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BACKGROUND: Syndromic surveillance uses prediagnostic data to detect events of public health interest as quickly as possible. Emergency department chief complaints are commonly used for timeliness—EpiCenter can notify the Ohio Department of Health within minutes of a patient mentioning ‘Ebola’ during registration—but their specificity is limited. Specificity is particularly critical in emerging situations where the likelihood of exposure is very low, media visibility is high, and the symptoms overlap with common illnesses. The experience with Ebola virus disease (EVD) in the US matches this scenario. A patient mentioning ‘ebola’ or ‘fever’ in their complaint is much more likely to have influenza or to be among the “worried well,” but genuine cases are not impossible and need to be identified quickly. Triage notes are a prediagnostic data source that could improve specificity in these scenarios. The objective of this work is to determine if they contain information that can be used to assess whether a patient meets the high risk criteria for Ebola virus exposure.
METHODS: Triage notes are collected on an ongoing basis from 58 hospitals in Ohio via their syndromic surveillance feed to the EpiCenter system. Triage notes were analyzed from the two month period following Frontier Flight 1143 from Cleveland on October 13th taken by a nurse later diagnosed with EVD. These notes were compared with corresponding chief complaints to determine if they could be used to assess the risk of exposure to the virus.
RESULTS: Shortly after October 13th, several patients sought testing after taking a different flight on the same plane. This history information was present in the triage notes, revealing a lack of close contact with a known patient and putting them at low risk for contracting EVD. Subsequently, many hospitals added specific history or exposure questions related to EVD to their triage process. These included questions about travel to West African nations where the Ebola outbreak is ongoing; travel to Dallas, TX where the known US cases had occurred; and contact with individuals diagnosed with EVD. These questions and the answers were included in the triage note data and made it possible to determine that none of the patients were in the high risk category.
CONCLUSIONS: The additional details on history and exposure in triage notes can be used in a syndromic surveillance setting to improve the specificity of prediagnostic evaluation when risk is low and public awareness is high.