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. 2007 Sep 2:333–359. doi: 10.1016/B978-012369378-5/50025-9

TABLE 23.6.

Performance of Bayesian and other classifiers in detecting syndromes

Classifier Being Tested Reference Standard for Comparison Sensitivity (95% CI) Specificity (95% CI) Positive Likelihood Ratio (95% CI) Negative Likelihood Ratio (95% CI)
Respiratory Syndrome
Chief Complaint Utah Department of Health 0.52 0.89 5.0 0.54
Bayesian Classifier (UDOH) Respiratory with fever (0.51–0.54) (0.89–0.90) (4.74–5.22) (0.52–0.56)
Respiratory
(CCBC)a
CCBCb Human review of ED reports 0.77 0.90 7.9 0.26
(0.59–0.88) (0.88–0.92) (5.8–10.8) (0.13–0.49)
CCBCa Utah ICD-9 list 0.60 0.94 10.45 0.25 (0.13–0.49)
(0.59–0.62) (0.94–0.95) (9.99–10.96)
Manual Assignmentc Human review of ED reports 0.47 0.99 56.73 0.53 (0.46–0.63)
for Pediatric respiratory illness (0.38–0.55) (0.97–0.99) (18.12–177.59)
CCBCd ICD-9 list 0.63 0.94 11.14 0.39
(0.63–0.64) (0.94–0.94) (11.00–11.30) (0.39–0.40)
CCBCe Human review of ED reports 0.34 0.98 18.0 0.67
(0.30–0.38) (0.97–0.99) (11.24–28.82) (0.63–0.71)
CCBC Respiratory Human review of ED reports 0.02 0.99 20.83 0.99
and Keyword Fevere for Febrile respiratory (0.01–0.04) (0.99–1.0) (2.18–199.28) (0.97–1.0)
Gastrointestinal (GI) Syndrome
CCBC GIa UDOH Gastroenteritis 0.71 0.90 7.34 0.32
without blood (0.69–0.74) (0.90–0.90) (6.98–7.72) (0.29–0.35)
CCBC GIf Human review of ED reports 0.63 0.94 7.77 0.40
for Acute infectious GI (0.35–0.85) (0.92–0.96) (4.77–12.65) (0.20–0.80)
CCBCa Utah ICD-9 list 0.74 0.92 9.5 0.28
(0.72–0.76) (0.92–0.92) (9.04–9.94) (0.26–0.30)
CCBCd ICD-9 list 0.69 0.96 15.70 0.32
(0.68–0.70) (0.96–0.96) (15.46–15.95) (0.32–0.33)
CCBCe Human review of ED reports 0.22 0.90 2.09 0.87
(0.16–0.29) (0.88–0.91) (1.51–2.91) (0.80–0.95)
CCBC GI and Keyword Human review of ED reports 0.04 0.99 60.82 0.96
Fevere
Neurologic/Encephalitic for Febrile GI Syndrome (0.02–0.08) (0.99–1.0) (7.65–483.45) (0.93–0.99)
CCBC Neurologica UDOH Meningitis/Encephalitis 0.47 0.93 4383.26g 0.53
(0.32–0.63) (0.93–0.94) (1394.21–13780.56) (0.39–0.72)
CCBCa Utah ICD-9 list 0.72 0.95 13.5 0.29
(0.69–0.76) (0.94–0.95) (12.57–14.41) (0.26–0.33)
CCBCd ICD-9 list 0.68 0.93 9.25 0.35
(0.67–0.69) (0.93–0.93) (9.076–9.418) (0.34–0.36)
CCBCe Human review of ED reports 0.31 0.97 8.89 0.72
(0.27–0.35) (0.95–0.98) (6.25–12.65) (0.68–0.76)
CCBC Neurologic and Human review of ED reports 0.03 0.99 12.79 0.98
Keyword Fevere for Febrile Neurologic (0.01–0.07) (0.99–1.0) (2.89–56.59) (0.95–1.0)
Constitutional Syndrome
CCBCd ICD-9 list 0.46 0.97 13.65 0.56
(0.45–0.47) (0.97–0.98) (13.30–14.0) (0.55–0.57)
CCBCe Human review of ED reports 0.27 0.95 5.12 0.77
(0.23–0.32) (0.93–0.96) (3.82–6.85) (0.72–0.82)
Rash syndrome
CCBC Rasha UDOH Febrile illness with 0.50 0.99 55.6 0.51
rash (0.40–0.59) (0.99–0.99) (44.25–69.91) (0.42–0.61)
CCBCa Utah ICD-9 0.60 0.99 80.9 0.40
(0.52–0.67) (0.99–0.99) (67.43–97.07) (0.33–0.49)
CCBCd ICD-9 list 0.47 0.99 65.25 0.54
(0.45–0.49) (0.99–0.99) (61.79–68.90) (0.52–0.56)
CCBCe Human review of ED reports 0.31 0.99 34.01 0.70
(0.24–0.39) (0.98–1.0) (18.76–61.68) (0.62–0.78)
CCBC Rash and Human review of ED reports 0.12 1.0 h 0.88
Keyword Fevere for Febrile rash (0.05–0.27) (0.99–1.0) (0.78–1.0)
Hemorrhagic Syndrome
CCBCd ICD-9 list 0.75 0.99 49.01 0.25
(0.74–0.76) (0.98–0.99) (47.79–50.25) (0.24–0.26)
CCBCe Human review of ED reports 0.39 0.99 36.61 0.62
(0.34–0.44) (0.98–0.99) (20.96–63.93) (0.57–0.68)
CCBC Hemorrhagic Human review of ED reports 0.0 1.0 h 1.0
and Keyword Fevere for Febrile hemorrhagic (0–0.07) (1.0–1.0) (1.0–1.0)
Reference Standard Sensitivity Specificity Positive Likelihood Negative Likelihood
Classifier Being Tested for Comparison (95% CI) (95% CI) Ratio (95% CI) Ratio (95% CI)
Botulinic syndrome
CCBCa UDOH Botulism-like 0.17 0.998 104.45 0.83
(0.05–0.45) (0.998–0.999) (28.57–381.86) (0.64–1.07)
CCBCa Utah ICD-9 list 0.22 0.999 166.94 0.78
(0.13–0.36) (0.998–0.999) (89.07–312.90) (0.67–0.91)
CCBCd ICD-9 list 0.30 0.99 44.26 0.70
(0.28–0.32) (0.99–0.99) (41.06–47.70) (0.68–0.72)
CCBCe Human review of ED reports 0.10 0.99 10.96 0.91
(0.06–0.17) (0.99–1.0) (5.11–23.48) (0.86–0.97)
Fever
Keywordg Human review of ED reports 0.61 1.0 h 0.39
(0.51–0.69) (0.96–1.0) (0.31–0.49)
a

From Wagner, M., Espino, J., Tsui, F.-C., et al. (2004). Syndrome and outbreak detection from chief complaints: the experience of the Real-Time Outbreak and Disease Surveillance Project. MMWR Morb Mortal Wkly Rep 53(Suppl):28–31, with permission.

b

From Chapman, W. W., Espino, J. U., Dowling, J. N., et al. (2003). Detection of Acute Lower Respiratory Syndrome from Chief Complaints and ICD-9 Codes. Technical Report, CBMI Report Series 2003. Pittsburgh, PA: Center for Biomedical Informatics, University of Pittsburgh, with permission.

c

From Beitel, A. J., Olson, K. L., Reis, B. Y., et al. (2004). Use of emergency department chief complaint and diagnostic codes for identifying respiratory illness in a pediatric population. Pediatr Emerg Care 20:355–60, with permission.

d

From Chapman, W. W., Dowling, J. N., and Wagner, M. M. (2005). Classification of emergency department chief complaints into seven syndromes: a retrospective analysis of 527,228 patients. Ann Emerg Med 46(5):445–455.

e

From Chapman WW, unpublished results.

f

From Ivanov, O., Wagner, M. M., Chapman, W. W., et al. (2002). Accuracy of three classifiers of acute gastrointestinal syndrome for syndromic surveillance. In: Proceedings of American Medical Informatics Association Symposium, 345–9, with permission.

g

From Chapman, W. W., Dowling, J. N., Wagner, M. M. (2004). Fever detection from free-text clinical records for biosurveillance. J Biomed Inform 2004;120–7, with permission.

g

Large positive likelihood ratio due to specificity of 0.9999.

h

Not able to calculate (denominator is zero). CCBC, Chief complaint Bayesian classifier CI, confidence interval.