Waller Anna

The opioid overdose crisis has rapidly expanded in North Carolina (NC), paralleling the epidemic across the United States. The number of opioid overdose deaths in NC has increased by nearly 40% each year since 2015.1 Critical to preventing overdose deaths is increasing access to the life-saving drug naloxone, which can reverse overdose symptoms and progression. Over 700 EMS agencies across NC respond to over 1,000,000 calls each year; naloxone administration was documented in over 15,000 calls in 2017.2 Linking EMS encounters with naloxone administration to the corresponding ED visit assists in understanding the health outcomes of these patients. However, less than 66% of NC EMS records with naloxone administration in 2017 were successfully linked to an ED visit record. This study explored methods to improve EMS and ED data linkage, using a multistage process to maximize the number of correctly linked records while avoiding false linkages.

Objective: To improve linkage between North Carolina's Emergency Medical Services (EMS) and Emergency Department (ED) data using an iterative, deterministic approach.

Suicide is a leading cause of mortality in the United States, causing about 45,000 deaths annually. Research suggests that universal screening in health care settings may be beneficial for prevention, but few studies have combined detailed suicide circumstances with ED encounter data to better understand care-seeking behavior prior to death.

Objective: To identify potential emergency department (ED) visits prior to suicide deaths in North Carolina (NC) and describe pre-suicide care-seeking in EDs.

Over the last few decades, the United States has made considerable progress in decreasing the incidence of motor vehicle occupants injured and killed in traffic collisions.1 However, there is still a need for continued motor vehicle crash (MVC) injury surveillance, particularly for vulnerable road users, such as pedestrians and bicyclists. In NC, the average annual number of pedestrian-motor vehicle crashes increased by 13.5 percent during the period 2011-2015, as compared to 2006-2010.2 Therefore, the Carolina Center for Health Informatics (CCHI), as part of a NC Governor's Highway Safety Program-funded project to improve statewide MVC injury surveillance, developed and evaluated four ICD-10-CM based case definitions for use with NC DETECT, NC's statewide syndromic surveillance system.

Objective: To evaluate four ICD-10-CM based case definitions designed to capture pedestrian and bicycle crash-related emergency department (ED) visits in North Carolina's statewide syndromic surveillance system, NC DETECT.

In North Carolina there has been an escalation of poisoning deaths. In 2011, the number of fatal poisonings was 1,368 deaths, with 91% classified as drug overdoses with the majority of those due to opioid analgesics.[1] Far greater numbers of drug overdoses result in hospitalization, emergency department (ED) or outpatient clinic visits, or resolve without the individual seeking medical attention. Although public health authorities have long employed death data for drug overdose surveillance in NC, little attention has been paid to the use of ED data for this purpose. Through the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT), NC collects information on 99.5% of all acute-care ED visits across the state, primarily for syndromic surveillance purposes. Despite the timeliness and completeness of this data system, drug overdose surveillance is a challenge due to lack of a standardized definition for the positive identification of opioid overdoses. In this study we used NC DETECT ED data to describe visits due to drug, and more specifically, opioid overdoses. Objective: To describe the epidemiologic characteristics for emergency department visits due to drug overdoses in North Carolina.

The North Carolina Division of Public Health (NC DPH) has been collecting emergency department data in collaboration with the Carolina Center for Health Informatics in the UNC Department of Emergency Medicine since 1999. As of August 2011, there are 113 of 115 emergency departments sending data electronically at least once daily to NC DETECT. Data elements include disposition, initial vital signs, up to 11 ICD-9-CM final diagnosis codes, up to five external cause of injury codes (E-codes),as well as the arrival date and time, patient sex and age, patient zip and county, and chief complaint. As of January 2008, NC DETECT emergency department data covered 99% of the NC population and captures approximately 4.5 million ED visits each year. As a result, requests for data from researchers continue to increase. Use of the data for public health purposes is covered by the mandate requiring hospitals to submit their emergency department data to NC DPH.

Objective

To describe the process by which researchers request access to data sets of emergency department data from NC DETECT,the history of this process,and the resulting best practices and lessons learned.

NC DETECT provides near-real-time statewide surveillance capacity to local, regional and state level users across NC with twice daily data feeds from 117 (99%) emergency departments (EDs), hourly updates from the statewide poison center, and daily feeds from statewide EMS runs and select urgent care centers. The NC DETECT Web Application provides access to aggregate and line listing analyses customized to users' respective jurisdictions. The most active users are state-level epidemiologists (DPH) and hospital-based public health epidemiologists (PHEs). The use of NC DETECT is included in PHE job descriptions and NC DETECT functionality has been developed specifically to meet the surveillance needs of this group, including data entry of aggregated lab results for flu and respiratory panels. Interviews of local health department (LHD) users completed as part of an evaluation project have suggested that functionality specifically tailored to LHDs may increase their use of the NC DETECT Web application [1]. As of June 2011, there were 139 LHD users with active accounts to use the Web application (out of 384 total users with active accounts).

Objective

To describe the development, implementation and preliminary evaluation of new dashboard interfaces in NC DETECT, designed primarily for infrequent users of NC DETECT at local health departments.

Tracking emergency department (ED) asthma visits is an important part of asthma surveillance, as ED visits can be preventable and may represent a failure of asthma control efforts. When using limited clinical ED datasets for secondary purposes such as public health surveillance, it is important to employ a standard approach to operationally defining ED visits attributable to asthma. The prevailing approach uses only the primary ICD-9-CM diagnosis assigned to the ED visit; however, doing so may underestimate the public health impact of asthma. We conducted this pilot study to determine the value of including ED visits with asthma-related diagnoses in secondary or tertiary positions. For example, for an ED visit with a primary diagnosis of upper respiratory infection and secondary diagnosis of asthma, it is possible that the infection triggered the asthma exacerbation and the visit could be attributed to both infection and asthma.

Objective

Determine operational definition of ED visits attributable to asthma for public health surveillance purposes.

Animal bites may have potentially devastating consequences, including physical and emotional trauma, infection, rabies exposure, hospitalization, and, rarely, death. NC law requires animal bites be reported to local health directors. However, methods for recording and storing bite data vary among municipalities. NC does not have a statewide system for reporting and surveillance of animal bites. Additionally, many animal bites are likely not reported to the appropriate agencies. NC DETECT provides near-real-time statewide surveillance capacity to local, regional, and state level users with twice daily data feeds from NC EDs. Between 2008 and 2010, 110 to 113 EDs were submitting visit data to NC DETECT. Several animal bite-related on-line reports are available and provide aggregate and visit-level analyses customized to users' respective jurisdictions. The NC DETECT ED visit database currently provides the most comprehensive and cost-effective source of animal bite data in NC.

Objective

We describe the use of emergency department (ED) visit data collected through the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) for surveillance of animal bites in North Carolina (NC). Animal bite surveillance using ED visit data provides useful and timely information for public health practitioners involved in bite surveillance and prevention in NC.