Although there is the occasional perception that a biosurveillance organization must choose between collecting chief complaints or ICD codes, this is a false issue. They each have strengths and limitations. They vary in availability by healthcare organization, time latencies, and the accuracy with which they can discriminate among different syndromes and diagnoses. Outbreaks vary in their rapidity, early syndromic presentation, and whether they cause people to seek hospital care versus outpatient care. It is likely that future research will show that chief complaints are superior to ICD codes for monitoring for some outbreaks and ICD codes are superior for other outbreaks.
At the present time, the strongest statement about their respective roles is that chief complaints—because of the low time latency—may prove to be more useful for detecting sudden events. ICD codes—because of their ability to support more diagnostically precise syndromes (or disease categories)— may prove to be more useful for detecting smaller outbreaks.
A biosurveillance organization should collect and analyze both. Algorithms for case detection can utilize both types of data (Chapter 13). Because chief complaints and ICD-codes are associated with a specific patient, it is possible to link them (and other data) to improve the sensitivity and specificity of case detection.
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