We conclude this chapter with a brief overview of gold standards. We use the term gold standard to refer to data and methods that an evaluator can use to establish "ground truth'' about the existence and timing of an outbreak or of an individual case. An example of gold standard data is pneumonia and influenza surveillance data. An example of a gold standard method is ascertainment of disease status of individual patients by manual review of patient charts.
If an outbreak has been investigated and documented by a biosurveillance organization, the documentation will serve as an excellent gold standard for research. Otherwise, an evalua-tor will have to develop a gold standard if he wishes to conduct many of the above studies.
Examples of gold standards that have been used in biosurveillance research include:
• ICD-9—coded hospital discharge diagnoses
• ICD-9—coded outpatient billing diagnoses
• Influenza surveillance data
• Manual review of hospital charts
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