical variables are distinct functions of patient age, and sufficient 1-year mortality data for each age group simply do not exist. We report the development and validation of a new methodology to use adult mortality data to generate continuously age-adjusted acuity scores for pediatrics. Clinical data were extracted from EMRs at three pediatric hospitals covering 105,470 inpatient visits over a 3-year period. The RI input variable set was used as a starting point for the development of the pediatric Rothman Index (pRI). Age-dependence of continuous variables was determined by plotting mean values versus age. For variables determined to be age-dependent, polynomial functions of mean value and mean standard deviation versus age were constructed. Mean values and standard deviations for adult RI excess risk curves were separately estimated. Based on the "find the center of the channel" hypothesis, univariate pediatric risk was then computed by applying a z-score transform to adult mean and standard deviation values based on polynomial pediatric mean and standard deviation functions. Multivariate pediatric risk is estimated as the sum of univariate risk. Other age adjustments for categorical variables were also employed. Age-specific pediatric excess risk functions were compared to age-specific expert-derived functions and to in-hospital mortality. AUC for 24-h mortality and pRI scores prior to unplanned ICU transfers were computed. Age-adjusted risk functions correlated well with similar functions in Bedside PEWS and PAWS. Pediatric nursing data correlated well with risk as measured by mortality odds ratios. AUC for pRI for 24-h mortality was 0.93 (0.92, 0.94), 0.93 (0.93, 0.93) and 0.95 (0.95, 0.95) at the three pediatric hospitals. Unplanned ICU transfers correlated with lower pRI scores. Moreover, pRI scores declined prior to such events. A new methodology to continuously age-adjust patient acuity provides a tool to facilitate timely identification of physiologic deterioration in hospitalized children.


Subject(s)
Child, Hospitalized , Data Mining , Electronic Health Records , Hospital Mortality , Risk Assessment , Severity of Illness Index , Child , Child, Preschool , Female , Hospitals, Pediatric , Humans , Infant , Male , Patient Acuity
2.
Pediatrics ; 137(5)2016 05.
Article in English | MEDLINE | ID: mdl-27244775

ABSTRACT

BACKGROUND: Infectious Diseases Society of America guidelines recommend that key antimicrobial stewardship program (ASP) personnel include an infectious disease (ID) physician leader and dedicated ID-trained clinical pharmacist. Limited resources prompted development of an alternative model by using ID physicians and service-based clinical pharmacists at a pediatric hospital. The aim of this study was to analyze the effectiveness and impact of this alternative ASP model. METHODS: The collaborative ASP model incorporated key strategies of education, antimicrobial restriction, day 3 audits, and practice guidelines. High-use and/or high-cost antimicrobial agents were chosen with audits targeting vancomycin, caspofungin, and meropenem. The electronic medical record was used to identify patients requiring day 3 audits and to communicate ASP recommendations. Segmented regression analyses were used to analyze quarterly antimicrobial agent prescription data for the institution and selected services over time. RESULTS: Initiation of ASP and day 3 auditing was associated with blunting of a preexisting increasing trend for caspofungin drug starts and use and a significant downward trend for vancomycin drug starts (relative change -12%) and use (-25%), with the largest reduction in critical care areas. Although meropenem use was already low due to preexisting requirements for preauthorization, a decline in drug use (-31%, P = .021) and a nonsignificant decline in drug starts (-21%, P = .067) were noted. A 3-month review of acceptance of ASP recommendations found rates of 90%, 93%, and 100% for vancomycin, caspofungin, and meropenem, respectively. CONCLUSIONS: This nontraditional ASP model significantly reduced targeted drug usage demonstrating acceptance of integration of service-based clinical pharmacists and ID consultants.


Subject(s)
Anti-Infective Agents/therapeutic use , Practice Patterns, Physicians'/standards , Quality Assurance, Health Care , Anti-Infective Agents/economics , Cooperative Behavior , Cost Savings , Drug Costs , Drug Utilization Review , Hospitals, Pediatric , Humans , Medical Audit , Pennsylvania , Pharmacists , Pharmacy Service, Hospital/standards , Practice Guidelines as Topic
3.
J Am Med Inform Assoc ; 21(e2): e304-11, 2014 Oct.
Article in English | MEDLINE | ID: mdl-24674844

ABSTRACT

OBJECTIVE: Evidence indicates that users incur significant physical and cognitive costs in the use of order sets, a core feature of computerized provider order entry systems. This paper develops data-driven approaches for automating the construction of order sets that match closely with user preferences and workflow while minimizing physical and cognitive workload. MATERIALS AND METHODS: We developed and tested optimization-based models embedded with clustering techniques using physical and cognitive click cost criteria. By judiciously learning from users' actual actions, our methods identify items for constituting order sets that are relevant according to historical ordering data and grouped on the basis of order similarity and ordering time. We evaluated performance of the methods using 47,099 orders from the year 2011 for asthma, appendectomy and pneumonia management in a pediatric inpatient setting. RESULTS: In comparison with existing order sets, those developed using the new approach significantly reduce the physical and cognitive workload associated with usage by 14-52%. This approach is also capable of accommodating variations in clinical conditions that affect order set usage and development. DISCUSSION: There is a critical need to investigate the cognitive complexity imposed on users by complex clinical information systems, and to design their features according to 'human factors' best practices. Optimizing order set generation using cognitive cost criteria introduces a new approach that can potentially improve ordering efficiency, reduce unintended variations in order placement, and enhance patient safety. CONCLUSIONS: We demonstrate that data-driven methods offer a promising approach for designing order sets that are generalizable, data-driven, condition-based, and up to date with current best practices.


Subject(s)
Cognition , Medical Order Entry Systems , Pediatrics/organization & administration , User-Computer Interface , Workload/psychology , Efficiency , Electronic Health Records , Time Factors
4.
J Healthc Eng ; 4(3): 427-52, 2013.
Article in English | MEDLINE | ID: mdl-23965597

ABSTRACT

This study examines a new approach of using the Design Structure Matrix (DSM) modeling technique to improve the design of Electronic Medical Record (EMR) user interfaces. The usability of an EMR medication dosage calculator used for placing orders in an academic hospital setting was investigated. The proposed method captures and analyzes the interactions between user interface elements of the EMR system and groups elements based on information exchange, spatial adjacency, and similarity to improve screen density and time-on-task. Medication dose adjustment task time was recorded for the existing and new designs using a cognitive simulation model that predicts user performance. We estimate that the design improvement could reduce time-on-task by saving an average of 21 hours of hospital physicians' time over the course of a month. The study suggests that the application of DSM can improve the usability of an EMR user interface.


Subject(s)
Database Management Systems , Decision Support Systems, Clinical , Electronic Health Records , Information Storage and Retrieval/methods , Medication Systems, Hospital , User-Computer Interface , Medical Order Entry Systems
5.
Stud Health Technol Inform ; 192: 734-8, 2013.
Article in English | MEDLINE | ID: mdl-23920654

ABSTRACT

Higher cognitive workload due to poor usability is a significant, unanticipated consequence of healthcare information technology (IT), resulting in new types of medical errors. An important example of this can be observed in the use of order sets, which allow safe and efficient provider order entry guided by known best practices. This paper aims to improve IT-enabled order entry by re-designing order sets using data-driven approaches to develop new order sets that match current usage and workflow, while incurring minimum cognitive workload. Applying optimization models embedded with clustering techniques, our methods identify items for constituting order sets that are relevant based on historical ordering data wherein items for a single patient are often placed together or in close temporal proximity during hospital stay. Results indicate that the new approaches dominate current solutions, significantly reducing cognitive workload, and improving order set content. Data driven methods thus offer a promising approach for designing order sets that are generalizable, evidence-based and up-to-date with current best practices.


Subject(s)
Cognitive Reserve , Database Management Systems , Databases, Factual , Information Storage and Retrieval/methods , Medical Order Entry Systems , User-Computer Interface , Workload , Humans , Workflow
6.
AMIA Annu Symp Proc ; 2012: 281-90, 2012.
Article in English | MEDLINE | ID: mdl-23304298

ABSTRACT

Microbiology study results are necessary for conducting many comparative effectiveness research studies. Unlike core laboratory test results, microbiology results have a complex structure. Federating and integrating microbiology data from six disparate electronic medical record systems is challenging and requires a team of varied skills. The PHIS+ consortium which is partnership between members of the Pediatric Research in Inpatient Settings (PRIS) network, the Children's Hospital Association and the University of Utah, have used "FURTHeR' for federating laboratory data. We present our process and initial results for federating microbiology data from six pediatric hospitals.


Subject(s)
Clinical Laboratory Information Systems/organization & administration , Hospitals, Pediatric/organization & administration , Medical Records Systems, Computerized/organization & administration , Microbiology , Systematized Nomenclature of Medicine , Comparative Effectiveness Research , Delivery of Health Care, Integrated/organization & administration , Humans , Software
7.
AMIA Annu Symp Proc ; 2012: 1294-301, 2012.
Article in English | MEDLINE | ID: mdl-23304408

ABSTRACT

Computerized physician order entry (CPOE) systems can create unintended consequences. These include medication errors and adverse drug events. We look at a less understood error; patient misidentification. First, two email surveys were used to establish potential risk factors for this error. Next, an automated detection trigger was designed and validated with inpatient medication orders at a large pediatric hospital. The incidence was 0.064% per medication ordered. Finally, a case-control study identified the following as significant risk factors on multivariate analysis: patient age, last name spelling, bed proximity, medical service, time/date of order, and ordering intensity. These results can be used to improve patient safety by increasing awareness of high risk situations and guiding future research.


Subject(s)
Medical Order Entry Systems , Medication Errors , Age Factors , Case-Control Studies , Data Collection , Electronic Mail , Humans , Medication Errors/statistics & numerical data , Multivariate Analysis , Names , Patient Identification Systems , Risk Factors
8.
J Hosp Med ; 6(5): 256-63, 2011 May.
Article in English | MEDLINE | ID: mdl-21374798

ABSTRACT

OBJECTIVE: To determine the comparative effectiveness of common pleural drainage procedures for treatment of pneumonia complicated by parapneumonic effusion (ie, complicated pneumonia). DESIGN: Multicenter retrospective cohort study. SETTING: Forty children's hospitals contributing data to the Pediatric Health Information System. PARTICIPANTS: Children with complicated pneumonia requiring pleural drainage. MAIN EXPOSURES: Initial drainage procedures were categorized as chest tube without fibrinolysis, chest tube with fibrinolysis, video-assisted thoracoscopic surgery (VATS), and thoracotomy. MAIN OUTCOME MEASURES: Length of stay (LOS), additional drainage procedures, readmission within 14 days of discharge, and hospital costs. RESULTS: Initial procedures among 3500 patients included chest tube without fibrinolysis (n = 1762), chest tube with fibrinolysis (n = 623), VATS (n = 408), and thoracotomy (n = 797). Median age was 4.1 years. Overall, 716 (20.5%) patients received an additional drainage procedure (range, 6.8-44.8% across individual hospitals). The median LOS was 10 days (range, 7-14 days across individual hospitals). The median readmission rate was 3.8% (range, 0.8%-33.3%). In multivariable analysis, differences in LOS by initial procedure type were not significant. Patients undergoing initial chest tube placement with or without fibrinolysis were more likely to require additional drainage procedures. However, initial chest tube without fibrinolysis was the least costly strategy. CONCLUSION: There is variability in the treatment and outcomes of children with complicated pneumonia. Outcomes were similar in patients undergoing initial chest tube placement with or without fibrinolysis. Those undergoing VATS received fewer additional drainage procedures but had no differences in LOS compared with other strategies.


Subject(s)
Drainage/methods , Pleural Effusion/complications , Pleural Effusion/therapy , Pneumonia/complications , Pneumonia/therapy , Adolescent , Child , Child, Preschool , Cohort Studies , Female , Humans , Infant , Male , Pleural Effusion/physiopathology , Pneumonia/physiopathology , Retrospective Studies , Treatment Outcome
9.
Pediatr Infect Dis J ; 30(4): e63-7, 2011 Apr.
Article in English | MEDLINE | ID: mdl-21283047

ABSTRACT

UNLABELLED: BACKGROUND This study describes differences in the values of cerebrospinal fluid (CSF) white blood cell (WBC), glucose, and protein counts in infants less than 60 days of age with fever who were not proven to have viral or bacterial meningitis. METHODS: Three independent retrospective medical record reviews were conducted using a population of infants less than 60 days of age who presented to the Emergency Department with fever. Full-term infants were included if a lumbar puncture was performed within 24 hours of admittance and bacterial or viral meningitis was not identified as the cause of fever. RESULTS: A total of 1091 infants were included and grouped by week of age. Significant trends were found for CSF WBC and CSF protein with the highest values observed during the first week of life. Mean for CSF WBC was 8.63 cells/mm for infants aged 0 to 1 week and decreased for each age group ending with infants 8 weeks of age having a mean of 2.22 cell/mm. For CSF protein, a similar trend was observed. No significant differences were found for CSF glucose. CONCLUSIONS: Significant differences exist for infants by week of age for CSF WBC and CSF protein. These values can be used to assist in interpreting laboratory findings and making management decisions for infants less than 60 days of age.


Subject(s)
Cerebrospinal Fluid/chemistry , Cerebrospinal Fluid/cytology , Fever of Unknown Origin/diagnosis , Age Factors , Emergency Medical Services , Glucose/cerebrospinal fluid , Humans , Infant , Infant, Newborn , Leukocyte Count , Proteins/analysis , Retrospective Studies
10.
Acad Emerg Med ; 18(2): 158-66, 2011 Feb.
Article in English | MEDLINE | ID: mdl-21314775

ABSTRACT

OBJECTIVES: The objective was to describe the emergency department (ED) resource burden of the spring 2009 H1N1 influenza pandemic at U.S. children's hospitals by quantifying observed-to-expected utilization. METHODS: The authors performed an ecologic analysis for April through July 2009 using data from 23 EDs in the Pediatric Health Information System (PHIS), an administrative database of widely distributed U.S. children's hospitals. All ED visits during the study period were included, and data from the 5 prior years were used for establishing expected values. Primary outcome measures included observed-to-expected ratios for ED visits for all reasons and for influenza-related illness (IRI). RESULTS: Overall, 390,983 visits, and 88,885 visits for IRI, were included for Calendar Weeks 16 through 29, when 2009 H1N1 influenza was circulating. The subset of 106,330 visits and 31,703 IRI visits made to the 14 hospitals experiencing the authors' definition of ED surge during Weeks 16 to 29 was also studied. During surge weeks, the 14 EDs experienced 29% more total visits and 51% more IRI visits than expected (p < 0.01 for both comparisons). Of ED IRI visits during surge weeks, only 4.8% were admitted to non-intensive care beds (70% of expected, p < 0.01), 0.19% were admitted to intensive care units (44% of expected, p < 0.01), and 0.01% received mechanical ventilation (5.0% of expected, p < 0.01). Factors associated with more-than-expected visits included ages 2-17 years, payer type, and asthma. No factors were associated with more-than-expected hospitalizations from the ED. CONCLUSIONS: During the spring 2009 H1N1 influenza pandemic, pediatric EDs nationwide experienced a marked increase in visits, with far fewer than expected requiring nonintensive or intensive care hospitalization. The data in this study can be used for future pandemic planning.


Subject(s)
Hospitalization/statistics & numerical data , Hospitals, Pediatric/statistics & numerical data , Influenza, Human/therapy , Adolescent , Child , Child, Preschool , Chronic Disease/epidemiology , Databases, Factual , Health Care Rationing , Humans , Infant , Infant, Newborn , Influenza A Virus, H1N1 Subtype , Influenza, Human/epidemiology , Male , Pandemics , Regression Analysis , Risk Factors , Severity of Illness Index , United States/epidemiology , Young Adult
11.
J Pediatr ; 157(1): 98-102.e1, 2010 Jul.
Article in English | MEDLINE | ID: mdl-20304421

ABSTRACT

OBJECTIVES: To assess the relationship between children's hospital readmission and the performance of child health systems in the states in which hospitals are located. STUDY DESIGN: We conducted a retrospective cohort study of 197,744 patients 2 to 18 years old from 39 children's hospitals located in 24 states in the United States in 2005. Subjects were observed for a year after discharge for readmission to the same hospital. The odds of readmission were modeled on the basis of patient-level characteristics and state child health system performance as ranked by the Commonwealth Fund. RESULTS: A total of 1.8% of patients were readmitted within a week, 4.8% within a month, and 16.3% within 365 days. After adjustment for patient-level characteristics, the probability of readmission varied significantly between states (P=.001), and the likelihood of readmission during the ensuing year increased as the states' health system performance ranking improved. States in the best ranking quartile had a 2.03% higher readmission rate than states in the lowest quartile (P=.02); the same directional relationship was observed for readmission intervals from 1 to 365 days after discharge. CONCLUSIONS: Hospital readmission rates are significantly related to the performance of the surrounding health care system.


Subject(s)
Child, Hospitalized/statistics & numerical data , Health Services Accessibility/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Patient Readmission/statistics & numerical data , Adolescent , Child , Child, Preschool , Female , Follow-Up Studies , Hospitals/statistics & numerical data , Humans , Male , Retrospective Studies , United States
12.
AMIA Annu Symp Proc ; 2010: 652-6, 2010 Nov 13.
Article in English | MEDLINE | ID: mdl-21347059

ABSTRACT

It is accepted that intravenous fluid (IVF) therapy can result in hospital-acquired dysnatremias in pediatric patients, with associated morbidity and mortality. There is interest in improving IVF therapy to prevent dysnatremias, but the optimal approach is controversial. In this study, we develop Natremia Deviation and Intravenous Renderer (NaDIR), a tool that preprocesses large volumes of electronic medical record data obtained from an academic pediatric hospital in order to analyze (1) IVF therapy, (2) the epidemiology of dysnatremias, and (3) the impact of IVFs on changes in serum sodium (ΔS(Na)). We then applied NaDIR to 3,256 inpatient records over a 3 month period, which revealed (1) a 19.9% incidence of dysnatremias, (2) a significant increase in lengths of stay associated with dysnatremias, and (3) a novel linear relationship between ΔS(Na) and IVF tonicity. This demonstrates that EMR data that can be readily analyzed to discover epidemiologic and predictive knowledge.


Subject(s)
Hypernatremia , Hyponatremia , Child , Electronic Health Records , Fluid Therapy , Humans , Sodium
13.
Clin Infect Dis ; 49(9): 1369-76, 2009 Nov 01.
Article in English | MEDLINE | ID: mdl-19788359

ABSTRACT

BACKGROUND: Streptococcal toxic shock syndrome (TSS) is a rare and severe manifestation of group A streptococcal infection. The role of intravenous immunoglobulin (IVIG) for streptococcal TSS in children is controversial. This study aims to describe the epidemiology of streptococcal TSS in children and to determine whether adjunctive therapy with IVIG is associated with improved outcomes. METHODS: A multicenter, retrospective cohort study of children with streptococcal TSS from 1 January 2003 through 31 December 2007 was conducted. Propensity scores were used to determine each child's likelihood of receiving IVIG. Differences in the primary outcomes of death, hospital length of stay, and total hospital costs were compared after matching IVIG recipients and nonrecipients on propensity score. RESULTS: The median patient age was 8.2 years. IVIG was administered to 84 (44%) of 192 patients. The overall mortality rate was 4.2% (95% confidence interval, 1.8%-8.0%). Differences in mortality between IVIG recipients (n = 3; 4.5%) and nonrecipients (n = 3; 4.5%) were not statistically significant (p > .99). Although patients receiving IVIG had higher total hospital and drug costs than nonrecipients, differences in hospital costs were not significant once drug costs were removed (median difference between matched patients, $6139; interquartile range, -$8316 to $25,993; P = .06). No differences were found in length of hospital stay between matched IVIG recipients and nonrecipients. CONCLUSION: This multicenter study is, to our knowledge, the largest to describe the epidemiology and outcomes of children with streptococcal TSS and the first to explore the association between IVIG use and clinical outcomes. IVIG use was associated with increased costs of caring for children with streptococcal TSS but was not associated with improved outcomes.


Subject(s)
Immunoglobulins, Intravenous/therapeutic use , Immunologic Factors/therapeutic use , Shock, Septic/drug therapy , Streptococcal Infections/drug therapy , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Retrospective Studies , Shock, Septic/economics , Streptococcal Infections/economics , Treatment Outcome
14.
Pediatrics ; 123(1): 286-93, 2009 Jan.
Article in English | MEDLINE | ID: mdl-19117894

ABSTRACT

BACKGROUND: Children with complex chronic conditions depend on both their families and systems of pediatric health care, social services, and financing. Investigations into the workings of this ecology of care would be advanced by more accurate methods of population-level predictions of the likelihood for future hospitalization. METHODS: This was a retrospective cohort study. Hospital administrative data were collected from 38 children's hospitals in the United States for the years 2003-2005. Participants included patients between 2 and 18 years of age discharged from an index hospitalization during 2004. Patient characteristics documented during the index hospitalization or any previous hospitalization during the preceding 365 days were included. The main outcome measure was readmission to the hospital during the 365 days after discharge from the index admission. RESULTS: Among the cohort composed of 186856 patients discharged from the participating hospitals during 2004, the mean age was 9.2 years, with 54.4% male and 52.9% identified as non-Hispanic white. A total of 17.4% were admitted during the previous 365 days, and among those discharged alive (0.6% died during the admission), 16.7% were readmitted during the ensuing 365 days. The final readmission model exhibited a c statistic of 0.81 across all hospitals, with a range from 0.76 to 0.84 for each hospital. Bootstrap-based assessments demonstrated the stability of the final model. CONCLUSIONS: Accurate population-level prediction of hospital readmissions is possible, and the resulting predicted probability of hospital readmission may prove useful for health services research and planning.


Subject(s)
Child, Hospitalized , Patient Readmission/trends , Adolescent , Child , Child, Preschool , Cohort Studies , Delivery of Health Care/trends , Female , Humans , Longitudinal Studies , Male , Predictive Value of Tests , Retrospective Studies
15.
Arch Pediatr Adolesc Med ; 161(3): 282-90, 2007 Mar.
Article in English | MEDLINE | ID: mdl-17339510

ABSTRACT

OBJECTIVES: To describe the magnitude of off-label drug use, to identify drugs most commonly used off-label, and to identify factors associated with off-label drug use in children hospitalized in the United States. DESIGN: Retrospective cohort study. SETTING: Administrative database containing inpatient resource utilization data from January 1 to December 31, 2004, from 31 tertiary care pediatric hospitals in the United States. PARTICIPANTS: Hospitalized patients 18 years or younger. MAIN EXPOSURES: Institution and patient characteristics. MAIN OUTCOME MEASURES: Off-label drug use was defined as use of a specific drug in a patient younger than the Food and Drug Administration-approved age range for any indication of that drug. RESULTS: At least 1 drug was used off-label in 297 592 (78.7%) of 355 409 patients discharged during the study. Off-label use accounted for $270 275 849 (40.5%) of the total dollars spent on these medications. Medications classified as central or autonomic nervous system agents or as fluids or nutrients, or gastrointestinal tract agents were most commonly used off-label, whereas antineoplastic agents were rarely used off-label. Factors associated with off-label use in multivariate analysis were as follows: undergoing a surgical procedure, age older than 28 days, greater severity of illness, and all-cause in-hospital mortality. CONCLUSIONS: Most patients hospitalized at tertiary care pediatric institutions receive at least 1 medication outside the terms of the Food and Drug Administration product license. Substantial variation in the frequency of off-label use was observed across diagnostic categories and drug classes. Despite the frequent off-label use of drugs, using an administrative database, we cannot determine which of these treatments are unsafe or ineffective and which treatments result in substantial benefit to the patient.


Subject(s)
Drug Utilization/statistics & numerical data , Drug Utilization/standards , Hospitalization , Adolescent , Child , Child, Preschool , Cohort Studies , Drug Labeling , Female , Humans , Infant , Infant, Newborn , Male , Retrospective Studies
16.
AMIA Annu Symp Proc ; : 445-9, 2005.
Article in English | MEDLINE | ID: mdl-16779079

ABSTRACT

Using data from over 450,000 pediatric encounters three data sources were evaluated for their ability to support early detection of a yearly outbreak of rotavirus disease: 1) Laboratory studies ordered, 2) Diagnosis codes, and 3) Free text "reason for visit" strings categorized as Gastrointestinal syndrome by a support vector machine software classifier. We found that in this setting the categorized free text analyzed through simple control charts detected each outbreak within 10 days of their beginning as determined by laboratory detection of rotavirus antigen (the gold standard). Outbreak detection by laboratory studies was delayed an average of 14 days and by diagnosis codes by an average of 20 days. We conclude that categorized text may provide a valuable basis for real-time detection of disease outbreaks.


Subject(s)
Algorithms , Diarrhea/virology , Disease Outbreaks , Gastrointestinal Diseases/diagnosis , Rotavirus Infections/diagnosis , Rotavirus/isolation & purification , Antigens, Viral/blood , Community-Acquired Infections/diagnosis , Community-Acquired Infections/epidemiology , Community-Acquired Infections/virology , Diarrhea/epidemiology , Gastrointestinal Diseases/epidemiology , Gastrointestinal Diseases/virology , Hospitals, Pediatric , Humans , International Classification of Diseases , Medical Records , Rotavirus/immunology , Rotavirus Infections/epidemiology , Software
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