Automated real time constant-specificity surveillance for disease outbreaks

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Automated real time constant-specificity surveillance for disease outbreaks

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Title: Automated real time constant-specificity surveillance for disease outbreaks
Author: Wieland, Shannon C; Berger, Bonnie; Brownstein, John Samuel; Mandl, Kenneth David

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Citation: Wieland, Shannon C, John S Brownstein, Bonnie Berger, and Kenneth D Mandl. 2007. Automated real time constant-specificity surveillance for disease outbreaks. BMC Medical Informatics and Decision Making 7: 15.
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Abstract: Background: For real time surveillance, detection of abnormal disease patterns is based on a difference between patterns observed, and those predicted by models of historical data. The usefulness of outbreak detection strategies depends on their specificity; the false alarm rate affects the interpretation of alarms. Results: We evaluate the specificity of five traditional models: autoregressive, Serfling, trimmed seasonal, wavelet-based, and generalized linear. We apply each to 12 years of emergency department visits for respiratory infection syndromes at a pediatric hospital, finding that the specificity of the five models was almost always a non-constant function of the day of the week, month, and year of the study (p < 0.05). We develop an outbreak detection method, called the expectation-variance model, based on generalized additive modeling to achieve a constant specificity by accounting for not only the expected number of visits, but also the variance of the number of visits. The expectation-variance model achieves constant specificity on all three time scales, as well as earlier detection and improved sensitivity compared to traditional methods in most circumstances. Conclusion: Modeling the variance of visit patterns enables real-time detection with known, constant specificity at all times. With constant specificity, public health practitioners can better interpret the alarms and better evaluate the cost-effectiveness of surveillance systems.
Published Version: doi://10.1186/1472-6947-7-15
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