Analysis of the Korean Emergency Department Syndromic Surveillance System: Mass Type Acute Diarrheal Syndrome

Ahn, Shin; Lee, Jae Ho; Kim, Won; Lim, Kyung Soo

EDSS was introduced as the epidemics of infectious diseases and bioterrorismal threats were issued globally. If performed effectively, it could offer great opportunities for early detection and preparedness for the target diseases or accidents like bioterrorism. It is crucial to systematize its adoption and application, and successive amelioration of current system is indispensable. Attempts to improve accuracies in the EDSS were made. Beitel et al. [4] , in their study of pediatric population, reported that using the ICD-9 code alone or in combination with the chief complaint code improved identification of respiratory syndromes than using the chief complaint code alone, and Fleischauer et al. [5] reported the ICD-9 code provides better performance than the chief complaint code in the EDSS. But the limitations in using the diagnostic code are the variance in coding, errors in input, time consumption until the diagnosis being made and changes in the confirmative diagnosis after short term emergency care. On the contrary, using the chief complaint enables early detection, one of the main objects in surveillance system, and therefore numerous medical institute use this code in their surveillance systems [11, 12] . Some studies stress on the capability of early detection, and to improve the sensitivity of surveillance system, they modified their preexisting chief complaint codes by adding other chief complaints that were not related to specific disease and were not included previously [4] . Despite diverse attempts in improving syndromic surveillance performance in other countries, the Korean EDSS still maintains the method of inputting data manually to the computer by the reporter's judgment. After all, accurate data couldn't be reported, and the EDSS could not play its role properly. Our institution developed our own EDSS program named Emergency Room Syndrome Surveillance (Figure 4 ). Its main purpose was to enable the emergency department administrator to detect early the increase in the number of target syndromes visiting emergency room, and to allow the emergency practitioners for preliminary actions towards the target syndromes, so they could serve as a frontline vigilance in our own hospital. It is automated, real time monitoring system. Data regarding target syndromes are gathered automatically. This process is carried out by collecting the daily numbers of patients' chief complaints which are related to target syndromes, and total number of each syndromic patient is displayed in our electronic medical record system. So whenever the number of target syndromic patient is increased much more than previous data, emergency doctors and nurses can specifically pay attention to the related disease and be prepared. If the program mentioned above were applied to the Korean EDSS, improvement of the accuracy of the system's performance by ameliorating the passive and manual method of daily reports could be expected.