scholarly journals Using a Syndromic Surveillance System to Evaluate the Impact of a Change in Alcohol Law

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Julia A. Dilley ◽  
Atar Baer ◽  
Jeff Duchin ◽  
Julie E. Maher
Keyword(s):  
Surveillance System ◽  
Syndromic Surveillance ◽  
Washington State ◽  
Chief Complaint ◽  
King County ◽  
Syndromic Surveillance System ◽  
Liquor Stores ◽  
Diagnosis Codes ◽  
Ed Visits ◽  
The Impact

In 2011, Washington State voters passed an initiative which closed state liquor stores and opened private sector liquor sales. We examined trends in alcohol-related emergency department (ED) visits associated with this law change. Data were from the King County syndromic surveillance system. Alcohol-related ED visits were identified using chief complaint search strings and diagnosis codes. We used a linear regression model with a spline at the date of law change and controlled for other factors. Significant increases in alcohol-related ED visits were observed associated with the law change among minors (age <21) and adults ages 40 and older.

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 Validation of Syndromic ILI Data for Use in CDC’s ILINet Surveillance, Pennsylvania

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Sameh W Boktor ◽  
Kristen Waller ◽  
Lenee Blanton ◽  
Krista Kniss
Keyword(s):  
Sore Throat ◽  
Surveillance System ◽  
Syndromic Surveillance ◽  
Correlation Coefficients ◽  
Chief Complaint ◽  
The State ◽  
Surveillance Data ◽  
Syndromic Surveillance System ◽  
Ed Visits ◽  
Number Of Visits

Objective: Discuss use of syndromic surveillance as a source for the state’s ILI/Influenza surveillanceDiscuss reliability of syndromic data and methods to address problems caused by data outliers and inconsistencies.Introduction: ILINet is a CDC program that has been used for years for influenza-like illness (ILI) surveillance, using a network of outpatient providers who volunteer to track and report weekly the number of visits due to ILI and the total number of visits to their practice. Pennsylvania has a network of 95 providers and urgent care clinics that submit data to ILINet. However, ongoing challenges in recruiting and retaining providers, and inconsistent weekly reporting are barriers to receiving accurate, representative, and timely ILI surveillance data year-round. Syndromic surveillance data have been used to enhance outpatient ILI surveillance in a number of jurisdictions, including Pennsylvania. At present, 156 hospitals, or 90% of all Pennsylvania hospitals with emergency departments (EDs), send chief complaint and other information on their ED visits to the Department of Health’s (PADOH) syndromic surveillance system. PADOH evaluated the consistency and reliability of ILI syndromic data as compared to ILINet data, to confirm that syndromic data were suitable for use in ILINet.Methods: Pennsylvania ILINet data from the past 6 influenza seasons (2011-2012 to 2016-2017, or 314 weeks of data) were downloaded from the CDC’s ILINet website. The statewide weekly percent of visits due to ILI in ILINet was used as the standard for comparisons. For syndromic surveillance, PADOH uses the Epicenter platform hosted by Health Monitoring Systems (HMS); visit-level data are also stored in SAS datasets at PADOH, and HMS forwards a subset of data to the National Syndromic Surveillance System Program. Using syndromic data from the same time period, the proportion of weeks with no syndromic data available was calculated for each facility. A state-developed ILI algorithm (very similar to the 2016 algorithm developed by the ISDS Syndrome Definitions Workgroup) was applied to ED visit chief complaint data to identify visits likely to be due to ILI. The algorithm flags the ER visit as ILI if chief complaint has any combinations of words for flu or fever plus either cough and sore throat or fever and both cough or sore throat . The percent of ED visits due to ILI per the syndromic algorithm (ILIsyn) was calculated for each week by hospital and state-wide. Facility ILIsyn trends were compared to the State level percent ILI data from ILINet by visually examining plots and by calculating Pearson correlation coefficients. Facilities that had >=15 weeks where ILIsyn differed from percent ILI in ILINet by more than 5% were considered to be poorly correlated.Results: A total of 156 hospitals were evaluated in the study. Twenty of the hospitals were excluded because they did not have syndromic data for at least 50% of the weeks in the study period, and an additional 20 were excluded because they had not agreed to have data forwarded to CDC. Of the remaining 116 facilities, individual facility correlation coefficients between ILIsyn and ILINet trends ranged from 0.03 to 0.82 (examples are in Figure 1). Twenty-four hospitals (20.7%) were determined to be poorly correlated. When data from the remaining 92 hospitals were combined, the state ILINet and state-wide ILIsyn trends were strongly correlated statistically and graphically (r=0.82, p <0.0001, Figure 2). Syndromic data from these 92 facilities were deemed acceptable for inclusion in ILINet. Conclusions: Syndromic surveillance data are a valuable source for ILI surveillance. However, evaluation at the hospital-specific level revealed that useful information is not obtained from all facilities. This project demonstrated that validation of data at the facility level is crucial to obtaining reliable and meaningful information. More work is needed to understand which factors distinguish well-correlated from poorly-correlated facilities, and how to improve the quality of information obtained from poorly-correlated facilities.

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 Using an Emergency Department Syndromic Surveillance System to Assess the Impact of Cyclone Bejisa, Reunion Island

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Pascal Vilain ◽  
Frédéric Pagès ◽  
Katia Mougin-Damour ◽  
Xavier Combes ◽  
Pierre-Jean Marianne Dit Cassou ◽  
...  
Keyword(s):  
Surveillance System ◽  
Syndromic Surveillance ◽  
Health Impact ◽  
Epidemiological Surveillance ◽  
Reunion Island ◽  
Syndromic Surveillance System ◽  
Réunion Island ◽  
Ed Visits ◽  
Set Up ◽  
The Impact

On January 2, 2014 the cyclone Bejisa struck Reunion Island. In anticipation, an epidemiological surveillance was set up in order to assess the impact in the aftermath of the cyclone. Short-term health effects were assessed using a syndromic surveillance system based on data of EDs and EMS. A peak of calls to the EMS was observed the day of the cyclone and an increase of ED visits over the next two days. At the same time, a significant increase of visits for trauma, burns, conjunctivitis was detected. The reactivity and the flexibility of the syndromic surveillance system allowed to rapidly assess the health impact of the cyclone.

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.

scholarly journals Building a Better Syndromic Surveillance System: the New York City Experience

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Robert Mathes ◽  
Jessica Sell ◽  
Anthony W. Tam ◽  
Alison Levin-Rector ◽  
Ramona Lall
Keyword(s):  
New York ◽  
New York City ◽  
York City ◽  
Surveillance System ◽  
Syndromic Surveillance ◽  
Alternative Methods ◽  
Detection Methods ◽  
Syndromic Surveillance System ◽  
Aberration Detection ◽  
Ed Visits

The New York City (NYC) syndromic surveillance system has been monitoring syndromes from city emergency department (ED) visits since 2001. We conducted an evaluation of statistical aberration detection methods currently in use in our system as well as alternative methods, applying six temporal and four spatio-temporal aberration detection methods to two years of ED visits in NYC spiked with synthetic outbreaks. We found performance varied between the methods in regard to sensitivity, specificity, and timeliness, and implementation of these methods will depend on needs, frequency of signals, and technical skill.

scholarly journals Inconsistency of Timeliness in a Chief Complaint-Based Syndromic Surveillance System During Two Influenza Epidemic Seasons

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Tao Tao ◽  
Qi Zhao ◽  
Jun Zong ◽  
Xue Li ◽  
Vinod Diwan ◽  
...  
Keyword(s):  
Surveillance System ◽  
Syndromic Surveillance ◽  
Clinical Manifestations ◽  
Chief Complaint ◽  
Influenza Surveillance ◽  
Influenza Epidemic ◽  
Surveillance Network ◽  
Syndromic Surveillance System ◽  
Positive Rate ◽  
Patient Groups

This study estimated the early warning timeliness of a chief complaint-based syndromic surveillance system towards seasonal influenza epidemics. Findings showed that the timliness of ILI data sources changed across two influenza epidemic seasons. ILI reported from different levels of health facilities and patient groups showed distinct timeliness towards influenza epidemics indicated by virus positive rate (VPR) from National Influenza Surveillance Network. The changes of dominant strains, clinical manifestations, population groups affected in different influenza seasons might account for this inconsistency.

scholarly journals Flexibility of ED surveillance system to monitor dengue outbreak in Reunion Island

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Pascal Vilain ◽  
Muriel Vincent ◽  
Anne Fouillet ◽  
Katia Mougin-Damour ◽  
Xavier Combes ◽  
...  
Keyword(s):  
Public Health ◽  
Surveillance System ◽  
Syndromic Surveillance ◽  
Reunion Island ◽  
Regional Office ◽  
Syndromic Surveillance System ◽  
Dengue Outbreak ◽  
Icd 10 ◽  
Réunion Island ◽  
Ed Visits

ObjectiveTo describe the characteristics of ED vitis related to dengue fever and to show how the syndromic surveillance system can be flexible for the monitoring of this outbreak.IntroductionIn Reunion Island, a French overseas territory located in the southwestern of Indian Ocean, the dengue virus circulation is sporadic. Since 2004, between 10 and 221 probable and confirmed autochthonous dengue fever cases have been reported annually. Since January 2018, the island has experienced a large epidemic of DENV serotype 2. As of 4 September 2018, 6,538 confirmed and probable autochthonous cases have been notified1. From the beginning of the epidemic, the regional office of National Public Health Agency (ANSP) in Indian Ocean enhanced the syndromic surveillance system in order to monitor the outbreak and to provide hospital morbidity data to public health authorities.MethodsIn Reunion Island, the syndromic surveillance system called OSCOUR® network (Organisation de la Surveillance Coordonnée des Urgences) is based on all emergency departments (ED)2. Anonymous data are collected daily directly from the patients’ computerized medical files completed during medical consultations. Every day, data files are sent to the ANSP via a regional server over the internet using a file transfer protocol. Each file transmitted to ANSP includes all patient visits to the ED logged during the previous 24 hours (midnight to midnight). Finally, data are integrated in a national database (including control of data quality regarding authorized thesauri) and are made available to the regional office through an online application3.Following the start of dengue outbreak in week 4 of 2018, the regional office organized meetings with physicians in each ED to present the dengue epidemiological update and to recommend the coding of ED visit related to dengue for any suspect case (acute fever disease and two or more of the following signs or symptoms: nausea, vomiting, rash, headache, retro-orbital pain, myalgia). During these meetings, it was found that the version of ICD-10 (International Classification of Diseases) was different from one ED to another. Indeed, some ED used A90, A91 (ICD-10 version: 2015) for visit related to dengue and others used A97 and subdivisions (ICD-10 version: 2016). As the ICD-10 version: 2015 was implemented at the national server, some passages could be excluded. In this context, the thesaurus of medical diagnosis implemented in the national database has been updated so that all codes can be accepted. ED visits related to dengue fever has been then described according to age group, gender and hospitalization.ResultsFrom week 9 of 2018, the syndromic surveillance system was operational to monitor dengue outbreak. The regional office has provided each week, an epidemic curve of ED visits for dengue and a dashboard on descriptive characteristic of these visits. In total, 441 ED visits for dengue were identified from week 9 to week 34 of 2018 (Figure 1). On this period, the weekly number of ED visits for dengue was correlated with the weekly number of probable and confirmed autochthonous cases (rho=0.86, p<0.001). Among these visits, the male/female ratio was 0.92 and median (min-max) age was 44 (2-98) years. The distribution by age group showed that 15-64 year-old (72.1%, n=127) were most affected. Age groups 65 years and more and 0-14 year-old represented respectively 21.8% (n=96) and 6.1% (n=27) of dengue visits. About 30% of dengue visits were hospitalized.ConclusionsAccording Buehler et al., “the flexibility of a surveillance system refers to the system's ability to change as needs change. The adaptation to changing detection needs or operating conditions should occur with minimal additional time, personnel, or other resources. Flexibility generally improves the more data processing is handled centrally rather than distributed to individual data-providing facilities because fewer system and operator behavior changes are needed...” 4.During this dengue outbreak, the syndromic surveillance system seems to have met this purpose. In four weeks (from week 5 to week 9 of 2018), the system was able to adapt to the epidemiological situation with minimal additional resources and personnel. Indeed, updates were not made in the IT systems of each EDs’ but at the level of the national ANSP server (by one person). This surveillance system was also flexible thank to the reactivity of ED physicians who timely implemented coding of visits related to dengue fever.In conclusion, ED surveillance system constitutes an added-value for the dengue outbreak monitoring in Reunion Island. The automated collection and analysis data allowed to provide hospital morbidity (severe dengue) data to public health authorities. Although the epidemic has decreased, this system also allows to continue a routine active surveillance in order to quickly identify a new increase.References1Santé publique France. Surveillance de la dengue à la Réunion. Point épidémiologique au 4 septembre 2018. http://invs.santepubliquefrance.fr/fr/Publications-et-outils/Points-epidemiologiques/Tous-les-numeros/Ocean-Indien/2018/Surveillance-de-la-dengue-a-la-Reunion.-Point-epidemiologique-au-4-septembre-2018. [Accessed September 8, 2018].2Vilain P, Filleul F. La surveillance syndromique à la Réunion : un système de surveillance intégré. [Syndromic surveillance in Reunion Island: integrated surveillance system]. Bulletin de Veille Sanitaire. 2013;(21):9-12. http://invs.santepubliquefrance.fr/fr/Publications-et-outils/Bulletin-de-veille-sanitaire/Tous-les-numeros/Ocean-indien-Reunion-Mayotte/Bulletin-de-veille-sanitaire-ocean-Indien.-N-21-Septembre-2013. [Accessed September 4, 2018].3Fouillet A, Fournet N, Caillère N et al. SurSaUD® Software: A Tool to Support the Data Management, the Analysis and the Dissemination of Results from the French Syndromic Surveillance System. OJPHI. 2013; 5(1): e118.4Buehler JW, Hopkins RS, Overhage JM, Sosin DM, Tong V; CDC Working Group. Framework for evaluating public health surveillance systems for early detection of outbreaks: recommendations from the CDC Working Group. MMWR Recomm Rep. 2004;53(RR-5):1-11.

scholarly journals Usefulness of Syndromic Surveillance during Ultra-endurance Running Races: Example with the “Grand Raid de la Réunion” Ultra Trail

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Aurélie Martin ◽  
Pascal Vilain ◽  
Arnaud Bourdé ◽  
Xavier Combes ◽  
Pierre-Jean Marianne dit Cassou ◽  
...  
Keyword(s):  
Syndromic Surveillance ◽  
Health Impact ◽  
La Réunion ◽  
Endurance Running ◽  
Syndromic Surveillance System ◽  
Sporting Event ◽  
Ed Visits ◽  
Global Increase ◽  
Ultra Endurance ◽  
The Impact

The "Grand Raid de la Réunion" is one of the hardest ultra trails in the world. This endurance running race has consequences on health's runners. We used syndromic surveillance to estimate the health impact of this sporting event on the Emergency Departments (ED) of Reunion Island. During the race's period, a global increase of the ED visits all causes was observed. The syndromic surveillance system detected a significant ED visits' increase for hydro-electrolytic disorders. These results highlight the usefulness of syndromic surveillance to estimate the impact on health of a mass gathering on a sporting event of great magnitude.

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