Validity of emergency department syndromic surveillance for Influenza in children

急诊科儿童流感症状监测的有效性

• 批准号: 7770099
• 负责人: Carla Rodriguez-Watson
• 金额: $ 2.25万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2011-12-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7770099
• 关键词: Validity; emergency; department; syndromic; surveillance

DESCRIPTION (provided by the investigator): The study objective is to describe the validity of influenza-like-illness (ILI) from emergency department (ED) data to predict laboratory-confirmed influenza in a pediatric population during epidemic periods in King County, Washington. The specific aims are to: Aim 1. a) Estimate and compare the accuracy of various influenza-like illness (ILI) syndromes for detecting laboratory-confirmed influenza; b) Estimate the accuracy of Respiratory Syndrome for detecting laboratory-confirmed influenza. Compare the accuracy of Respiratory with ILI; and c) (Exploratory Analysis) Develop a symptom prediction model for lab-confirmed influenza, which will be translated into an ILI classifier. Aim 2. Describe and compare temporal trends of ILI visits with positive influenza isolates from laboratory surveillance. The impact of various ILI syndrome classifications on ecological accuracy, using laboratory surveillance as a gold-standard, will be described. A retrospective cohort of children < 18 years of age who presented to the Seattle Children's Hospital ED during known influenza periods from 2000-2005 will be randomly selected to address Aim 1. Chief complaint and diagnoses fields will be used to categorize records as positive or negative for ILI and Respiratory Syndrome. ILI and Respiratory definitions tested will represent those currently used in operation across the U.S. The Principal Investigator will also test new definitions informed by exploratory analysis. Logistic regression will be used to model the probability of laboratory-confirmed influenza given presence of ILI/Respiratory Syndrome, administrative and demographic risk factors, and other respiratory infection. Logic regression, a method for identifying population subsets based on a Boolean combination of binary coded risk factors, will be used in the exploratory analysis. Using a simulated prospective analysis, optimal ILI definitions from Aim 1 will be applied to all ED visits presenting between 2005-2008. All visits will be coded as positive or negative for ILI syndrome. ILI positive visits will be aggregated, and frequencies estimated and compared with the frequency of positive influenza isolates from the UW Clinical Virology Laboratory using dynamic linear models, a form of time-series analysis. Aberrations, or signals, will be defined from ED data when observed values exceed expected values at some threshold. Signals from ED and laboratory data will be compared. The project is consistent with the increasing emphasis on improving surveillance systems for influenza and the unique role children play in its transmission. This study provides the first validation of a syndrome definition from syndromic data sources against a single, laboratory-confirmed disease.

描述（由研究者提供）：研究目的是描述来自急诊科（艾德）数据的流感样疾病（ILI）预测华盛顿金县流行期间儿科人群中实验室确诊流感的有效性。具体目标是：目标1。a）评估和比较各种流感样疾病（ILI）综合征检测实验室确认流感的准确性; B）评估呼吸综合征检测实验室确认流感的准确性。比较呼吸系统与ILI的准确性;以及c）（探索性分析）开发实验室确认的流感的症状预测模型，其将被转化为ILI分类器。目标2.描述并比较实验室监测中流感病毒分离株阳性的ILI就诊时间趋势。各种ILI综合征分类对生态准确性的影响，使用实验室监测作为金标准，将被描述。将随机选择2000-2005年已知流感期间到西雅图儿童医院艾德就诊的< 18岁儿童的回顾性队列，以解决目标1。主诉和诊断字段将用于将记录分类为ILI和呼吸综合征阳性或阴性。测试的ILI和呼吸定义将代表美国各地目前使用的定义。主要研究者还将测试探索性分析得出的新定义。考虑到ILI/呼吸道综合征、行政和人口统计风险因素以及其他呼吸道感染的存在，将使用逻辑回归对实验室确认的流感的概率进行建模。逻辑回归是一种基于二进制编码风险因素的布尔组合识别人群子集的方法，将用于探索性分析。使用模拟前瞻性分析，目标1中的最佳ILI定义将应用于2005-2008年期间的所有艾德访视。所有访视将编码为ILI综合征阳性或阴性。将汇总ILI阳性访视，估计频率，并使用动态线性模型（一种时间序列分析形式）与UW临床病毒学实验室的阳性流感分离株频率进行比较。 当观察值超过某个阈值的预期值时，将根据艾德数据定义畸变或信号。将比较来自艾德的信号和实验室数据。该项目与日益强调改善流感监测系统以及儿童在其传播中发挥的独特作用相一致。这项研究首次验证了综合征定义的综合征数据来源对一个单一的，实验室确认的疾病。