No other code sets other than the DoD-GEIS and CDC/DoD code sets appear to be in use in a functioning biosurveillance system. At present, DoD-GEIS code sets are in use in the ESSENCE biosurveillance system (Lombardo et al., 2003) and table 23.10 Two Examples of Intensional Definitions of CDC/DoD ICD Code Sets_
Syndrome Definition Condition
Botulism- ACUTE condition that may represent Botulism like exposure to botulinum toxin
ACUTE paralytic conditions consistent with botulism: cranial nerve VI (lateral rectus) palsy, ptosis, dilated pupils, decreased gag reflex, media rectus palsy ACUTE descending motor paralysis (including muscles of respiration) ACUTE symptoms consistent with botulism: diplopia, dry mouth, dysphagia, difficulty focusing to a near point Fever ACUTE potentially febrile illness of Not applicable origin not specified INCLUDES fever and septicemia not otherwise specified INCLUDES unspecified viral illness even though unknown if fever is present EXCLUDE entry in this syndrome category if more specific diagnostic code is present allowing same patient visit to be categorized as respiratory, neurological or gastrointestinal illness syndrome
CDC, Centers for Disease Control and Prevention; DoD, U.S. Department of Defense.
the CDC/DoD code sets are in use in the National Bioterrorism Syndromic Surveillance Demonstration Program (Yih et al., 2004). The other code sets that researchers describe in the literature were created for research studies.
For example, Lazarus et al. (2002) used a slight modification of ESSENCE code sets and also created an influenza-like illness (ILI) code set. They based this code set on the CDC sentinel surveillance definition of ILI, which is fever (body temperature measured in the office > 37.8°C) plus cough or sore throat without a known cause. Miller and colleagues created an ILI code set that includes 31 ICD codes (Miller et al., 2004). Most of the codes in the set are symptoms of influenza. Ritzwoller et al. (2005) created an ILI code set. This code set included codes for respiratory illness plus fever (780.6). Espino and Wagner (2001a) created a respiratory code set that includes 64 ICD codes. To create this code set, experts reviewed all ICD codes assigned as ED chief complaints over a three-year period. Tsui et al. (2001) created an influenza code set from this respiratory code set and viral illness ICD codes (Tsui et al., 2001). Ivanov created a gastrointestinal code set that includes 16 ICD codes (Ivanov et al., 2002). As with Espino and Wagner (2001a), experts reviewed all ICD codes assigned as ED chief complaints over a three-year period. Beitel et al. (2004) created respiratory, lower respiratory, and upper respiratory code sets. To create the respiratory code set, they merged ICD codes 460.00-519.xx (encompasses all "diseases of the respiratory system''), 786.xx (encompasses all "symptoms involving the respiratory system and other chest symptoms''), and the ESSENCE respiratory code set except ICD code 079.99 (Viral syndrome). They then divided respiratory into lower respiratory and upper respiratory based on the part of the respiratory system implied by the code. When a code did not imply any anatomy or implied anatomy that spanned the upper and lower parts of the respiratory system, they added it to the upper respiratory set.
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