Gould Deborah

Syndromic surveillance systems, although initially developed in response to bioterrorist threats, are increasingly being used at the local, state, and national level to support early identification of infectious disease and other emerging threats to public health. To facilitate detection, one of the goals of CDC's National Syndromic Surveillance Program (NSSP) is to develop and share new sets of syndrome codes with the syndromic surveillance Community of Practice. Before analysts, epidemiologists, and other practitioners begin customizing queries to meet local needs, especially monitoring ED visits in near-real time during public health emergencies, they need to understand how syndromes are developed. More than 4,000 hospital routinely send data to NSSP's BioSense Platform, representing about 55 percent of ED visits in the United States (2). The platform's surveillance component, ESSENCE,* is a web-based application for analyzing and visualizing prediagnostic hospital ED data. ESSENCE's Chief Complaint Query Validation (CCQV) data source, which is a national-level data source with access to chief complaint (CC) and discharge diagnoses (DD) from reporting sites, was designed for testing new queries.

Objective: Emergency department (ED) visits related to mental health (MH) disorders have increased since 2006 (1), indicating a potential burden on the healthcare delivery system. Surveillance systems has been developed to identify and understand these changing trends in how EDs are used and to characterize populations seeking care. Many state and local health departments are using syndromic surveillance to monitor MH-related ED visits in near real-time. This presentation describes how queries can be created and customized to identify select MH sub-indicators (for adults) by using chief complaint text terms and diagnoses codes. The MH sub-indicators examined are mood and depressive disorders, schizophrenic disorders, and anxiety disorders. Wider adoption of syndromic surveillance for characterizing MH disorders can support long-term planning for healthcare resources and service delivery.

Between 2006 and 2013, the rate of emergency department (ED) visits related to mental and substance use disorders increased substantially. This increase was higher for mental disorders visits (55 percent for depression, anxiety or stress reactions and 52 percent for psychoses or bipolar disorders) than for substance use disorders (37 percent) visits. This increasing number of ED visits by patients with mental disorders indicates a growing burden on the health-care delivery system. New methods of surveillance are needed to identify and understand these changing trends in ED utilization and affected underlying populations. Syndromic surveillance can be leveraged to monitor mental health-related ED visits in near real-time. ED syndromic surveillance systems primarily rely on patient chief complaints (CC) to monitor and detect health events. Some studies suggest that the use of ED discharge diagnoses data (Dx), in addition to or instead of CC, may improve sensitivity and specificity of case identification.

Objective: The objectives of this study are to

(1) create a mental health syndrome definition for syndromic surveillance to monitor mental health-related ED visits in near real time;

(2) examine whether CC data alone can accurately detect mental health related ED visits; and

(3) assess the added value of using Dx data to detect mental health-related ED visits.