Westheimer Emily, Paladini Marc, Balter Sharon, Weiss Don, Fine Anne, Nguyen Trang Quyen
PLoS Curr. 2012 Aug 17;4:e500563f3ea181. doi: 10.1371/500563f3ea181.
To use laboratory data to assess the specificity of syndromes used by the New York City emergency department (ED) syndromic surveillance system to monitor influenza activity.
For the period from October 1, 2009 through March 31, 2010, we examined the correlation between citywide ED syndrome assignment and laboratory-confirmed influenza and respiratory syncytial virus (RSV). In addition, ED syndromic data from five select NYC hospitals were matched at the patient and visit level to corresponding laboratory reports of influenza and RSV. The matched dataset was used to evaluate syndrome assignment by disease and to calculate the sensitivity and specificity of the influenza-like illness (ILI) syndrome.
Citywide ED visits for ILI correlated well with influenza laboratory diagnoses (R=0.92). From October 1, 2009, through March 31, 2010, there were 264,532 ED visits at the five select hospitals, from which the NYC Department of Health and Mental Hygiene (DOHMH) received confirmatory laboratory reports of 655 unique cases of influenza and 1348 cases of RSV. The ED visit of most (56%) influenza cases had been categorized in the fever/flu syndrome; only 15% were labeled ILI. Compared to other influenza-related syndromes, ILI had the lowest sensitivity (15%) but the highest specificity (90%) for laboratory-confirmed influenza. Sensitivity and specificity varied by age group and influenza activity level.
The ILI syndrome in the NYC ED syndromic surveillance system served as a specific but not sensitive indicator for influenza during the 2009-2010 influenza season. Despite its limited sensitivity, the ILI syndrome can be more informative for tracking influenza trends than the fever/flu or respiratory syndromes because it is less likely to capture cases of other respiratory viruses. However, ED ILI among specific age groups should be interpreted alongside laboratory surveillance data. ILI remains a valuable tool for monitoring influenza activity and trends as it facilitates comparisons nationally and across jurisdictions and is easily communicated to the public.
利用实验室数据评估纽约市急诊科（ED）症状监测系统用于监测流感活动的综合征的特异性。
在2009年10月1日至2010年3月31日期间，我们研究了全市急诊科综合征诊断与实验室确诊的流感及呼吸道合胞病毒（RSV）之间的相关性。此外，选取了纽约市五家医院的急诊科症状数据，在患者和就诊层面与相应的流感和RSV实验室报告进行匹配。匹配后的数据集用于按疾病评估综合征诊断，并计算流感样疾病（ILI）综合征的敏感性和特异性。
全市急诊科ILI就诊情况与流感实验室诊断结果相关性良好（R = 0.92）。2009年10月1日至2010年3月31日期间，五家选取医院的急诊科就诊患者有264,532例，纽约市卫生和精神卫生部门（DOHMH）收到了655例流感确诊病例和1348例RSV病例的实验室确诊报告。大多数（56%）流感病例的急诊科就诊被归类为发热/流感综合征；只有15%被标记为ILI。与其他流感相关综合征相比，ILI对实验室确诊流感的敏感性最低（15%），但特异性最高（90%）。敏感性和特异性因年龄组和流感活动水平而异。
纽约市急诊科症状监测系统中的ILI综合征在2009 - 2010年流感季节是流感的一个特异性但不敏感的指标。尽管其敏感性有限，但ILI综合征在追踪流感趋势方面比发热/流感或呼吸道综合征更具信息价值，因为它不太可能捕获其他呼吸道病毒病例。然而，特定年龄组的急诊科ILI应结合实验室监测数据进行解读。ILI仍然是监测流感活动和趋势的宝贵工具，因为它便于在全国范围内和不同辖区之间进行比较，并且易于向公众传达。
