PT  - JOURNAL ARTICLE
AU  - Steven Horng
AU  - Nathaniel R. Greenbaum
AU  - Larry A. Nathanson
AU  - James C McClay
AU  - Foster R. Goss
AU  - Jeffrey A. Nielson
TI  - Consensus Development of a Modern Ontology of Emergency Department Presenting Problems – the HierArchical Presenting Problem ontologY (HaPPy)
AID  - 10.1101/126870
DP  - 2017 Jan 01
TA  - bioRxiv
PG  - 126870
4099  - http://biorxiv.org/content/early/2017/04/12/126870.short
4100  - http://biorxiv.org/content/early/2017/04/12/126870.full
AB  - Objective Numerous attempts have been made to create a standardized ‘presenting problem’ or ‘chief complaint’ list to characterize the nature of an Emergency Department visit. Previous attempts have failed to gain widespread adoption as none were freely sharable and contained the right level of specificity, structure, and clinical relevance to gain acceptance by the larger emergency medicine community. Using real-world data, we constructed a presenting problem list that addresses these challenges.Materials and Methods We prospectively captured the presenting problems for 112,612 consecutive emergency department patient encounters at an urban, academic, Level I trauma center. No patients were excluded. We used a modified Delphi consensus process to iteratively derive our system using real-world data. We used the first 95% of encounters to derive our ontology; the remaining 5% for validation. All concepts were mapped to SNOMED-CT.Results Our system consists of a polyhierarchical ontology containing 690 unique concepts, 2,113 synonyms, and 30,605 non-visible descriptions to correct misspellings and non-standard terminology. Our ontology successfully captured structured data for 95.8% of visits in our validation dataset.Discussion and Conclusion We present the HierArchical Presenting Problem ontologY (HaPPy). This ontology was empirically derived then iteratively validated by an expert consensus panel. HaPPy contains 690 presenting problem concepts, each concept being mapped to SNOMED-CT. This freely sharable ontology should help to facilitate presenting problem based quality metrics, research, and patient care.