TABLE 23.2.

CoCo Syndrome Definitions

CoCo Syndrome	Definition
Gastrointestinal	Includes pain or cramps anywhere in the abdomen, nausea vomiting, diarrhea and abdominal distension or swelling.
Constitutional	Is made up of nonlocalized, systemic problems including fever, chills, body aches, flu symptoms (viral syndrome), weakness, fatigue, anorexia, malaise, irritability, weight loss, lethargy, sweating (diaphoresis), light headedness, faintness and fussiness.
	Shaking (not chills) is not constitutional but is other. Includes all of the “vaguely unwell” terms: doesn't feel well, feels ill, feeling sick or sick feeling, feels bad all over, not feeling right, sick, in pain, poor vital signs.
	Shaking or shaky or trembling (not chills) are not constitutional but are other (8).
	However, tremor(s) is neurological (7).
	Note: cold usually means a URI (cold symptoms; 3), not chills. Weakness, especially localized, is often neurological (7), rather than constitutional.
Respiratory	Includes the nose (coryza) and throat (pharyngitis), as well as the lungs. Examples of respiratory include congestion, sore throat, tonsillitis, sinusitis, cold symptoms, bronchitis, cough, shortness of breath, asthma, chronic obstructive pulmonary disease (COPD), pneumonia, hoarseness, aspiration, throat swelling, pulmonary edema (by itself; if combined with congestive heart failure, it is 8). If both cold symptoms and flu symptoms are present, the syndrome is respiratory.
	Note: “Sore throat trouble swallowing” is respiratory, not respiratory and botulinic. That is, the difficulty in swallowing is assumed to be an aspect of the sore throat.
Rash	Includes any description of a rash, such as macular, papular, vesicular, petechial, purpuric or hives. Ulcerations are not normally considered a rash unless consistent with cutaneous anthrax (an ulcer with a black eschar).
	Note: Itch or itchy by itself is not a rash.
Hemorrhagic	Is bleeding from any site except the central nervous system, e.g., vomiting blood (hematemesis), nose bleed (epistaxis), hematuria, gastrointestinal bleeding (site unspecified), rectal bleeding and vaginal bleeding. Bleeding from a site for which we have a syndrome should be classified as hemorrhagic and as the relevant syndrome (e.g., Hematochesia is gastrointestinal and hemorrhagic; hemoptysis is respiratory and hemorrhagic). Bleeding from a site for which we have a syndrome should be classified as hemorrhagic only without reference to the relevant syndrome, except hematochesia… hemoptysis.
	Note: “Spitting up blood” is assumed to be hemoptysis.
Botulinic	Includes ocular abnormalities (diplopia, blurred vision, photophobia), difficulty speaking (dysphonia, dysarthria, slurred speech) and difficulty swallowing (dysphagia).
Neurological	Covers nonpsychiatric complaints which relate to brain function. Included are headache, head pain, migraine, facial pain or numbness, seizure, tremor, convulsion, loss of consciousness, syncope, fainting, ataxia, confusion, disorientation, altered mental status, vertigo, concussion, meningitis, stiff neck, tingling, numbness, cerebrovascular accident (CVA; cerebral bleed), tremor(s), vision loss or blindness (but changed or blurred vision or vision problem is botulinic). Dizziness is constitutional and neurological.
	Note: headache can be constitutional is some contexts, for example, “headache cold sxs achey” or “headache flu sxs.”
Other	Is a pain or process in a system or area we are not monitoring. For example, flank pain most likely arises from the genitourinary system, which we are not modeling, and would be considered other. Chest pain with no mention of the source of the pain is considered other (e.g., chest pain [other] versus pleuritic chest pain [respiratory]). Earache or ear pain is other. Trauma is other. Hepatic encephalopathy (not neurological), dehydration (not constitutional), difficulty sleeping or inability to sleep (not constitutional), constipation (not constitutional), and choking (but aspiration is respiratory) are all other.

Note: A physician or other medical expert refers to these definitions when creating training examples for the CoCo Bayesian classifier (described in Chapter 17).