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The Value of Patient Self-report for Disease Surveillance

^a Division of Emergency Medicine, Children’s Hospital, Boston, MA
^b Clinical Research Program, Children’s Hospital, Boston, MA
^c Department of Pediatrics, Harvard Medical School, Boston, MA
^d Department of Biostatistics, Harvard School of Public Health, Boston, MA
^e Department of Epidemiology, Harvard School of Public Health, Boston, MA
^f Children’s Hospital Informatics Program at the Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA

^_* Correspondence: Florence T Bourgeois MD, MPH, Division of Emergency Medicine, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115 (Email: florence.bourgeois{at}childrens.harvard.edu).

Received for publication: 04/24/06; accepted for publication: 07/14/07.

Objective: To determine the accuracy of self-reported information from patients and families for use in a disease surveillance system.

Design: Patients and their parents presenting to the emergency department (ED) waiting room of an urban, tertiary care children’s hospital were asked to use a Self-Report Tool, which consisted of a questionnaire asking questions related to the subjects’ current illness.

Measurements: The sensitivity and specificity of three data sources for assigning patients to disease categories was measured: the ED chief complaint, physician diagnostic coding, and the completed Self-Report Tool. The gold standard metric for comparison was a medical record abstraction.

Results: A total of 936 subjects were enrolled. Compared to ED chief complaints, the Self-Report Tool was more than twice as sensitive in identifying respiratory illnesses (Rate ratio [RR]: 2.10, 95% confidence interval [CI] 1.81–2.44), and dermatological problems (RR: 2.23, 95% CI 1.56–3.17), as well as significantly more sensitive in detecting fever (RR: 1.90, 95% CI 1.67–2.17), gastrointestinal problems (RR: 1.10, 95% CI 1.00–1.20), and injuries (RR: 1.16, 95% CI 1.08–1.24). Sensitivities were also significantly higher when the Self-Report Tool performance was compared to diagnostic codes, with a sensitivity rate ratio of 4.42 (95% CI 3.45–5.68) for fever, 1.70 (95% CI 1.49–1.93) for respiratory problems, 1.15 (95% CI 1.04–1.27) for gastrointestinal problems, 2.02 (95% CI 1.42–2.87) for dermatologic problems, and 1.06 (95% CI 1.01–1.11) for injuries.

Conclusions: Disease category assignment based on patient-reported information was significantly more sensitive in correctly identifying a disease category than data currently used by national and regional disease surveillance systems.