Results about Chief Complaints and OTC. Michael Wagner, MD PhD Real-time Outbreak and Disease Surveillance (RODS) Laboratory University of Pittsburgh. National Retail Data Monitor. OTC products have UPC bar codes Stores use optical scanners
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Michael Wagner, MD PhDReal-time Outbreak and Disease Surveillance (RODS) LaboratoryUniversity of Pittsburgh
Wagner et al, Design of a National Retail Data Monitor, JAMIA, Sept. 2003;10(5) 409-20
OPEN SOURCE DEVELOPERS!
Monday 3:30-5:30 PM
Health Department Use
-Pennsylvania ~50 hospitals
-Utah ~25 EDs and Urgent cares
-Ohio 3 hospitals
-Under development Michigan, Atlantic City
Tsui et al, Technical Description of RODS: A Real-time Public Health Surveillance System, JAMIA, Sept. 2003;10(5) 399-408
There is information
(Area under curve is not 0.5)
There is noise
For many syndromes of interest to bioterrorism, we can detect half the cases
Next question: can we use an array of these noisy detectors to achieve accurate detection of outbreaks?
Sensitivity, specificity and likelihood ratio positive (LR+) measurements for the CoCo
classifier using the Utah Department of Health emergency department gold standard.
Respiratory infection with fever*
Gastroenteritis without blood
Meningitis / encephalitis
Febrile illness with rash*
*Required documentation of fever in the patient record.
Courtesy Per Gesteland, MD
Hospital Pneumonia and Influenza Diagnoses
SDs from Mean
Ivanov and Gesteland
Detection from CCs precede that from admissions by 23 days Chief Complaints
(95% CI 12-33)
ICD-9s for gastroenteritis and rotavirus
Prospective Investigation of Signal Anomalies Chief Complaints
(…and other product categories related to the early symptomatic treatment of bioterrorism diseases)?
… Precautionary water advisory issued on 4/23
Detectable peak on 4/2 in sales of over-the-counter diarrheal remedies
3X increase in sales
Public health awareness April 5, 1993
Proctor et al. Surveillance data for waterborne illness detection: an assessment following a massive waterborne outbreak of Cryptosporidium infection. Epidemiol Infect. 1998;120(1):43-54.
***Proctor et al. Surveillance data for waterborne illness detection: an assessment following a massive waterborne outbreak of Cryptosporidium infection. Epidemiol Infect. 1998;120(1):43-54.
Fit curve using expectation-maximization algorithm
4.6 std dev increase
False Alarm Rate=25% Sales Data During a Real Outbreak
Probability of Detection
Detection Delay (days from start of inject)Average Detection Performance for a 4.6 SD North Battleford Perturbation into 500 U.S. Zip Codes
Maximum validity, but rare
Maximum validity, and answer question whether heretofore undetectable outbreaks can be detected, but expensive
Very important for exploring “detectability”