Syndrome Creation

Previous reports have demonstrated the media’s influence on emergency departments (ED) visits in situations such as dramatized acetaminophen overdose, media report of celebrity suicides, television public announcements for early stroke care and cardiac visits following President Clinton’s heart surgery. No previous study has demonstrated the influence of media-publicized trauma on ED visits. On 16 March 2009, the actress Natasha Richardson suffered a traumatic brain injury leading to her death on 18 March; these events were widely publicized by national news sources. The health departments of New York City, Boston, Duval County and Seattle monitor ED visits daily, and capture 95, 100, 100 and 95% of all ED visits, respectively. The data collected include basic demographic information, chief complaint and in some cases ICD-9 diagnosis codes.

Objective

This study describes an increase in head trauma-related visits to ED in New York City, New York; Boston, Massachusetts; Duval County, Florida; and Seattle, Washington following the widespread media coverage of actress Natasha Richardson’s head injury and subsequent fatal epidural hematoma.

Medically unexplained syndromes (MUS) are conditions that are diagnosed on the basis of symptom constellations and are characterized by a lack of well-defined pathogenic pathways. The three most common MUS are chronic fatigue syndrome, irritable bowel syndrome, and fibromyalgia. Different types of persistent symptoms, originating from different organ systems, characterize these syndromes. Patients often meet the criteria for more than one MUS.

Objectives

We sought to develop a guideline and annotation schema that can be consistently applied to identify MUS found in VA clinical documents. These efforts will support building a reference standard used for training and evaluation of a Natural Language Processing system developed for automated symptom extraction. Our overarching goal is to characterize the occurrence of MUS in Operation Enduring Freedom/Operation Iraqi Freedom veterans.