Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2007 Mar-Apr;14(2):206-11.
doi: 10.1197/jamia.M2253. Epub 2007 Jan 9.

Linking surveillance to action: incorporation of real-time regional data into a medical decision rule

Andrew M Fine  1 , Lise E Nigrovic, Ben Y Reis, E Francis Cook, Kenneth D Mandl
Affiliations

Linking surveillance to action: incorporation of real-time regional data into a medical decision rule

Andrew M Fine et al. J Am Med Inform Assoc. 2007 Mar-Apr.

Abstract

Objective: Broadly, to create a bidirectional communication link between public health surveillance and clinical practice. Specifically, to measure the impact of integrating public health surveillance data into an existing clinical prediction rule. We incorporate data about recent local trends in meningitis epidemiology into a prediction model differentiating aseptic from bacterial meningitis.

Design and measurements: Retrospective analysis of a cohort of all 696 children with meningitis admitted to a large urban pediatric hospital from 1992 to 2000. We modified a published bacterial meningitis score by adding a new epidemiological context adjustor variable. We examined 540 possible rules for this adjustor, varying both the number of aseptic meningitis cases that needed to be seen, and the recent time window in which they were seen. We performed sensitivity analyses with each of 540 possibilities in order to identify the optimal rule--namely, the one that included the most cases of aseptic meningitis without missing additional cases of bacterial meningitis, as compared with the published prediction model. We used bootstrap methods to validate this new score.

Results: The optimal rule was found to be: "at least four cases of aseptic meningitis in the previous 10 days." The epidemiological context adjustor based on surveillance of recent cases of meningitis allowed the correct identification of an additional 47 cases (7%) of aseptic meningitis without missing any additional cases of bacterial meningitis. The epidemiological context adjustor was validated, showing significance in 84% of 1,000 bootstrap samples.

Conclusion: Epidemiological contextual information can improve the performance of a clinical prediction rule. We provide a methodological framework for leveraging regional surveillance data to improve medical decision-making.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Sensitivity for bacterial meningitis (ability of score to identify bacterial meningitis) using epidemiological context adjustor at different cut-offs.
Figure 2
Figure 2
Specificity for bacterial meningitis (ability of score to identify aseptic meningitis) using epidemiological context adjustor at different cut-offs.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Laupacis A, Sekar N, Stiell IG. Clinical prediction rulesA review and suggested modifications of methodological standards. JAMA 1997;277:488-494. - PubMed
    1. Reilly BM, Evans AT. Translating clinical research into clinical practice: impact of using prediction rules to make decisions Ann Intern Med 2006;144:201-209. - PubMed
    1. Parker AA, Staggs W, Dayan GH, Ortega-Sanchez IR, Rota PA, Lowe L, et al. Implications of a 2005 measles outbreak in Indiana for sustained elimination of measles in the United States N Engl J Med 2006;355:447-455. - PubMed
    1. Kahneman D, Slovic P, Tversky A. Judgment under Uncertainty: Heuristics and Biases. New York: Cambridge University Press; 1982.
    1. Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them Acad Med 2003;78:775-780. - PubMed

Publication types