Utility of a near real-time emergency department syndromic surveillance system to track injuries in New York City

Development and Evaluation of Syndromic Surveillance Definitions for Fall- and Hip Fracture-Related Emergency Department Visits Among Adults Aged 65 Years and Older, United States 2017-2018

OBJECTIVE

To develop syndromic surveillance definitions for unintentional fall- and hip fracture-related emergency department (ED) visits among older adults (aged ≥65 years) for use in the Centers for Disease Control and Prevention's National Syndromic Surveillance Program (NSSP) data and compare the percentage of ED visits captured using these new syndromes with ED visits from the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample (HCUP-NEDS), a nationally representative administrative data set.

DESIGN/SETTING

Syndromic definitions were developed using chief complaint terms and discharge diagnosis codes in NSSP data. The percentages of ED visits among older adults related to falls and hip fractures in NSSP were compared with the percentages in HCUP-NEDS in 2017 and 2018.

MEASURES

Prevalence ratios were calculated as the relative difference in the percentage of ED visits related to falls or hip fractures in NSSP compared with HCUP-NEDS. Counts and percentages calculated using HCUP-NEDS were weighted to produce nationally representative estimates. Data were analyzed overall and by sex and age group.

RESULTS

The percentage of ED visits among older adults related to falls in NSSP was 12% less in 2017 (10.81%) and 7% less in 2018 (11.42%) compared with HCUP-NEDS (2017: 12.30%; 2018: 12.26%). The percentage of ED visits among older adults related to hip fractures in NSSP was 41% less in 2017 (0.65%) and 30% less in 2018 (0.76%) compared with HCUP-NEDS (2017: 1.10%; 2018: 1.09%). In both 2017 and 2018, a higher percentage of ED visits among older women and adults aged 85 years or older were related to falls or hip fractures compared with older men and younger age groups across both data sets.

CONCLUSION

A smaller percentage of older adults' ED visits met the falls and hip fracture definitions in NSSP compared with HCUP-NEDS in 2017 and 2018. However, demographic trends remained similar across both data sets.

Differences and similarities between emergency department syndromic surveillance and hospital discharge data for nonfatal drug overdose

PURPOSE

Emergency department syndromic surveillance and hospital discharge data have been used to detect and monitor nonfatal drug overdose, yet few studies have assessed the differences and similarities between these two data sources.

METHODS

The Centers for Disease Control and Prevention Drug Overdose Surveillance and Epidemiology system data from 14 states were used to compare these two sources at estimating monthly overdose burden and trends from January 2018 through December 2019 for nonfatal all drug, opioid-, heroin-, and stimulant-involved overdoses.

RESULTS

Compared to discharge data, syndromic data captured 13.3% more overall emergency department visits, 67.8% more all drug overdose visits, 15.6% more opioid-involved overdose visits, and 78.8% more stimulant-involved overdose visits. Discharge data captured 18.9% more heroin-involved overdoses. Significant trends were identified for all drug (Average Monthly Percentage Change [AMPC]=1.1, 95% CI=0.4,1.8) and stimulant-involved overdoses (AMPC=2.4, 95% CI=1.2,3.7) in syndromic data; opioid-involved overdoses increased in both discharge and syndromic data (AMPC_Discharge=0.9, 95% CI=0.2,1.7; AMPC_Syndromic=1.9, CI=1.1,2.8).

CONCLUSIONS

Results demonstrate that discharge data may be better for reporting counts, yet syndromic data are preferable to detect changes quickly and to alert practitioners and public health officials to local overdose clusters. These data sources do serve complementary purposes when examining overdose trends.

Emergency department syndromic surveillance systems: a systematic review

BACKGROUND

Syndromic surveillance provides public health intelligence to aid in early warning and monitoring of public health impacts (e.g. seasonal influenza), or reassurance when an impact has not occurred. Using information collected during routine patient care, syndromic surveillance can be based on signs/symptoms/preliminary diagnoses. This approach makes syndromic surveillance much timelier than surveillance requiring laboratory confirmed diagnoses. The provision of healthcare services and patient access to them varies globally. However, emergency departments (EDs) exist worldwide, providing unscheduled urgent care to people in acute need. This provision of care makes ED syndromic surveillance (EDSyS) a potentially valuable tool for public health surveillance internationally. The objective of this study was to identify and describe the key characteristics of EDSyS systems that have been established and used globally.

METHODS

We systematically reviewed studies published in peer review journals and presented at International Society of Infectious Disease Surveillance conferences (up to and including 2017) to identify EDSyS systems which have been created and used for public health purposes. Search criteria developed to identify "emergency department" and "syndromic surveillance" were applied to NICE healthcare, Global Health and Scopus databases.

RESULTS

In total, 559 studies were identified as eligible for inclusion in the review, comprising 136 journal articles and 423 conference abstracts/papers. From these studies we identified 115 EDSyS systems in 15 different countries/territories across North America, Europe, Asia and Australasia. Systems ranged from local surveillance based on a single ED, to comprehensive national systems. National EDSyS systems were identified in 8 countries/territories: 2 reported inclusion of ≥85% of ED visits nationally (France and Taiwan).

CONCLUSIONS

EDSyS provides a valuable tool for the identification and monitoring of trends in severe illness. Technological advances, particularly in the emergency care patient record, have enabled the evolution of EDSyS over time. EDSyS reporting has become closer to 'real-time', with automated, secure electronic extraction and analysis possible on a daily, or more frequent basis. The dissemination of methods employed and evidence of successful application to public health practice should be encouraged to support learning from best practice, enabling future improvement, harmonisation and collaboration between systems in future.

PROSPERO NUMBER

CRD42017069150 .

Advancing the Use of Emergency Department Syndromic Surveillance Data, New York City, 2012-2016

INTRODUCTION

The use of syndromic surveillance has expanded from its initial purpose of bioterrorism detection. We present 6 use cases from New York City that demonstrate the value of syndromic surveillance for public health response and decision making across a broad range of health outcomes: synthetic cannabinoid drug use, heat-related illness, suspected meningococcal disease, medical needs after severe weather, asthma exacerbation after a building collapse, and Ebola-like illness in travelers returning from West Africa.

MATERIALS AND METHODS

The New York City syndromic surveillance system receives data on patient visits from all emergency departments (EDs) in the city. The data are used to assign syndrome categories based on the chief complaint and discharge diagnosis, and analytic methods are used to monitor geographic and temporal trends and detect clusters.

RESULTS

For all 6 use cases, syndromic surveillance using ED data provided actionable information. Syndromic surveillance helped detect a rise in synthetic cannabinoid-related ED visits, prompting a public health investigation and action. Surveillance of heat-related illness indicated increasing health effects of severe weather and led to more urgent public health messaging. Surveillance of meningitis-related ED visits helped identify unreported cases of culture-negative meningococcal disease. Syndromic surveillance also proved useful for assessing a surge of methadone-related ED visits after Superstorm Sandy, provided reassurance of no localized increases in asthma after a building collapse, and augmented traditional disease reporting during the West African Ebola outbreak.

PRACTICE IMPLICATIONS

Sharing syndromic surveillance use cases can foster new ideas and build capacity for public health preparedness and response.

Use of syndromic surveillance data to monitor poisonings and drug overdoses in state and local public health agencies

BACKGROUND

The incidence of poisoning and drug overdose has risen rapidly in the USA over the last 16 years. To inform local intervention approaches, local health departments (LHDs) in North Carolina (NC) are using a statewide syndromic surveillance system that provides timely, local emergency department (ED) and Emergency Medical Services (EMS) data on medication and drug overdoses.

OBJECTIVE

The purpose of this article is to describe the development and use of a variety of case definitions for poisoning and overdose implemented in NC's syndromic surveillance system and the impact of the system on local surveillance initiatives.

DESIGN, SETTING, PARTICIPANTS

Thirteen new poisoning and overdose-related case definitions were added to NC's syndromic surveillance system and LHDs were trained on their use for surveillance purposes. Twenty-one LHDs were surveyed on the utility and impact of these new case definitions.

RESULTS/CONCLUSIONS

Ninety-one per cent of survey respondents (n = 29) agreed or strongly agreed that their ability to access timely ED data was vital to inform community-level overdose prevention work. Providing LHDs with access to local, timely data to identify pockets of need and engage stakeholders facilitates the practice of informed injury prevention and contributes to the reduction of injury incidence in their communities.