Emergency Department Chief Complaint Versus Discharge Diagnosis for Tracking Disease Measures


ESSENCE is a web-based syndromic surveillance system utilized by DHMH to detect and track outbreaks, suspicious patterns of illness, public health emergencies, and biological threats. ESSENCE ED chief complaint data is collected daily from 47 emergency departments in Maryland (all 45 acute care hospitals and 2 freestanding emergency medical facilities). A chief complaint in ESSENCE is a free text field that lists the patient’s reason for the ED visit upon arrival at the hospital. Chief complaint data may be comprehensive or abbreviated and may include a single reason or multiple reasons for the ED visit. Medical history may be included in chief complaint data, which can create low specificity (false positive cases). Chief complaint data alone may yield less accurate modeling and lower outbreak detection sensitivity. This analysis evaluates whether counts of chief complaints are appropriate indicators of disease burden for several specific illnesses, by comparing chief complaints to their corresponding discharge diagnoses.


The state of Maryland has incorporated chief complaint data from 100% of its acute care emergency departments (ED) into the Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE). In 2012, the Maryland Department of Health and Mental Hygiene (DHMH) began using this statewide disease surveillance system to track several specific disease measures including certain chronic diseases. The validity of using ESSENCE ED data to track and analyze these health outcomes was evaluated.

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Original Publication Year: 
Event/Publication Date: 
December, 2013

August 22, 2018

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