Development and Validation of a Syndrome Definition for Suspected Nonfatal Unintentional/Undetermined Intent Stimulant-Involved Overdoses

2021 ◽  
pp. 003335492110544
Author(s):  
Cassandra M. Pickens ◽  
Lawrence Scholl ◽  
Stephen Liu ◽  
Herschel Smith ◽  
Stephanie Snodgrass
Keyword(s):  
Decision Rules ◽  
Weighted Average ◽  
Signs And Symptoms ◽  
True Positive ◽  
Diagnosis Codes ◽  
Undetermined Intent ◽  
Chief Complaints ◽  
Control And Prevention ◽  
Ed Visits ◽  
Development And Validation

Objectives To monitor stimulant-involved overdose (SOD) trends, the Centers for Disease Control and Prevention (CDC) developed and evaluated the validity of a syndromic surveillance definition for suspected nonfatal, unintentional/undetermined intent stimulant-involved overdose (UUSOD). Methods We analyzed all emergency department (ED) visits in CDC’s surveillance system that met the UUSOD syndrome definition (January 2018–December 2019). We classified visits as true positive, possible, or not UUSODs after reviewing diagnosis codes and chief complaints. We first assessed whether visits were acute SODs, subsequently classifying acute SODs by intent. The percentage of true-positive UUSODs did not include intentional or possibly intentional visits. We considered all visits with UUSOD diagnosis codes to be acute SODs and reviewed them for intent. We manually reviewed and double-coded a 10% random sample of visits without UUSOD diagnosis codes using decision rules based on signs and symptoms. The overall percentage of true-positive UUSODs was a weighted average of the percentage of true-positive UUSODs based on diagnosis codes and the percentage of true-positive UUSODs determined by manually reviewing visits without codes. Results During 2018-2019, 40 045 ED visits met the syndrome definition for UUSOD. Approximately half (n = 18 793; 46.9%) of 40 045 visits had UUSOD diagnosis codes, indicating acute SOD; of these, 98.6% (n = 18 534) were true-positive UUSODs. Of 2125 manually reviewed visits without UUSOD diagnosis codes, 32.6% (n = 693) were true-positive UUSODs, 54.2% (n = 1151) were possible UUSODs, and 13.2% (n = 281) were not UUSODs. Overall, 63.6% of visits were true-positive UUSODs, 29.3% were possible UUSODs, and 7.1% were not UUSODs. Practice Implications CDC’s UUSOD definition may assist in surveillance efforts with further refinement to capture data on SOD clusters and trends.

scholarly journals Free-Text Mining to Improve Syndrome Definition Matching Across Emergency Departments

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Kristin Arkin
Keyword(s):  
Text Mining ◽  
Influenza Season ◽  
Chief Complaint ◽  
Free Text ◽  
Diagnosis Code ◽  
Diagnosis Codes ◽  
Chief Complaints ◽  
Group A ◽  
Ed Visits ◽  
Group B

ObjectiveWe sought to use free text mining tools to improve emergency department (ED) chief complaint and discharge diagnosis data syndrome definition matching across facilities with differing robustness of data in the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) application in Idaho’s syndromic surveillance system.IntroductionStandard syndrome definitions for ED visits in ESSENCE rely on chief complaints. Visits with more words in the chief complaint field are more likely to match syndrome definitions. While using ESSENCE, we observed geographic differences in chief complaint length, apparently related to differences in electronic health record (EHR) systems, which resulted in disparate syndrome matching across Idaho regions. We hypothesized that chief complaint and diagnosis code co-occurrence among ED visits to facilities with long chief complaints could help identify terms that would improve syndrome match among facilities with short chief complaints.MethodsThe ESSENCE-defined influenza-like illness (ILI) chief complaint syndrome was used as the base syndrome for this analysis. Syndrome-matched visits were defined as visits that match the syndrome definition.We assessed chief complaints and diagnosis code co-occurrence of syndrome-matched visits using the RCRAN TidyText package and developed a bigram network from normalized, concatenated chief complaint and diagnosis code (CCDD) fields and normalized diagnosis code (DD) fields per previously described methodologies.1 Common connections were defined by a natural break in frequency of pair occurrence for CCDD pairs (30 occurrences) and DD pairs (5 occurrences).The ESSENCE syndrome was revised by adding relevant bigram network clusters and logic operators. We compared time series of the percent of ED visits matched to the ESSENCE syndrome with those matched to the revised syndrome. We stratified the time series by facilities grouped by short (average < 4 words, “Group A”) and long (average ≥ 4 words, “Group B”) chief complaint fields (Figure 1). Influenza season start was defined as two consecutive weeks above baseline, or the 95% upper confidence limit of percent syndrome-matched visits outside of the CDC ILI surveillance season. Season trends and influenza-related deaths in Idaho residents were compared.ResultsDuring August 1, 2016 through July 31, 2017, 1,587 (1.17%) of 135,789 ED visits matched the ESSENCE syndrome. Bigram networks of CCDD fields produced clusters already included by the ESSENCE syndrome. The bigram network of DD fields (Figure 2) produced six clusters. The revised syndrome definition included the ESSENCE syndrome, 3 single DD terms, and 3 two DD terms combined. The start of influenza season was identified as the same week for both ILI syndrome definitions (ESSENCE baseline 0.70%; revised baseline 2.21%). The ESSENCE syndrome indicated the season peaked during Morbidity and Mortality Weekly Report (MMWR) week 2017-05 with the season ending MMWR week 2017-14. The revised syndrome indicated 2017-20 as the season end. Multiple peaks seen with the revised syndrome during MMWR weeks 2017-02, 2017-05, and 2017-10 mirrored peaks in influenza-related deaths during MMWR weeks 2017-03, 2017-06, and 2017-11.ILI season onset was five weeks earlier with the revised syndrome compared with the ESSENCE syndrome in Group A facilities, but remained the same in Group B. The annual percentage of ED visits related to ILI was more uniform between facility groups under the revised syndrome than the ESSENCE syndrome. Unlike the trend seen with the ESSENCE syndrome, the revised syndrome shows low-level ILI activity in both groups year-round.ConclusionsIn Idaho, dramatic differences in ED visit chief complaint word counts were seen between facilities; bigram networks were found to be an important tool to identify diagnosis codes and logical operators that built more inclusive syndrome definitions when added to an existing chief complaint syndrome. Bigram networks may aid understanding the relationship between chief complaints and diagnosis codes in syndrome-matched visits.Use of trade names and commercial sources is for identification only and does not imply endorsement by the Centers for Disease Control and Prevention, the Public Health Service, or the U.S. Department of Health and Human Services.References1. Silge, J., Robinson, D. (2017). “Text Mining with R”. O’Reilly.

scholarly journals Using Real-Time Syndromic Surveillance to Analyze the Impact of a Cold Weather Event in New Mexico

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Victoria F. Dirmyer
Keyword(s):  
Real Time ◽  
Syndromic Surveillance ◽  
Chief Complaint ◽  
Cold Weather ◽  
Weather Event ◽  
Diagnosis Codes ◽  
Chief Complaints ◽  
Icd 10 ◽  
Ed Visits ◽  
The Impact

Objective. This report describes the development of a novel syndromic cold weather syndrome for use in monitoring the impact of cold weather events on emergency department attendance. Methods. Syndromic messages from seven hospitals were analyzed for ED visits that occurred over a 12-day period. A cold weather syndrome was defined using terms in the self-reported chief complaint field as well as specific ICD-10-CM codes related to cold weather. A κ statistic was calculated to assess the overall agreement between the chief complaint field and diagnosis fields to further refine the cold weather syndrome definition. Results. Of the 3,873 ED visits that were reported, 487 were related to the cold weather event. Sixty-three percent were identified by a combination of diagnosis codes and chief complaints. Overall agreement between chief complaint and diagnosis codes was moderate (κ=0.50; 95% confidence interval = 0.48–0.52). Conclusion. Due to the near real-time reporting of syndromic surveillance data, analysis results can be acted upon. Results from this analysis will be used in the state’s emergency operations plan (EOP) for cold weather and winter storms. The EOP will provide guidance for mobilization of supplies/personnel, preparation of roadways and pedestrian walkways, and the coordination efforts of multiple state agencies.

scholarly journals 143. Initial Impact of COVID-19 on Ambulatory Antibiotic Prescribing for Respiratory Viral Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S82-S82
Author(s):  
Zahra Kassamali Escobar ◽  
Todd Bouchard ◽  
Jose Mari Lansang ◽  
Scott Thomassen ◽  
Joanne Huang ◽  
...  
Keyword(s):  
Primary Care ◽  
Viral Infections ◽  
Respiratory Infections ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Specific Rate ◽  
Inclusion Criteria ◽  
Diagnosis Codes ◽  
Control And Prevention ◽  
Viral Respiratory Infections

Abstract Background Between 15–50% of patients seen in ambulatory settings are prescribed an antibiotic. At least one third of this usage is considered unnecessary. In 2019, our institution implemented the MITIGATE Toolkit, endorsed by the Centers for Disease Control and Prevention to reduce inappropriate antibiotic prescribing for viral respiratory infections in emergency and urgent care settings. In February 2020 we identified our first hospitalized patient with SARS-CoV(2). In March, efforts to limit person-to-person contact led to shelter in place orders and substantial reorganization of our healthcare system. During this time we continued to track rates of unnecessary antibiotic prescribing. Methods This was a single center observational study. Electronic medical record data were accessed to determine antibiotic prescribing and diagnosis codes. We provided monthly individual feedback to urgent care prescribers, (Sep 2019-Mar 2020), primary care, and ED providers (Jan 2020 – Mar 2020) notifying them of their specific rate of unnecessary antibiotic prescribing and labeling them as a top performer or not a top performer compared to their peers. The primary outcome was rate of inappropriate antibiotic prescribing. Results Pre toolkit intervention, 14,398 patient visits met MITIGATE inclusion criteria and 12% received an antibiotic unnecessarily in Jan-April 2019. Post-toolkit intervention, 12,328 patient visits met inclusion criteria and 7% received an antibiotic unnecessarily in Jan-April 2020. In April 2020, patient visits dropped to 10–50% of what they were in March 2020 and April 2019. During this time the unnecessary antibiotic prescribing rate doubled in urgent care to 7.8% from 3.6% the previous month and stayed stable in primary care and the ED at 3.2% and 11.8% respectively in April compared to 4.6% and 10.4% in the previous month. Conclusion Rates of inappropriate antibiotic prescribing were reduced nearly in half from 2019 to 2020 across 3 ambulatory care settings. The increase in prescribing in April seen in urgent care and after providers stopped receiving their monthly feedback is concerning. Many factors may have contributed to this increase, but it raises concerns for increased inappropriate antibacterial usage as a side effect of the SARS-CoV(2) pandemic. Disclosures All Authors: No reported disclosures

Emergency Physicians Performing Point-of-Care Lung Sonography to Diagnose Pneumonia: A Prospective Multicenter Study

2021 ◽  
pp. 875647932098324
Author(s):  
Mohammad Amin Zare ◽  
Mahtab Mizani ◽  
Azadeh Sameti ◽  
Alireza Bahmani ◽  
Marzieh Fathi
Keyword(s):  
Multicenter Study ◽  
Predictive Value ◽  
Point Of Care ◽  
Signs And Symptoms ◽  
Clinical Syndrome ◽  
Emergency Physicians ◽  
Prospective Multicenter Study ◽  
Lung Sonography ◽  
Ed Visits ◽  
Limited Accuracy

Objective: There has always been some issues in the accurate diagnosis of pneumonia, a common cause of emergency department (ED) visits and revisits, which is typically made based on the patient’s clinical syndrome. This is made more difficult due to the traditional chest radiography having limited accuracy. This prospective multicenter study was conducted to determine the diagnostic accuracy of a point-of-care lung sonography performed by emergency physicians for the diagnosis of pneumonia in an acute care setting. This was compared with chest computed tomography (CT), the diagnostic gold standard. Methods: ED patients who presented with signs and symptoms of pneumonia were eligible to enroll in the study. After enrollment, point-of-care lung sonography was performed on patients by emergency physicians who had passed a focused teaching course on lung sonographic findings of pneumonia. All enrolled patients were followed up. Patients who underwent a chest CT during their hospital admission course were finally included and analyzed. Results: Emergency physicians who performed a point-of-care lung sonography had a sensitivity of 100%, specificity of 75%, positive predictive value of 88.88%, negative predictive value of 100%, and an overall accuracy of 90% in the diagnosis of pneumonia. Conclusion: These emergency physicians could accurately diagnose pneumonia, with a point-of-care lung sonography, after completing a focused sonography course.

Inconsistencies in Overdose Suicide Death Investigation Practice and Potential Remedies Using Technology: A Centers for Disease Control and Prevention Consultation Meeting Summary

2021 ◽  
pp. 192536212110224
Author(s):  
Melissa C. Mercado ◽  
Deborah M. Stone ◽  
Caroline W. Kokubun ◽  
Aimée-Rika T. Trudeau ◽  
Elizabeth Gaylor ◽  
...  
Keyword(s):  
System Integration ◽  
Data Privacy ◽  
Burden Of Proof ◽  
The United States ◽  
Privacy And Security ◽  
Death Scene ◽  
Undetermined Intent ◽  
Control And Prevention ◽  
Scene Description ◽  
Death Investigation

Introduction: It is widely accepted that suicides—which account for more than 47 500 deaths per year in the United States—are undercounted by 10% to 30%, partially due to incomplete death scene investigations (DSI) and varying burden-of-proof standards across jurisdictions. This may result in the misclassification of overdose-related suicides as accidents or undetermined intent. Methods: Virtual and in-person meetings were held with suicidologists and DSI experts from five states (Spring-Summer 2017) to explore how features of a hypothetical electronic DSI tool may help address these challenges. Results: Participants envisioned a mobile DSI application for cell phones, tablets, or laptop computers. Features for systematic information collection, scene description, and guiding key informant interviews were perceived as useful for less-experienced investigators. Discussion: Wide adoption may be challenging due to differences in DSI standards, practices, costs, data privacy and security, and system integration needs. However, technological tools that support consistent and complete DSIs could strengthen the information needed to accurately identify overdose suicides.

scholarly journals Interrupted time series design to evaluate ICD-9-CM to ICD-10-CM coding changes on trends in Colorado emergency department visits related to traumatic brain injury

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Lauren Alexis De Crescenzo ◽  
Barbara Alison Gabella ◽  
Jewell Johnson
Keyword(s):  
Public Health ◽  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Interrupted Time Series ◽  
Emergency Department Visits ◽  
Control And Prevention ◽  
Icd 10 ◽  
Ed Visits ◽  
The Impact

Abstract Background The transition in 2015 to the Tenth Revision of the International Classification of Disease, Clinical Modification (ICD-10-CM) in the US led the Centers for Disease Control and Prevention (CDC) to propose a surveillance definition of traumatic brain injury (TBI) utilizing ICD-10-CM codes. The CDC’s proposed surveillance definition excludes “unspecified injury of the head,” previously included in the ICD-9-CM TBI surveillance definition. The study purpose was to evaluate the impact of the TBI surveillance definition change on monthly rates of TBI-related emergency department (ED) visits in Colorado from 2012 to 2017. Results The monthly rate of TBI-related ED visits was 55.6 visits per 100,000 persons in January 2012. This rate in the transition month to ICD-10-CM (October 2015) decreased by 41 visits per 100,000 persons (p-value < 0.0001), compared to September 2015, and remained low through December 2017, due to the exclusion of “unspecified injury of head” (ICD-10-CM code S09.90) in the proposed TBI definition. The average increase in the rate was 0.33 visits per month (p < 0.01) prior to October 2015, and 0.04 visits after. When S09.90 was included in the model, the monthly TBI rate in Colorado remained smooth from ICD-9-CM to ICD-10-CM and the transition was no longer significant (p = 0.97). Conclusion The reduction in the monthly TBI-related ED visit rate resulted from the CDC TBI surveillance definition excluding unspecified head injury, not necessarily the coding transition itself. Public health practitioners should be aware that the definition change could lead to a drastic reduction in the magnitude and trend of TBI-related ED visits, which could affect decisions regarding the allocation of TBI resources. This study highlights a challenge in creating a standardized set of TBI ICD-10-CM codes for public health surveillance that provides comparable yet clinically relevant estimates that span the ICD transition.

scholarly journals Rare Dysplastic Gangliocytoma of Cerebellum: A Case Report

2020 ◽  
Author(s):  
Nidhish Kumar ◽  
Sharvani Singh ◽  
Bipin Kumar
Keyword(s):  
Obstructive Hydrocephalus ◽  
Tertiary Care ◽  
Signs And Symptoms ◽  
Cowden Syndrome ◽  
Verbal Response ◽  
Cerebellar Hemisphere ◽  
Cancer Syndrome ◽  
Dysplastic Gangliocytoma ◽  
Significant Family History ◽  
Chief Complaints

Lhermitte and Duclos first described Dysplastic Gangliocytoma in 1920. Lhermitte Duclos Disease (LDD) is an extremely rare disorder of uncertain prognosis and pathogenesis. LDD is recognised as a part of Cowden Disease, which being an autosomal-dominant phacomatosis and cancer syndrome. Till date only about 225 cases of LDD have currently been reported in medical literature. It is most commonly seen in young adults with a peak incidence in third or fourth decade with signs and symptoms of cerebellar dysfunction or increased intracranial pressure leading to obstructive hydrocephalus. A 36-year-old female came to Neuromedicine Outpatient Department (OPD) in a Tertiary Care Superspecialty Hospital with chief complaints of headache and vomiting, difficulty in swallowing liquid food since two months with no significant family history. The patient’s general condition was not good with significant weakness on presentation. The patient was conscious, oriented with pulse rate of 78/bpm, blood pressure of 118/80 mm of Hg with bilateral clear chest with normal S1 S2 sound. The Glasgow Coma Scale (GCS) was found to be Eye response-4, Verbal response-5, Motor response-6. Magnetic Resonance Imaging (MRI) of patient showed large heterogeneous non-enhancing lesion involving left cerebellar hemisphere, vermis and cerebellar peduncle with widened cerebellar folia with a “Tigroid appearance”. A diagnosis of Cerebellar Gangliocytoma was made and was treated successfully with surgery and diagnostically proven with biopsy and immunohistochemistry. The background history of Cowden syndrome was not present in index case.

scholarly journals EFFECT OF PERINEAL REPAIR AND MUSHAKADI TAILA MATRABASTI IN MANAGEMENT OF RECTAL PROLAPSE (GUDABHARMSA): A CASE STUDY

2020 ◽  
Vol 8 (8) ◽  
pp. 4267-4270
Author(s):  
Sapna Maheshwari ◽  
Harshit Shah ◽  
Pragnesh Patel
Keyword(s):  
Rectal Prolapse ◽  
Signs And Symptoms ◽  
Cost Effective ◽  
Complete Rectal Prolapse ◽  
Full Thickness ◽  
Perineal Repair ◽  
Chief Complaints ◽  
Surgical Options ◽  
External Rectal Prolapse

Rectal prolapse can present in a variety of forms and is associated with a range of symptoms including pain, incomplete evacuation, bloody and/or mucous rectal discharge, and fecal incontinence or constipa-tion. Complete external rectal prolapse is characterized by a circumferential, full-thickness protrusion of the rectum through the anus, which may be intermittent or may be incarcerated and poses a risk of strangu-lation. There are multiple surgical options to treat rectal prolapse, and thus care should be taken to under-stand each patient’s symptoms, bowel habits, anatomy, and pre-operative expectations. We propose an al-gorithm based on available outcomes data in the literature, an understanding of ano-rectal physiology, and expert opinion that can serve as a guide to determining the rectal prolapse operation that will achieve the best possible postoperative outcomes for individual patients. Mushakadi Taila Matrabasti will be given in Sushrut Samhita as a treatment1 with perineal repair. So, it is really needed to find a safe, easier, less com-plicating, cost effective and fruitful approach for the management of disease through Ayurveda. A 62year old male patient came to the hospital with chief complaints of protrusion of mass from the anus with mu-cous discharge, constipation since last 5 years. He was diagnosed as complete rectal prolapse. Considering the signs and symptoms of rectal prolapse, the treatment of rectal prolapsed was planned with perineal re-pair and Mushakadi Taila Matarabasti as per mentioned in the treatment of Gudabhransha by Aacharya Sushruta.

scholarly journals Developing Syndromic Surveillance to Monitor and Respond to Adverse Health Events Related to Psychoactive Substance Use: Methods and Applications

2017 ◽  
Vol 132 (1_suppl) ◽  
pp. 65S-72S ◽  
Author(s):  
Michelle L. Nolan ◽  
Hillary V. Kunins ◽  
Ramona Lall ◽  
Denise Paone
Keyword(s):  
Public Health ◽  
New York ◽  
New York City ◽  
York City ◽  
Syndromic Surveillance ◽  
Psychoactive Drug ◽  
Surveillance Systems ◽  
Chief Complaints ◽  
Level Information ◽  
Ed Visits

Introduction: Recent increases in drug overdose deaths, both in New York City and nationally, highlight the need for timely data on psychoactive drug-related morbidity. We developed drug syndrome definitions for syndromic surveillance to monitor drug-related emergency department (ED) visits in real time. Materials and Methods: We used 2012 archived syndromic surveillance data from New York City hospitals to develop definitions for psychoactive drug-related syndromes. The dataset contained ED visit-level information that included patients’ chief complaints, dates of visits, ZIP codes of residence, discharge diagnoses, and dispositions. After manually reviewing chief complaints, we developed a classification scheme comprising 3 categories (overdose, drug mention, and drug abuse/misuse), which we used to define 25 psychoactive drug syndromes. From July 2013 through December 2015, the New York City Department of Health and Mental Hygiene performed daily syndromic surveillance of psychoactive drug-related ED visits using the 25 syndrome definitions. Results: Syndromic surveillance triggered 4 public health investigations, supported 8 other public health investigations that had been triggered by other mechanisms, and resulted in the identification of 5 psychoactive drug-related outbreaks. Syndromic surveillance also identified a substantial increase in synthetic cannabinoid-related visits (from an average of 3 per week in January 2014 to >300 per week in July 2015) and an increase in heroin overdose visits (from 80 to 171 in the first 3 quarters of 2012 and 2014, respectively) in a single neighborhood. Practice Implications: Syndromic surveillance using these novel definitions enabled monitoring of trends in psychoactive drug-related morbidity, initiation and support of public health investigations, and targeting of interventions. Health departments can refine these definitions for their jurisdictions using the described methods and integrate them into existing syndromic surveillance systems.

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