scholarly journals Monitoring Heat-Related Illness through Syndromic Surveillance in Los Angeles County

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Jimmy Duong ◽  
Michael Lim ◽  
Emily Kajita ◽  
Bessie Hwang
Keyword(s):  
Public Health ◽  
Los Angeles ◽  
Syndromic Surveillance ◽  
Los Angeles County ◽  
Correlation Coefficients ◽  
Temperature Data ◽  
Extreme Heat ◽  
Chief Complaints ◽  
Ed Visits ◽  
Council Of State

ObjectiveTo analyze Los Angeles County’s (LAC) extreme heat season in 2018 and evaluate the Council of State and Territorial Epidemiologists’ (CSTE) syndrome query for heat-related-illness (HRI) in Los Angeles County (LAC)IntroductionLAC experienced several days of record-breaking temperatures during the summer of 2018. Downtown Los Angeles temperatures soared to 108°F in July with an average daily maximum of 92°F. Extreme heat events such as these can pose major risks to human health. Syndromic surveillance can be a useful tool in providing near real-time surveillance of HRI. In 2014, a working group was formed within the CSTE Climate Change Subcommittee to define and analyze HRI. The workgroup’s goal was to provide guidance to public health professionals in adapting and implementing an HRI syndrome surveillance query. The Acute Communicable Disease Control Program’s (ACDC) Syndromic Surveillance Unit utilized CSTE’s HRI query to provide surveillance during the extreme heat season in 2018 in LAC. Additional modifications to the CSTE query were evaluated for potential improvements towards characterizing HRI trends.MethodsFrom May 1 to September 30, 2018, Emergency Department (ED) data were queried for cases using the CSTEs definition for HRI. The queries consisted of key word searches within the chief complaint (CC) data field, and, if available, the diagnosis data fields. The query was derived from the CSTE HRI query published in 20161. In addition, ACDC explored the utility of expanding the CSTE syndrome definition to include additional chief complaints commonly associated with HRI such as dehydration and syncope. Both queries were applied on all participating syndromic EDs in LAC alongside daily high temperature data trends. Local temperature data for downtown Los Angeles weather station KCQT were taken from the Weather Underground website. Spearman correlation coefficients were calculated for each query during the heat season. Similarly, both queries were also applied during colder months from October 1, 2017 to April 30, 2018 for comparison. Lastly, results for dehydration and syncope were independently assessed apart from other HRI query terms during both heat seasons and colder months.ResultsThe CSTE HRI query and the query with the added terms yielded 1,258 and 63,332 ED visits, respectively, during the heat season. On July 6, the maximum daily temperature peaked at 108 °F; the HRI and the query with the added terms yielded 136 and 618 ED visits, respectively. The HRI query and the HRI query with the added terms had a correlation coefficient of 0.714 (p <0.0001) and 0.427 (p <0.0001), respectively. During colder months, the CSTE HRI query and the query with the added terms yielded 377 and 86,008, respectively, with correlation coefficients of 0.342 (p < 0.0001) and 0.133 (p < 0.052). The syncope-only query saw no variation in HRI classified encounters throughout the heat season (mean: 328; min: 228; max: 404) or colder months (mean: 328; min: 261; max: 404) with correlation coefficients of 0.238 (p = 0.003) and 0.155 (p = 0.024), respectively. Similarly, the dehydration-only query saw no variation in HRI classified encounters throughout the heat season (mean: 96; min: 58; max: 258) or colder months (mean: 94; min: 60; max: 160) with correlation coefficients of 0.596 (p < 0.0001) and -0.016 (p = 0.822).ConclusionsThe CSTE HRI query proved to be a strong indicator for HRI, and the addition of terms associated with dehydration and syncope to the CSTE HRI query weakened the correlation with temperature. Compared to the original CSTE HRI query, the added terms yielded a 4934% increase in HRI classified encounters during the heat season; however, these were likely due to causes other than HRI -- adding the extra terms resulted in a weaker correlation with temperature. Additionally, the comparative analysis showed that, with the added terms, the volume of HRI encounters was larger during colder months than hotter months suggesting misclassification of non-HRI illnesses. Surveillance of HRI has proven to be difficult because many of the HRI symptoms are too commonly associated with non-HRI conditions which would explain the weaker correlations when adding additional chief complaints associated with HRI. In conclusion, the CSTE syndrome definition for HRI proved to be the most robust query for HRI during the heat season. Case counts of HRI are difficult due to symptom overlap with many other medical conditions. However, syndromic surveillance using the CSTE HRI query is useful for trend analysis in near real-time during heat events.References1. Council of State and Territorial Epidemiologists. Heat-Related Illness Syndrome Query: A Guidance Document for Implementing Heat-Related Illness Syndromic Surveillance in Public Health Practice. Version 1.0. 2016 Sep. 12 p. 

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.

scholarly journals Harnessing Syndromic Surveillance Emergency Department Data to Monitor Health Impacts During the 2015 Special Olympics World Games

2017 ◽  
Vol 132 (1_suppl) ◽  
pp. 99S-105S ◽  
Author(s):  
Emily Kajita ◽  
Monica Z. Luarca ◽  
Han Wu ◽  
Bessie Hwang ◽  
Laurene Mascola
Keyword(s):  
Public Health ◽  
Los Angeles ◽  
Surveillance System ◽  
Syndromic Surveillance ◽  
Los Angeles County ◽  
International Travel ◽  
Poison Control ◽  
Special Olympics ◽  
Syndromic Surveillance System ◽  
Mass Gatherings

Introduction: Mass gatherings that attract a large international presence may cause or amplify point-source outbreaks of emerging infectious disease. The Los Angeles County Department of Public Health customized its syndromic surveillance system to detect increased syndrome-specific utilization of emergency departments (EDs) and other medical encounters coincident to the 2015 Special Olympics World Games. Materials and Methods: We queried live databases containing data on ED visits, California Poison Control System calls, and Los Angeles County coroner-investigated deaths for increases in daily counts from July 19 to August 6, 2015. We chose syndrome categories based on the potential for disease outbreaks common to international travel and dormitory settings, morbidity amplified by high temperatures, and bioterrorism threats inherent to mass gatherings. We performed line-list reviews and trend analyses of total, syndrome-specific, and region-specific daily counts, using cumulative sum-based signals. We also piloted a novel strategy of requesting that ED registrars proactively tag Special Olympics attendees in chief complaint data fields. Results: The syndromic surveillance system showed that the 2015 Special Olympics did not generate large-scale acute morbidities leading to detectable stress on local EDs. We recruited 10 hospitals for proactive patient tagging, from which 16 Special Olympics attendees were detected; these patients reported various symptoms, such as injury, vomiting, and syncope. Practice Implications: As an enhancement to traditional syndromic surveillance, proactive patient tagging can illuminate potential epidemiologic links among patients in challenging syndromic surveillance applications, such as mass gatherings. Syndromic surveillance has the potential to enhance ED patient polling and reporting of exposure, symptom, and other epidemiologic case definition criteria to public health agencies in near-real time.

scholarly journals A Comparison of Fever Classified Chief Complaints and Diagnoses with Recorded Body Temperatures

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Patricia Araki ◽  
Emily Kajita ◽  
Kelsey OYong ◽  
Monica Z. Luarca ◽  
Bessie Hwang ◽  
...  
Keyword(s):  
Emergency Department ◽  
Los Angeles ◽  
Syndromic Surveillance ◽  
Los Angeles County ◽  
Body Temperatures ◽  
Emergency Department Data ◽  
Chief Complaints

In an effort to evaluate patient stated "fever" chief complaints and diagnoses utilizing emergency department data from the Los Angeles County Syndromic Surveillance project, each were compared with measured patient body temperatures in the fever range.

scholarly journals Lessons Learned from an Extreme Heat Event using ACES for Situational Awareness, Ontario, Canada

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Nancy VanStone ◽  
Adam Van Dijk ◽  
Paul Belanger ◽  
Kieran Moore
Keyword(s):  
Public Health ◽  
Acute Care ◽  
Syndromic Surveillance ◽  
Extreme Heat ◽  
Health Impacts ◽  
Health Authorities ◽  
Extreme Heat Event ◽  
Heat Event ◽  
Public Health Authorities ◽  
Ed Visits

ObjectiveTo describe the lessons learned for public health decision-makers from an analysis of Acute Care Enhanced Surveillance (ACES) data for the heatwaves experienced in Ontario, Canada in the summer of 2018.IntroductionThe Acute Care Enhanced Surveillance (ACES) system provides syndromic surveillance for Ontario’s acute care hospitals. ACES receives over 99% of acute care records for emergency department (ED) visits; mean daily volume is 17,500 visits. ACES uses a maximum entropy classifier and generates more than 80 standard syndromes, fifteen of which are actively monitored for aberrational activity and are considered of higher public health relevance, including RESP (respiratory infection, non-croup), ILI (influenza-like illness), TOX (toxicological, chemical/drug exposure), AST (asthma), OPI (opioid exposure), CELL (cellulitis), GASTRO (gastroenteritis), ENVIRO (environmental, heat/cold exposure), MH (mental health), EOH (alcohol intoxication), DERM (rash), and SEP (bacteremia, sepsis).Syndromic surveillance provides a salient source of public health surveillance during extreme heat events; monitoring real-time ED visits can inform local public health authorities of health impacts, provide situation awareness to initiate and/or inform public health response, and help decision-makers allocate resources according to geographic (or demographic) vulnerability. While the use of syndromic surveillance has been well-characterized to monitor infectious disease outbreaks, its use to monitor the heat-health impacts is relatively novel for ACES users, specifically local public health authorities. This report describes the the data collected during an extended extreme heat event in Ontario, Canada, to highlight the value of syndromic surveillance during extreme heat events and make recommendations regarding incorporating ACES data into routine workflows.MethodsTemperature data were retrieved from Environment Canada historical databases for mid-June to mid-July 2018. Aggregate counts per day for total ED visits and and for individual syndromes were retrieved from ACES databases. Descriptive statistics were used to analyze all datasets.ResultsAn extreme heat event occurred in the southern region of Ontario in early summer, 2018. Environment Canada issues heat warnings for regions throughout Canada according to region-specific criteria; for southern Ontario, heat warnings are issued when 2 or more consecutive days of daytime maximum temperatures are expected to reach 31°C or when 2 or more consecutive days of humidex values are expected to reach 40. Extended heat warnings are issued when the event lasts beyond 2 days. An extended heat event occurred June 29 to July 5, 2018. Although the region is large, temperature data from Environment Canada’s climate monitoring station at Toronto’s Pearson Airport are shown (Figure 1) as an example of the temperatures observed for this time period in the region.ConclusionsLessons learned from an analysis of ACES data during an extreme heat event:1. The ENVIRO syndrome provides real-time monitoring of the health impacts during a heat event and may provide proxy for estimating the indirect effects of heat (e.g., impacts on chronic conditions). Public health authorities can monitor local health impacts during an extreme heat event.2. Patients seeking help at the ED do not appear to be skewed in acuity, sex nor age. This does not necessarily reflect the population that experiences the greatest impact from extreme heat, but rather those that are seeking help at the ED for the direct effects of heat. That said, an increase in ENVIRO counts does not indicate whether the increase is due to greater exposure to the heat (or sun), engaging in vigorous outdoor activity during the event (recreational or occupational), or lack of access to air conditioning.3. ED visits for ENVIRO can be geolocated to determine areas experiencing greater health impacts. This may allow allocation of resources to specifically address vulnerabilities. ACES has built-in mapping capabilities that allows a geovisualization of the home addresses for patients. Furthermore, aggregate counts for relevant syndromes are available for registered users on the Public Health Information Management System (PHIMS), a web-accessible GIS tool for situational awareness that gives public health decision-makers access to real time health impacts in concert with demographics, weather, and other emergency management information. 

scholarly journals Validation of Los Angeles County Department of Public Health Respiratory Syndrome using Electronic Health Records

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Kelsey OYong ◽  
Emily Kajita ◽  
Patricia Araki ◽  
Monica Luarca ◽  
Bessie Hwang
Keyword(s):  
Emergency Department ◽  
Los Angeles ◽  
Electronic Health Records ◽  
Syndromic Surveillance ◽  
Los Angeles County ◽  
Surveillance Systems ◽  
Health Records ◽  
High K ◽  
Chief Complaints ◽  
Electronic Health

In Los Angeles County, emergency department data is collected from hospitals and classified into syndromes based on chief complaints. To validate this respiratory syndromic surveillance categorization, chief complaint data were compared to discharge diagnoses extracted from electronic health records from one hospital emergency department in Los Angeles County during one week in January 2013. The agreement between syndrome classification and discharge diagnosis for respiratory reports is high (k=0.75), though over 25% of diagnosis data were missing. Further validation of additional syndromes is needed. Electronic health records are valuable sources of data and can enhance the validity of syndromic surveillance systems.

scholarly journals Public Health Efforts Can Impact Adoption of Current Susceptibility Breakpoints, but Closer Attention from Regulatory Bodies Is Needed

2018 ◽  
Vol 57 (3) ◽  
Author(s):  
James A. McKinnell ◽  
S. Bhaurla ◽  
P. Marquez-Sung ◽  
A. Pucci ◽  
M. Baron ◽  
...  
Keyword(s):  
Public Health ◽  
Patient Safety ◽  
Los Angeles ◽  
Antimicrobial Susceptibility ◽  
Los Angeles County ◽  
Susceptibility Testing ◽  
Clinical Care ◽  
Public Health Intervention ◽  
Antimicrobial Susceptibility Testing ◽  
Outreach Program

ABSTRACT Microbiological testing, including interpretation of antimicrobial susceptibility testing results using current breakpoints, is crucial for clinical care and infection control. Continued use of obsolete Enterobacteriaceae carbapenem breakpoints is common in clinical laboratories. The purposes of this study were (i) to determine why laboratories failed to update breakpoints and (ii) to provide support for breakpoint updates. The Los Angeles County Department of Public Health conducted a 1-year outreach program for 41 hospitals in Los Angeles County that had reported, in a prior survey of California laboratories, using obsolete Enterobacteriaceae carbapenem breakpoints. In-person interviews with hospital stakeholders and customized expert guidance and resources were provided to aid laboratories in updating breakpoints, including support from technical representatives from antimicrobial susceptibility testing device manufacturers. Forty-one hospitals were targeted, 7 of which had updated breakpoints since the prior survey. Of the 34 remaining hospitals, 27 (79%) assumed that their instruments applied current breakpoints, 17 (50%) were uncertain how to change breakpoints, and 10 (29%) lacked resources to perform a validation study for off-label use of the breakpoints on their systems. Only 7 hospitals (21%) were familiar with the FDA/CDC Antibiotic Resistance Isolate Bank. All hospitals launched a breakpoint update process; 16 (47%) successfully updated breakpoints, 12 (35%) received isolates from the CDC in order to validate breakpoints on their systems, and 6 (18%) were planning to update within 1 year. The public health intervention was moderately successful in identifying and overcoming barriers to updating Enterobacteriaceae carbapenem breakpoints in Los Angeles hospitals. However, the majority of targeted hospitals continued to use obsolete breakpoints despite 1 year of effort. These findings have important implications for the quality of patient care and patient safety. Other public health jurisdictions may want to utilize similar resources to bridge the patient safety gap, while manufacturers, the FDA, and others determine how best to address this growing public health issue.

scholarly journals Outbreak of ED visits related to the use of synthetic cannabinoids, Mayotte Island

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Pascal Vilain ◽  
Salamta Bah-Assoumani ◽  
Ali-Mohamed Youssouf ◽  
Laurent Filleul
Keyword(s):  
Public Health ◽  
Behavioral Disorders ◽  
Surveillance System ◽  
Syndromic Surveillance ◽  
Adverse Reactions ◽  
Health Agency ◽  
Case Definition ◽  
Syndromic Surveillance System ◽  
Ed Visits ◽  
Mental And Behavioral Disorders

ObjectiveTo confirm and to characterize the increase in emergency department (ED) visits related to the use of synthetic cannabinoids (SC)IntroductionOn October 2016, the Indian Ocean Regional Health Agency was alerted about an increase in ED visits related to adverse reactions associated with use of SC on Mayotte Island. In this context, an investigation based on a syndromic surveillance system was implemented by the regional unit of the French national public health agency.MethodsAn extraction of anonymized records routinely collected by the syndromic surveillance system (1) was carried out from January 1st, 2012 to October 30, 2016. ED visits related to the consumption of SC were identified from ICD-10 codes of the principal diagnostic according to two levels of confidence:- a probable case was defined as ED visit coded X69 (Intentional self-poisoning by and exposure to other and unspecified chemicals and noxious substances). This code has been implemented specifically by ED physicians since august 2015;- a suspect case was defined as ED visit coded: F11 (Mental and behavioral disorders due to use of opioids), F12 (Mental and behavioral disorders due to use of cannabinoids), F16 (Mental and behavioral disorders due to use of hallucinogens), F18 (Mental and behavioral disorders due to use of volatile solvents), F19 (Mental and behavioral disorders due to multiple drug use and use of other psychoactive substances).Based on these data, an epidemic curve and a descriptive analysis of ED visits were carried out.ResultsIn total, 146 ED visits related to adverse events associated with use of SC were registered from January 1st, 2012 to October 30, 2016. The epidemic curve shows two waves between 2015 and 2016 with a particularly high peak in August 2015 (Figure 1). In total, 49% (n=72/146) of these ED visits were probably related to adverse reactions associated to use SC and 51% (n=74/146) meet to the suspect case definition. On the surveillance period, men represented 84% of the patients (n=122) and median age (min – max) was 23 (8-62) years old. When the severity score variable was filled (n = 138), a vital emergency was reported for 4% (n = 5) of patients and 19% of patients were hospitalized.ConclusionsData from syndromic surveillance system allowed to confirm an increase in ED visits related to adverse reactions associated with use of SC in Mayotte Island. To our knowledge, it’s the first time that an outbreak related to use SC is described in the Ocean Indian areaThis phenomenon was particularly marked in 2015 with a peak of ED visits on August 2016.After this outbreak, the regional unit of the French national public health agency recommended the pursuit of the coding X69 in principal diagnosis with the following case definition: any patient with an adverse reaction attributed to synthetic cannabinoid use whether suspected by the medical team or declared by the patient himself or if the patient is in possession of the substance; and to raise awareness ED physicians to the notification of these poisonings to the Regional Addictive Surveillance Center.In conclusion, the young population, weakened by a precarious socio-economic situation, is a target for new synthetic drugs and a threat to public health. This emerging risk in Mayotte must be taken into account and must be actively monitored. In this context, collaborative work with the emergency services must continue in parallel with targeted prevention measures.References1. Vilain P, Maillard O, Raslan-Loubatie J, Abdou MA, Lernout T, Filleul L. Usefulness of Syndromic Surveillance for Early Outbreak Detection in Small Islands: The Case of Mayotte. Online Journal of Public Health Informatics. 2013;5(1):e149.

scholarly journals Characterizing the Effects of Extreme Cold Using Real-time Syndromic Surveillance, Ontario, Canada, 2010-2016

2017 ◽  
Vol 132 (1_suppl) ◽  
pp. 48S-52S ◽  
Author(s):  
Nancy VanStone ◽  
Adam van Dijk ◽  
Timothy Chisamore ◽  
Brian Mosley ◽  
Geoffrey Hall ◽  
...  
Keyword(s):  
Public Health ◽  
Acute Care ◽  
Surveillance System ◽  
Syndromic Surveillance ◽  
Cold Temperature ◽  
Syndromic Surveillance System ◽  
Southern Ontario ◽  
Threshold Temperatures ◽  
Ed Visits ◽  
Extreme Cold

Morbidity and mortality from exposure to extreme cold highlight the need for meaningful temperature thresholds to activate public health alerts. We analyzed emergency department (ED) records for cold temperature–related visits collected by the Acute Care Enhanced Surveillance system—a syndromic surveillance system that captures data on ED visits from hospitals in Ontario—for geographic trends related to ambient winter temperature. We used 3 Early Aberration Reporting System algorithms of increasing sensitivity—C1, C2, and C3—to determine the temperature at which anomalous counts of cold temperature–related ED visits occurred in northern and southern Ontario from 2010 to 2016. The C2 algorithm was the most sensitive detection method. Results showed lower threshold temperatures for Acute Care Enhanced Surveillance alerts in northern Ontario than in southern Ontario. Public health alerts for cold temperature warnings that are based on cold temperature–related ED visit counts and ambient temperature may improve the accuracy of public warnings about cold temperature risks.

Incidentally Detected SARS-COV-2 Among Hospitalized Patients in Los Angeles County, August to October 2020

2021 ◽  
Vol 16 (8) ◽  
Author(s):  
Jennifer Tsai ◽  
Elizabeth Traub ◽  
Kymberly Aoki ◽  
Kelsey Oyong ◽  
Heidi Sato ◽  
...  
Keyword(s):  
Public Health ◽  
Los Angeles ◽  
Emergency Preparedness ◽  
Medical Records ◽  
Confidence Limit ◽  
Los Angeles County ◽  
Resource Planning ◽  
Hospital Discharges ◽  
Hospitalization Rates ◽  
Test Result

We aimed to determine the percentage of COVID-19–associated hospitalizations reported to Los Angeles County (LAC) Public Health that might have been misclassified because of incidentally detected SARS-CoV-2. We retrospectively reviewed medical records from a randomly selected set of hospital discharges reported to LAC Public Health from August to October 2020 for a clinical diagnosis of COVID-19 or a positive SARS-CoV-2 test result. Among the 13,813 discharges from 85 hospitals reported to LAC Public Health as COVID-19–associated hospitalizations from August to October 2020, 346 were randomly selected and reviewed. SARS-CoV-2 detection was incidental to the reason for hospitalization in 12% (95% confidence limit, 9%-16%) of COVID-19 classified hospital discharges. Adjusting COVID-19–associated hospitalization rates to account for incidental SARS-CoV-2 detection could help public health policymakers and emergency preparedness personnel improve resource planning.

Introduction and History of Public Health in Los Angeles County

2012 ◽  
pp. 1-12
Author(s):  
Jonathan E. Fielding ◽  
Jonathan Freedman ◽  
Stephanie N. Caldwell
Keyword(s):  
Public Health ◽  
Los Angeles ◽  
Los Angeles County ◽  
History Of Public Health ◽  
History Of
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