NICC Creates Pathway to Update Chief Complaint

Community of Practice Technical Committee tackles a challenging issue

The NSSP Data Dictionary includes the term NICC, which is such a useful part of the NSSP vocabulary that it deserves thorough explanation. NICC stands for non-informative chief complaint. For background, sometimes NSSP receives chief complaint terms that are not informative. By "not informative," we mean that although the chief complaint may have a non-null value, the value itself may add negligible, if any, value to syndromic surveillance. For example, a chief complaint value of "unknown" is not informative.

Early versions of NSSP–ESSENCE would ingest and store the first non-null chief complaint value sent for a visit, regardless of the value of the chief complaint itself. For example, if the first non-null chief complaint was "unknown," then ESSENCE's chiefcomplaintorig and chiefcomplaintparsed columns would retain the value "unknown" despite receiving additional or more informative chief complaint data for that visit.

Further, using the same example, the DD portion of CCDD would also have "unknown." This was problematic because there may have been more informative chief complaint data reported for a visit but not reflected in ESSENCE chief complaint fields (including CCDD) and, thus, not considered in some CCDD categories.

The NSSP Community of Practice Technical Committee compiled a list of commonly used NICC terms. (See NICC Terminology table below.) The Technical Committee recommended that NSSP consider alternate processing rules when ingesting chief complaint data into ESSENCE. These processing rules would account for the possibility of a NICC term being reported as the first non-null chief complaint and the subsequent informative chief complaints not being leveraged. On the basis of this recommendation, the NSSP–ESSENCE ingestion process was modified.

The NSSP ingestion process continues to use the first non-null chief complaint during ingestion, even if the first non-null is a NICC. However, the current processing will "overwrite" a NICC chief complaint when a subsequent informative chief complaint is reported (in other words, a chief complaint value that is not on the NICC list).

Let's take an example of several messages and records associated with the same visit (ESSENCEID). Notice the ChiefComplaintOrig values reflected in the data reported in the messages. The first non-null is a NICC value: "Chief Complaint Not Present." However, other messages following this first message contain chief complaint data that are more informative.

How ESSENCE processed these data before the enhancement

Here's what a collapsed "one row" of data in ESSENCE looked like with the original processing rules:

Notice the non-informative value is now overwritten with the subsequently reported informative value.