scholarly journals Syndromic Surveillance for Situation Awareness: Understanding Syndrome Performance

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Kristin Arkin
Keyword(s):  
Emergency Department ◽  
Situation Awareness ◽  
Syndromic Surveillance ◽  
Chief Complaint ◽  
Surveillance Program ◽  
Initial Visit ◽  
Word Count ◽  
Data Submission ◽  
Daily Frequency ◽  
Ed Visits

ObjectiveIn August 2017, a large influx of visitors was expected to view the total solar eclipse in Idaho. The Idaho Syndromic Surveillance program planned to enhance situation awareness during the event. In preparation, we sought to examine syndrome performance of several newly developed chief complaint and combination chief complaint and diagnosis code syndrome definitions to aid in interpretation of syndromic surveillance data during the event.IntroductionThe August 21, 2017 total solar eclipse in Idaho was anticipated to lead to a large influx of visitors in many communities, prompting a widespread effort to assure Idaho was prepared. To support these efforts, the Idaho Syndromic Surveillance program (ISSp) developed a plan to enhance situation awareness during the event by conducting syndromic surveillance using emergency department (ED) visit data contributed to the National Syndromic Surveillance Program’s BioSense platform by Idaho hospitals. ISSp sought input on anticipated threats from state and local emergency management and public health partners, and selected 8 syndromes for surveillance.Ideally, the first electronic message containing information on an emergency department visit is sent to ISSp within 24 hours of the visit and includes the chief complaint for the visit. Data on other variables, such as diagnosis codes, are updated by subsequent messages for several days after the visit. Chief complaint (CC) text and discharge diagnosis (DD) codes are the primary variables used for syndrome match; delay in reporting these variables adversely affects timely syndrome match of visits. Because our plan included development of new syndrome definitions and querying data within 24 hours of visits, earlier than ISSp had done previously for trend analysis, we sought to better understand syndrome performance.MethodsWe defined messages with completed CC and DD as the last message regarding a visit where term count increased from previous messages regarding that visit, indicating new information was added to the field. We retrospectively assessed the total number of ED visits and calculated the daily frequency of completed CC and DD by days since visit date for visits during June 1–July 31, 2017. Additionally, we calculated facility mean word count in CC fields by averaging the word count of parsed, complete CC fields for visits occurring June 1–July 31, 2017 for each facility.During July 10–24, 2017, we calculated the daily frequency of visits occurring in the previous 90 days for total ED visits and syndrome-matched visits for 8 selected syndromes (heat-related illness; cold exposure; influenza-like-illness; nausea, vomiting, and diarrhea; animal/bug bites and stings; drowning/submersion; alcohol/drug intoxication; and medication replacement). Syndrome-matched visits were defined as visits with CC or DD that match the syndrome definition. We calculated the percent of syndrome-matched visits by syndromes defined with CC or CC and DD combined (CCDD) over time. Syndromes with fewer than 5 matched visits were excluded from analysis.ResultsComplete CCs were received for 99.1% of visits and complete DDs were received for 89.8% of visits. Complete CCs were submitted for 58.2% of visits within 1 day of the visit, 88.9% of visits within 3 days, and 98.9% of visits within 7 days. In contrast, complete DDs were submitted for 24.3% of visits within 1 day, 38.7% of visits within 3 days, and 53.7% of visits within 7 days (Table 1).During the observation period, data submission from facilities representing approximately 33% of visits was interrupted for 5 (36%) of 14 days. Heat-related illness, cold exposure, and drowning/submersion, were excluded from syndrome-match analysis. During the 9 days of uninterrupted data submission, 100% syndrome-matched visits for syndromes defined by CC alone and 69.1% syndrome-matched visits for syndromes defined by CCDD were identified within 6–7 days of initial visit. Facilities with interrupted data submission contributed 75% of CC syndrome-matched visits and 33% of CCDD syndrome-matched visits. The facility mean word count in CC fields from these facilities was >15 compared with 2–4 from other facilities.ConclusionsExamination of syndrome performance prior to a known event quantitated differences in timeliness of CC and DD completeness and syndrome match. CCs and DDs in visit messages were not complete within 24 hours of initial visit. CC completion was nearly 34 percentage points greater than DD completeness 1 day after initial visit and did not converge until ≥15 days after initial visit. Higher percentages of syndrome match within 6–7 days of initial visit were seen by CC alone than CCDD defined syndromes. Facilities using longer CCs contributed disproportionately to syndrome matching using CC, but not CCDD syndrome definitions. Syndromic surveillance system characteristics, including timeliness of CCs and DDs, length of CCs, and characteristics of facilities from which data transmission is interrupted should be considered when building syndrome definitions that will be used for surveillance within 7 days of emergency department visits and when interpreting syndromic surveillance findings.

scholarly journals Monitoring Sexual Violence Trends in Emergency Department Visits Using Syndromic Data From the National Syndromic Surveillance Program—United States, January 2017–December 2019

2021 ◽  
Vol 111 (3) ◽  
pp. 485-493
Author(s):  
Ashley Schappell D'Inverno ◽  
Nimi Idaikkadar ◽  
Debra Houry
Keyword(s):  
United States ◽  
Emergency Department ◽  
Sexual Violence ◽  
Syndromic Surveillance ◽  
Age Groups ◽  
The United States ◽  
Emergency Department Visits ◽  
Surveillance Program ◽  
Time Period ◽  
Ed Visits

Objectives. To report trends in sexual violence (SV) emergency department (ED) visits in the United States. Methods. We analyzed monthly changes in SV rates (per 100 000 ED visits) from January 2017 to December 2019 using Centers for Disease Control and Prevention’s National Syndromic Surveillance Program data. We stratified the data by sex and age groups. Results. There were 196 948 SV-related ED visits from January 2017 to December 2019. Females had higher rates of SV-related ED visits than males. Across the entire time period, females aged 50 to 59 years showed the highest increase (57.33%) in SV-related ED visits, when stratified by sex and age group. In all strata examined, SV-related ED visits displayed positive trends from January 2017 to December 2019; 10 out of the 24 observed positive trends were statistically significant increases. We also observed seasonal trends with spikes in SV-related ED visits during warmer months and declines during colder months, particularly in ages 0 to 9 years and 10 to 19 years. Conclusions. We identified several significant increases in SV-related ED visits from January 2017 to December 2019. Syndromic surveillance offers near-real-time surveillance of ED visits and can aid in the prevention of SV.

scholarly journals Comparing and Contrasting Two ESSENCE Syndrome Definition Query Methods

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Zachary M. Stein ◽  
Sophia Crossen
Keyword(s):  
Best Practices ◽  
Syndromic Surveillance ◽  
Chief Complaint ◽  
Surveillance Program ◽  
Discharge Diagnosis ◽  
True Positive ◽  
Patient Visit ◽  
Production Facility ◽  
Time Period ◽  
Ed Visits

ObjectiveTo compare and contrast two ESSENCE syndrome definition query methods and establish best practices for syndrome definition creation.IntroductionThe Kansas Syndromic Surveillance Program (KSSP) utilizes the ESSENCE v.1.20 program provided by the National Syndromic Surveillance Program to view and analyze Kansas Emergency Department (ED) data.Methods that allow an ESSENCE user to query both the Discharge Diagnosis (DD) and Chief Complaint (CC) fields simultaneously allow for more specific and accurate syndromic surveillance definitions. As ESSENCE use increases, two common methodologies have been developed for querying the data in this way.The first is a query of the field named “CC and DD.” The CC and DD field contains a concatenation of the parsed patient chief complaint and the discharge diagnosis. The discharge diagnosis consists of the last non-null value for that patient visit ID and the chief complaint parsed is the first non-null chief complaint value for that patient visit ID that is parsed by the ESSENCE platform. For this comparison, this method shall be called the CCDD method.The second method involves a query of the fields named, “Chief Complaint History” and “Discharge Diagnosis History.” While the first requires only one field be queried, this method queries the CC History and DD History fields, combines the resulting data and de-duplicates this final data set by the C_BioSense_ID. Chief Complaint History is a list of all chief complaint values related to a singular ED visit, and Discharge Diagnosis History is the same concept, except involving all Discharge Diagnosis values. For this comparison, this method shall be called the CCDDHX method.While both methods are based on the same query concept, each method can yield different results.MethodsA program was created in R Studio to analyze a user-provided query.Simple queries were randomly generated. Twenty randomly generated queries were run through the R Studio program and disparities between data sets were recorded. All KSSP production facility ED visits during the month of August 2017 were analyzed.Secondly, three queries actively utilized in KSSP practice were run through the program. These queries were Firework-Related Injuries, Frostbite and Cold Exposure, and Rabies Exposure. The queries were run on all KSSP production facility ED visits, and coincided with the timeline of relevant exposures.ResultsIn the random query trials, an average of 5.4% of the cases captured using the CCDD field method were unique and not captured by the same query in the CCDDHX method. Using the CCDDHX method, an average of 6.1% of the cases captured were unique and not captured by the CCDD method.When using the program to compare syndromes from actively utilized KSSP practice, the disparity between the two methods was much lower.Firework-Related InjuriesDuring the time period queried, the CCDD method returned 171 cases and the CCDDHX method returned 169 cases. All CCDDHX method cases were captured by the CCDD method. The CCDD method returned 2 cases not captured by the CCDDHX method. These two cases were confirmed as true positive firework-related injury cases.Frostbite and Cold ExposureDuring the time period queried, CCDD method returned 328 cases and the CCDDHX method returned 344 cases. The CCDDHX method captured 16 cases that the CCDD method did not. The CCDD method did not capture any additional cases when compared to the CCDDHX method. After review, 10 (62.5%) of these 16 cases not captured by the CCDD method were true positive cases.Rabies ExposureDuring the time period queried, the CCDD method returned 474 cases and the CCDDHX method returned 473 cases. The CCDDHX method captured 7 cases that the CCDD method did not. The CCDD method returned 8 cases not captured by the CCDDHX method. After review, the 7 unique cases captured in the CCDDHX method contained 3 (42.9%) true positive cases and 3 (37.5%) of the 8 cases not captured by the CCDDHX method were true positives.ConclusionsThe twenty random queries showed a disparity between methods. When utilizing the same program to analyze three actively utilized KSSP definitions, both methods yielded similar results with a much smaller disparity. The CCDDHX method inherently requires more steps and requires more queries to be run through ESSENCE, making the method less timely and more difficult to share. Despite these downsides, CCDDHX will capture cases that appear throughout the history of field updates.Further variance between methods is likely due to the CCDD field utilizing the ESSENCE-processed CC while the CCDDHX field utilizes the CC verbatim as produced by the ED facility. This allows the CCDD method to tap into the powerful spelling correction and abbreviation-parsing steps that ESSENCE employs, but incorrect machine corrections and replacements, while rare, can negatively affect syndrome definition performance.The greater disparity in methods for the random queries may be due to the short (3 letter) text portion of the queries. Short segments are more likely to be found in multiple words than text of actual queries. Utilizing larger randomly generated text segments may resolve this and is a planned next step for this research.Our next step is to share the R Studio program to allow further replication. The Kansas Syndromic Surveillance Program is also continuing similar research to ensure that best practices are being met. 

scholarly journals Developing and Validating a Fireworks-Related Syndrome Definition in Kansas

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Zachary M Stein
Keyword(s):  
Syndromic Surveillance ◽  
Public Information ◽  
False Positives ◽  
Chief Complaint ◽  
Surveillance Program ◽  
Anatomical Location ◽  
Free Text ◽  
Data Set ◽  
Ed Visits ◽  
Key Terms

ObjectiveTo develop a syndrome definition and analyze syndromic surveillance data usefulness in surveillance of firework-related emergency department visits in Kansas. Introduction Across the U.S.A., multiple people seek treatment for fireworks-related injuries around the July 4th holiday. Syndromic surveillance in Kansas allows for near real-time analysis of the injuries occurring during the firework selling season. During the 2017 July 4thholiday, the Kansas Syndromic Surveillance Program (KSSP) production data feed received data from 88 EDs at excellent quality and timeliness. Previous and current firework safety messaging in Kansas is dependent on voluntary reporting from hospitals across the state. With widespread coverage of EDs by KSSP, data can be more complete and timely to better drive analysis and public information Methods:KSSP data was queried through the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) v.1.20 provided by the National Syndromic Surveillance Program. Data between June 12, 2017 and August 13, 2017 were queried. The first query (Query A, Table 1.) searched the Discharge Diagnosis History field for the “W39” ICD-10 Diagnosis code, “Discharge of firework.” These records were searched for common firework terms contained in the Chief Complaint History field. These firework-related free text terms (Query B, Table 1.) were then combined with other potential firework-related terms to create a preliminary free text query (Query C, Table 1.). This preliminary query was run on the Chief Complaint History field. Data were then searched for false positive cases and appropriate negation terms were included to accommodate this. The new query with negation terms (Query D, Table 1.) was run on the Chief Complaint History field, combined with the results from the Discharge Diagnosis History field, and then combined records were de-duplicated based on a unique visit identifier. The final data set was then classified by the anatomical location of the injury and the gender and age group of the patient. Results:The initial query (Query A, Table 1.) for the diagnosis code “W39” returned 101 unique ED visits. Of these 101 unique ED visits, the following terms were identified in the Chief Complaint History field: shell, artillery, bomb, sparkler, grenade, fire cracker, firework, and firework show. These key terms were translated into Query B, Table 1. Other key terms deemed likely to capture specific firework-related exposures were then included into Query C, Table 1. , including roman, candle, lighter, M80, and punk. Query C was then used to query the Chief Complaint History field, returning 144 unique ED visits. Cases captured by Query C were then reviewed by hand for false positives and the negation terms, lighter fluid, fish, nut, and pistachio, were incorporated the Query D, Table 1. The previous process for Query C was then repeated on Query D, leaving a remaining 136 unique cases. Query A’s 101 unique ED visits was then combined with the 136 unique ED visits captured by Query D and de-duplicated. The de-duplicated data set contained 170 unique ED visits which were then reviewed by hand for false positives. The final removal of false positives from the combined and de-duplicated data set left a remaining 154 unique ED visits for firework-related injuries during this time period.For these data, the most common victims of firework injuries were males, accounting for 65.5% of all firework related ED visits and children ages 0 to 19 accounting for 44.2% of these visits. At every age breakout, male injuries exceeded female injuries. The most common anatomical location of the injury was one or both hands with 38.3% of all injuries mentioned hands as their primary injury. Injuries to the eyes, face, and head accounted for the second most injuries (28.6% of all patients). Conclusions: The selling of fireworks will be a yearly occurrence of a specific exposure that can potentially lead to injuries. Utilizing syndromic surveillance to review the holiday firework injuries is a very rapid method to assess the impact of these injuries and may allow for future direction of public information during the holiday. Having a syndrome definition that builds on knowledge from previous years will allow for quicker case identification as well.State public information regarding firework safety can be significantly bolstered by accurate and rapid data assessment. Developing a firework injury syndrome definition that is accurate and returns information rapidly has allowed for increased buy-in to the Kansas Syndromic Surveillance Program from public information offices, fire marshal’s offices, and other program fields.

scholarly journals Evaluation of ESSENCE Syndromic Definitions for ED Visits Related to Falls in Icy Weather

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Jessica Hensley ◽  
Sandra Gonzalez ◽  
Derry Stover ◽  
Thomas Safranek ◽  
Ming Qu
Keyword(s):  
Public Health ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Syndromic Surveillance ◽  
Hospital Admissions ◽  
Chief Complaint ◽  
Surveillance Program ◽  
Search Terms ◽  
Ed Visits ◽  
Sensitivity Specificity

ObjectiveThis project evaluated and compared two ESSENCE syndromic surveillance definitions for emergency department (ED) visits related to injuries associated with falls in icy weather using 2016-2017 data from two hospitals in Douglas County, Nebraska. The project determined the validity of the syndromic surveillance definition as applied to chief complaint and triage notes and compared the chief complaint data alone to chief complaint plus triage notes definitions to find the most reliable definition for ED visits resulting from fall-related injuries.IntroductionIcy weather events increase the risk for injury from falls on untreated or inadequately treated surfaces. These events often result in ED visits, which represents a significant public health and economic impact1.The goal of this project was to start the process toward an evaluation of the public health impact and the economic impact of falls associated to icy weather in Douglas County, NE for the ultimate purpose of designing and implementing injury prevention related public health protection measures. Additionally, the validated definition will be used by NE DHHS Occupational Health Surveillance Program to identify work related ice-related fall injuries that were covered by workers compensation. To achieve the goal, the first step was to identify a valid and reliable syndromic surveillance. Specifically, this project looked at the applicability of the ESSENCE syndromic surveillance definitions related to injuries associated with falls. Two syndromic surveillance definitions were compared, one that includes triage note and chief complaint search terms, and another that only includes chief complaint. The hypothesis was that the ESSENCE syndromic surveillance definition that includes triage note and chief complaint search terms, rather than the syndromic surveillance definition that only includes chief complaint, would be more effective at identifying ED visits resulting from fall-related injuries.MethodsThis project included 751 EDs visits from two hospitals located in Douglas County Nebraska, during ice events on December 16-18, 2016, January 10-12, 2017, and January 15-18, 2017.Two ESSENCE syndromic surveillance definitions, “Chief Complaint or Triage Note” and “Chief Complaint Only,” were used to identify fall-related ED visits from two participating EDs in Douglas County, NE. In the chief complaint and the triage note fields, the keywords selected were: fall, fell, or slip. In that the ESSENCE time series analysis indicated the increase in the number of falls were associated with ice events from baseline, an assumption was made that the increase was a result of the weather. Then, the Syndromic Surveillance Event Detection of Nebraska database was used to find the patient and visit identification numbers. These two identification numbers were used to identify the EHRs needed for a gold standard review. Chart data was used to evaluate the reliability and validity of the two syndromic surveillance definitions for the detection of falls on the study dates. This analysis was used to find the sensitivity, specificity and predictive value.ResultsThe sensitivity, specificity and positive predictive value for the “Chief Complaint Only” definition yielded 71.7%, 100%, and 100% respectively. The “Chief Complaint or Triage Note” definition results were 90.9%, 98.8%, and 95.5% for these analyses. Negative predictive value for both definitions was 97.5%.ConclusionsThe sensitivity indicates both definitions are unlikely to give false positives, and the positive predictive value indicates both definitions successfully identify most of the true positives found in the visits. However, the “Chief Complaint Only” definition resulted in a minimally higher specificity and positive predictive value. Therefore, the results indicate that although both definitions have similar specificity and positive predictive value, the “Chief Complaint or Triage Note” definition is more likely than the “Chief Complaint Only” definition to correctly identify ED visits related to falls in icy weather.References1. Beynon C, Wyke S, Jarman I, Robinson M, Mason J, Murphy K, Bellis MA, Perkins C. The cost of emergency hospital admissions for falls on snow and ice in England during winter 2009/10: a cross sectional analysis. Environmental Health 2011;10(60).

scholarly journals National and Regional Representativeness of Hospital Emergency Department Visit Data in the National Syndromic Surveillance Program, United States, 2014

2016 ◽  
Vol 10 (4) ◽  
pp. 562-569 ◽  
Author(s):  
Ralph J. Coates ◽  
Alejandro Pérez ◽  
Atar Baer ◽  
Hong Zhou ◽  
Roseanne English ◽  
...  
Keyword(s):  
Emergency Department ◽  
Syndromic Surveillance ◽  
Surveillance Program ◽  
Local Health ◽  
Hospital Emergency Department ◽  
Hospital Emergency ◽  
American Hospital ◽  
American Hospital Association ◽  
Ed Visits ◽  
State And Local

AbstractObjectiveWe examined the representativeness of the nonfederal hospital emergency department (ED) visit data in the National Syndromic Surveillance Program (NSSP).MethodsWe used the 2012 American Hospital Association Annual Survey Database, other databases, and information from state and local health departments participating in the NSSP about which hospitals submitted data to the NSSP in October 2014. We compared ED visits for hospitals submitting data with all ED visits in all 50 states and Washington, DC.ResultsApproximately 60.4 million of 134.6 million ED visits nationwide (~45%) were reported to have been submitted to the NSSP. ED visits in 5 of 10 regions and the majority of the states were substantially underrepresented in the NSSP. The NSSP ED visits were similar to national ED visits in terms of many of the characteristics of hospitals and their service areas. However, visits in hospitals with the fewest annual ED visits, in rural trauma centers, and in hospitals serving populations with high percentages of Hispanics and Asians were underrepresented.ConclusionsNSSP nonfederal hospital ED visit data were representative for many hospital characteristics and in some geographic areas but were not very representative nationally and in many locations. Representativeness could be improved by increasing participation in more states and among specific types of hospitals. (Disaster Med Public Health Preparedness. 2016;10:562–569)

scholarly journals Real-time monitoring of a mass K2-related overdose outbreak – Connecticut, 2018

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Kristen Soto ◽  
Erin Grogan ◽  
Alexander Senetcky ◽  
Susan Logan
Keyword(s):  
Emergency Department ◽  
Real Time ◽  
Syndromic Surveillance ◽  
Situational Awareness ◽  
Chief Complaint ◽  
Surveillance Data ◽  
Emergency Department Utilization ◽  
Syndromic Surveillance System ◽  
Ed Visits ◽  
State And Local

ObjectiveTo describe the use of syndromic surveillance data for real-time situational awareness of emergency department utilization during a localized mass overdose event related to the substance K2.IntroductionOn August 15, 2018, the Connecticut Department of Public Health (DPH) became aware of a cluster of suspected overdoses in an urban park related to the synthetic cannabinoid K2. Abuse of K2 has been associated with serious adverse effects and overdose clusters have been reported in multiple states. This investigation aimed to characterize the use of syndromic surveillance data to monitor a cluster of suspected overdoses in real time.MethodsThe EpiCenter syndromic surveillance system collects data on all emergency department (ED) visits at Connecticut hospitals. ED visits associated with the event were identified using ad hoc keyword analyses. The number of visits by facility location for the state, county, and city were communicated to state and local partners in real time. Gender, age, and repeated ED visits were assessed. After the event, surveillance findings were summarized for partnersResultsDuring the period of August 15–16, 2018 the number of ED visits with a mention of K2 in the chief complaint increased from three to 30 in the impacted county, compared to a peak of 5 visits during the period of March–July, 2018. An additional 25 ED visits were identified using other related keywords (e.g., weed). After the event, 72 ED visits were identified with K2 and location keywords in the chief complaint or triage notes. These 72 visits comprised 53 unique patients, with 12 patients returning to the ED 2–5 times over the two day period. Of 53 patients, 77% were male and the median age was 40 years (interquartile range 35–51 years). Surveillance findings were shared with partners in real time for situational awareness, and in a summary report on August 21.ConclusionsData from the EpiCenter system were consistent with reports from other data sources regarding this cluster of suspected drug overdoses. Next steps related to this event involve: monitoring data for reference to areas of concentrated substance use, enabling automated alerts to detect clusters of interest, and developing a plan to improve coordinate real-time communication with stakeholderswithin DPH and with external partners during events.

scholarly journals Detecting Suicide-Related Emergency Department Visits Among Adults Using the District of Columbia Syndromic Surveillance System

2017 ◽  
Vol 132 (1_suppl) ◽  
pp. 88S-94S ◽  
Author(s):  
S. Janet Kuramoto-Crawford ◽  
Erica L. Spies ◽  
John Davies-Cole
Keyword(s):  
Emergency Department ◽  
Surveillance System ◽  
Syndromic Surveillance ◽  
District Of Columbia ◽  
Chief Complaint ◽  
Emergency Department Visits ◽  
Added Value ◽  
Discharge Diagnosis ◽  
Syndromic Surveillance System ◽  
Ed Visits

Objectives: Limited studies have examined the usefulness of syndromic surveillance to monitor emergency department (ED) visits involving suicidal ideation or attempt. The objectives of this study were to (1) examine whether syndromic surveillance of chief complaint data can detect suicide-related ED visits among adults and (2) assess the added value of using hospital ED data on discharge diagnoses to detect suicide-related visits. Methods: The study data came from the District of Columbia electronic syndromic surveillance system, which provides daily information on ED visits at 8 hospitals in Washington, DC. We detected suicide-related visits by searching for terms in the chief complaints and discharge diagnoses of 248 939 ED visits for which data were available for October 1, 2015, to September 30, 2016. We examined whether detection of suicide-related visits according to chief complaint data, discharge diagnosis data, or both varied by patient sex, age, or hospital. Results: The syndromic surveillance system detected 1540 suicide-related ED visits, 950 (62%) of which were detected through chief complaint data and 590 (38%) from discharge diagnosis data. The source of detection for suicide-related ED visits did not vary by patient sex or age. However, whether the suicide-related terms were mentioned in the chief complaint or discharge diagnosis differed across hospitals. Conclusions: ED syndromic surveillance systems based on chief complaint data alone would underestimate the number of suicide-related ED visits. Incorporating the discharge diagnosis into the case definition could help improve detection.

scholarly journals Tracking suspected heroin overdoses in CDC's National Syndromic Surveillance Program

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Alana M. Vivolo-Kantor ◽  
R. Matthew Gladden ◽  
Aaron Kite-Powell ◽  
Michael Coletta ◽  
Grant Baldwin
Keyword(s):  
Public Health ◽  
United States ◽  
Emergency Department ◽  
Drug Overdose ◽  
Syndromic Surveillance ◽  
Case Definition ◽  
Chief Complaint ◽  
Heroin Overdose ◽  
Ed Visits ◽  
Overdose Deaths

ObjectiveThis paper analyzes emergency department syndromic data in the Centers for Disease Control and Prevention’s (CDC) National Syndromic Surveillance Program’s (NSSP) BioSense Platform to understand trends in suspected heroin overdose.IntroductionOverdose deaths involving opioids (i.e., opioid pain relievers and illicit opioids such as heroin) accounted for at least 63% (N = 33,091) of overdose deaths in 2015. Overdose deaths related to illicit opioids, heroin and illicitly-manufactured fentanyl, have rapidly increased since 2010. For instance, heroin overdose deaths quadrupled from 3,036 in 2010 to 12,989 in 2015. Unfortunately, timely response to emerging trends is inhibited by time lags for national data on both overdose mortality via vital statistics (8-12 months) and morbidity via hospital discharge data (over 2 years). Emergency department (ED) syndromic data can be leveraged to respond more quickly to emerging drug overdose trends as well as identify drug overdose outbreaks. CDC’s NSSP BioSense Platform collects near real-time ED data on approximately two-thirds of ED visits in the US. NSSP’s data analysis and visualization tool, Electronic Surveillance System for the Notification of Community-based Epidemics (ESSENCE), allows for tailored syndrome queries and can monitor ED visits related to heroin overdose at the local, state, regional, and national levels quicker than hospital discharge data.MethodsWe analyzed ED syndromic data using ESSENCE to detect monthly and annual trends in suspected unintentional or undetermined heroin overdose by sex and region for those 11 years and older. An ED visit was categorized as a suspected heroin overdose if it met several criteria, including heroin overdose ICD-9-CM and ICD-10-CM codes (i.e., 965.01 and E850.0; T40.1X1A, T40.1X4A) and chief complaint text associated with a heroin overdose (e.g., “heroin overdose”). Using computer code developed specifically for ESSENCE based on our case definition, we queried data from 9 of the 10 HHS regions from July 2016-July 2017. One region was excluded due to large changes in data submitted during the time period. We conducted trend analyses using the proportion of suspected heroin overdoses by total ED visits for a given month with all sexes and regions combined and then stratified by sex and region. To determine significant linear changes in monthly and annual trends, we used the National Cancer Institute’s Joinpoint Regression Program.ResultsFrom July 2016-July 2017, over 72 million total ED visits were captured from all sites and jurisdictions submitting data to NSSP. After applying our case definition to these records, 53,786 visits were from a suspected heroin overdose, which accounted for approximately 7.5 heroin overdose visits per 10,000 total ED visits during that timeframe. The rate of suspected heroin overdose visits to total ED visits was highest in June 2017 (8.7 per 10,000) and lowest in August 2016 (6.6 per 10,000 visits). Males accounted for a larger rates of visits over all months (range = 10.7 to 14.2 per 10,000 visits) than females (range = 3.8 to 4.7 per 10,000 visits). Overall, compared to July 2016, suspected heroin overdose ED visits from July 2017 were significantly higher for all sexes and US regions combined (β = .010, p = .036). Significant increases were also demonstrated over time for males (β = .009, p = .044) and the Northeast (β = .012, p = .025). No other significant increases or decreases were detected by demographics or on a monthly basis.ConclusionsEmergency department visits related to heroin overdose increased significantly from July 2016 to July 2017, with significant increases in the Northeast and among males. Urgent public health action is needed reduce heroin overdoses including increasing the availability of naloxone (an antidote for opioid overdose), linking people at high risk for heroin overdose to medication-assisted treatment, and reducing misuse of opioids by implementing safer opioid prescribing practices. Despite these findings, there are several limitations of these data: not all states sharing data have full participation thus limiting the representativeness of the data; not all ED visits are shared with NSSP; and our case definition may under-identify (e.g., visits missing discharge diagnosis codes and lacking specificity in chief complaint text) or over-identify (e.g., reliance on hospital staff impression and not drug test results) heroin overdose visits. Nonetheless, ED syndromic surveillance data can provide timely insight into emerging regional and national heroin overdose trends.ReferencesWarner M, Chen LH, Makuc DM, Anderson RN, Minino AM. Drug poisoning deaths in the United States, 1980-2008. NCHS Data Brief 2011(81):1-8.Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths - United States, 2010-2015. MMWR Morb Mortal Wkly Rep 2016;65(5051):1445-1452.Spencer MRA, F. Timeliness of Death Certificate Data for Mortality Surveillance and Provisional Estimates. National Center for Health Statistics 2017.Richards CL, Iademarco MF, Atkinson D, Pinner RW, Yoon P, Mac Kenzie WR, et al. Advances in Public Health Surveillance and Information Dissemination at the Centers for Disease Control and Prevention. Public Health Rep 2017;132(4):403-410.

scholarly journals Creation of a Kansas Spring Extreme Weather Syndrome Definition and Unique Records

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Zachary M. Stein
Keyword(s):  
Emergency Department ◽  
Health Effects ◽  
Syndromic Surveillance ◽  
Situational Awareness ◽  
Extreme Weather ◽  
Emergency Department Visits ◽  
Surveillance Program ◽  
Weather Events ◽  
Chief Complaints ◽  
Ed Visits

ObjectiveTo evaluate syndrome definitions capturing storm- and extremeweather-related emergency department visits in Kansas hospitalsparticipating in the National Syndromic Surveillance Program(NSSP).IntroductionKansas storms can occur without warning and have potential tocause a multitude of health issues. Extreme weather preparednessand event monitoring for public health effects is being developedas a function of syndromic surveillance at the Kansas Departmentof Health and Environment (KDHE). The Syndromic SurveillanceProgram at KDHE utilized emergency department (ED) data to detectdirect health effects of the weather events in the first 9 months of2016. Current results show injuries directly related to the storms andalso some unexpected health effects that warrant further exploration.MethodsA basic syndrome definition was defined based on extreme springand summer weather events experienced in Kansas. This broaddefinition pulled records from Kansas EDs that included the followingin the Chief Complaint or Triage Notes fields:●Storm●Rain●Torna(dos)●Wind●FloodThis broad syndrome definition was performed on data submittedto the Kansas’s production server through NSSP between January 1stand August 30th, 2016. After the initial pull, duplicate records for thesame patient and visit were removed.The remaining set was then searched by hand to identify termscaught by the syndrome definition that were not related to stormactivity or extreme weather. Record chief complaints were thenscanned by hand to identify common words containing the searchcriteria and then removed. Keywords not of interest to the syndromedefinition that were caught were: migraine, window, drain, restrain,train, and many other proper nouns that contained one of the keywords.These remaining visits were then sorted by nature of visit andunexpected records were recorded for future direction of syndromedefinition development.ResultsThe initial data pull under these conditions yielded 17,691 uniqueemergency department visits from January 1stto August 30thduringthe 2016 year. From this, records were classified based on key wordsresulting in the pull. The table below shows the initial pull results, theremaining records after errant results were expunged, the percentageof visits that were removed, and the most common reason for removal.Of these records remaining after cleaning, 20 were related tostorms, 62 were related to rain, 7 were related to tornado activity,66 were related to wind, and 14 were related to flooding along withthe mixed variable instances shown in the table. A majority of thewind-related ED visits were injuries and the majority of the tornadoactivity events were related to injuries sustained while taking shelter.Many of the injuries mentioning storms were sustained in preparationfor the storm, and a handful were due to mental stresses regardingstorm activity.ConclusionsSyndrome definition development is an iterative process thatwill vary by region. By manually looking at line-level data details,future searches can better accommodate these errant results and falsepositives. These studies will facilitate more rapid extreme weatherresponse in Kansas and allow better situational awareness. Alongwith general storm-related injuries, knowledge of the unusual recordscaught by a syndrome definition can also help direct public educationin preparation of future storms. With injuries sustained while takingshelter and injuries sustained in preparation for the storm, we can takethese unique ED visits and work on interventions to prevent futureoccurrences.

scholarly journals Monitoring suicide-related events using National Syndromic Surveillance Program data

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Marissa L. Zwald ◽  
Kristin M. Holland ◽  
Francis Annor ◽  
Aaron Kite-Powell ◽  
Steven A. Sumner ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
Real Time ◽  
Syndromic Surveillance ◽  
The United States ◽  
Chief Complaint ◽  
Surveillance Program ◽  
Joinpoint Regression ◽  
Self Harm ◽  
Ed Visits

ObjectiveTo describe epidemiological characteristics of emergency department (ED) visits related to suicidal ideation (SI) or suicidal attempt (SA) using syndromic surveillance data.IntroductionSuicide is a growing public health problem in the United States.1 From 2001 to 2016, ED visit rates for nonfatal self-harm, a common risk factor for suicide, increased 42%.2–4 To improve public health surveillance of suicide-related problems, including SI and SA, the Data and Surveillance Task Force within the National Action Alliance for Suicide Prevention recommended the use of real-time data from hospital ED visits.5 The collection and use of real-time ED visit data on SI and SA could support a more targeted and timely public health response to prevent suicide.5 Therefore, this investigation aimed to monitor ED visits for SI or SA and to identify temporal, demographic, and geographic patterns using data from CDC’s National Syndromic Surveillance Program (NSSP).MethodsCDC’s NSSP data were used to monitor ED visits related to SI or SA among individuals aged 10 years and older from January 1, 2016 through July 31, 2018. A syndrome definition for SI or SA, developed by the International Society for Disease Surveillance’s syndrome definition committee in collaboration with CDC, was used to assess SI or SA-related ED visits. The syndrome definition was based on querying the chief complaint history, discharge diagnosis, and admission reason code and description fields for a combination of symptoms and Boolean operators (for example, hang, laceration, or overdose), as well as ICD-9-CM, ICD-10-CM, and SNOMED diagnostic codes associated with SI or SA. The definition was also developed to include common misspellings of self-harm-related terms and to exclude ED visits in which a patient “denied SI or SA.”The percentage of ED visits involving SI or SA were analyzed by month and stratified by sex, age group, and U.S. region. This was calculated by dividing the number of SI or SA-related ED visits by the total number of ED visits in each month. The average monthly percentage change of SI or SA overall and for each U.S. region was also calculated using the Joinpoint regression software (Surveillance Research Program, National Cancer Institute).6ResultsAmong approximately 259 million ED visits assessed in NSSP from January 2016 to July 2018, a total of 2,301,215 SI or SA-related visits were identified. Over this period, males accounted for 51.2% of ED visits related to SI or SA, and approximately 42.1% of SI or SA-related visits were comprised of patients who were 20-39 years, followed by 40-59 years (29.7%), 10-19 years (20.5%), and ≥60 years (7.7%).During this period, the average monthly percentage of ED visits involving SI or SA significantly increased 1.1%. As shown in Figure 1, all U.S. regions, except for the Southwest region, experienced significant increases in SI or SA ED visits from January 2016 to July 2018. The average monthly increase of SI or SA-related ED visits was 1.9% for the Midwest, 1.5% for the West (1.5%), 1.1% for the Northeast, 0.9% for the Southeast, and 0.5% for the Southwest.ConclusionsED visits for SI or SA increased from January 2016 to June 2018 and varied by U.S. region. In contrast to previous findings reporting data from the National Electronic Injury Surveillance Program – All-Injury Program, we observed different trends in SI or SA by sex, where more ED visits were comprised of patients who were male in our investigation.2 Syndromic surveillance data can fill an existing gap in the national surveillance of suicide-related problems by providing close to real-time information on SI or SA-related ED visits.5 However, our investigation is subject to some limitations. NSSP data is not nationally representative and therefore, these findings are not generalizable to areas not participating in NSSP. The syndrome definition may under-or over-estimate SI or SA based on coding differences and differences in chief complaint or discharge diagnosis data between jurisdictions. Finally, hospital participation in NSSP can vary across months, which could potentially contribute to trends observed in NSSP data. Despite these limitations, states and communities could use this type of surveillance data to detect abnormal patterns at more detailed geographic levels and facilitate rapid response efforts. States and communities can also use resources such as CDC’s Preventing Suicide: A Technical Package of Policy, Programs, and Practices to guide prevention decision-making and implement comprehensive suicide prevention approaches based on the best available evidence.7References1. Stone DM, Simon TR, Fowler KA, et al. Vital Signs: Trends in State Suicide Rates — United States, 1999–2016 and Circumstances Contributing to Suicide — 27 States, 2015. Morb Mortal Wkly Rep. 2018;67(22):617-624.2. CDCs National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS). https://www.cdc.gov/injury/wisqars/index.html. Published 2018. Accessed September 1, 2018.3. Mercado M, Holland K, Leemis R, Stone D, Wang J. Trends in emergency department visits for nonfatal self-inflicted injuries among youth aged 10 to 24 years in the United States, 2005-2015. J Am Med Assoc. 2017;318(19):1931-1933. doi:10.1001/jama.2017.133174. Olfson M, Blanco C, Wall M, et al. National Trends in Suicide Attempts Among Adults in the United States. JAMA Psychiatry. 2017;10032(11):1095-1103. doi:10.1001/jamapsychiatry.2017.25825. Ikeda R, Hedegaard H, Bossarte R, et al. Improving national data systems for surveillance of suicide-related events. Am J Prev Med. 2014;47(3 SUPPL. 2):S122-S129. doi:10.1016/j.amepre.2014.05.0266. National Cancer Institute. Joinpoint Regression Software. https://surveillance.cancer.gov/joinpoint/. Published 2018. Accessed September 1, 2018.7. Centers for Disease Control and Prevention. Preventing Suicide: A Technical Package of Policy, Programs, and Practices. 

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