Query purpose:
To assist state, local, tribal, territorial, and federal public health practitioners in monitoring emergency department (ED) visits for suspected nonfatal opioid-involved overdoses using syndromic surveillance data.
Definition description:
The opioid overdose syndrome definition was designed to identify ED visits for suspected nonfatal opioid-involved overdoses of unintentional or undetermined intent. The query uses the Chief Complaint Discharge Diagnosis (CCDD) Parsed field (a combination of chief complaint and discharge diagnosis parsed) from ED visit records to identify encounters that meet the definition criteria:
- The chief complaint free text field is queried for terms indicating an overdose/poisoning and opioid involvement and for relevant exclusion terms (e.g., terms indicating fentanyl administration by medical personnel, opioid withdrawal without acute intoxication, etc., which would exclude ED visit records from this syndrome definition), and
- the discharge diagnosis parsed coded field is queried for International Classification of Diseases, Clinical Modification, 9th Revision (ICD-9-CM),1 International Classification of Diseases, Clinical Modification, 10th Revision (ICD-10-CM),2 and Systematized Nomenclature of Medicine – Clinical Terms (SNOMED-CT)3 diagnosis codes indicating acute opioid poisoning.
Within ESSENCE, the syndrome query is applied to the CCDD Parsed field, which combines these two fields of interest.
How it was developed:
This is the same logic as for the CCDD Category CDC Opioid Overdose v3 syndrome definition, but it is adapted to query the CCDD Parsed field, which mainly removes extraneous text from the discharge diagnosis portion of the CCDD field. Because of differences between the CCDD and CCDD Parsed fields, query results may be different between versions 3 and 4 of the opioid overdose syndrome definitions.
The definition was developed by testing ICD-10-CM, ICD-9-CM, and SNOMED-CT diagnosis codes indicating an acute opioid poisoning or intoxication and ICD-10-CM codes for opioid use, abuse, and dependence.
Next, overdose terms and opioid-specific terms that could be present in the chief complaint free text field were identified and added. Lastly, exclusion terms were identified (e.g., terms indicating fentanyl administration by medical personnel, withdrawal without acute intoxication, etc.) to avoid incorrectly capturing encounters that were not for an opioid-involved overdose.
How it works:
The CCDD Parsed field is used to query both the diagnosis codes and chief complaint free text field with exclusions (as necessary) to develop the syndrome definition.
- Automatic inclusion:
- If a diagnosis code indicates an opioid poisoning of unintentional or undetermined intent is present, the ED visit is automatically included in the syndrome.
- In addition, the ED visits are automatically included in the syndrome if an F11 ICD-10-CM code for opioid use “with intoxication” (e.g., F11229) is present or if there is a mention of naloxone in the chief complaint text.
- The ED visit is automatically included in the syndrome definition if the ED visit meets one or more of the nested drug overdose definitions:
- Heroin Overdose v5 Parsed
- CDC Fentanyl Overdose v2 Parsed
- Conditional inclusion:
- If the ED visit does not include diagnosis codes mentioned in the automatic inclusion above (opioid poisoning of unintentional or undetermined intent, or a diagnosis code for non-poisoning opioid use with intoxication), or mention of naloxone in the chief complaint text, then the visit is not automatically included.
- The visit is captured only if it includes two components:
- 1) Chief complaint text indicating an overdose or poisoning AND
- 2a) Chief complaint text indicating opioid involvement OR
- 2b) an ICD-10-CM code for opioid use, abuse, or dependence without intoxication (e.g., F1190).
- The list of exclusions is applied to the chief complaint text only when the automatic inclusion criteria are not met.
For consideration:
This definition is subject to limitations, including varying and limited toxicology and confirmatory testing in ED facilities to identify the specific drug(s) involved in the overdose. This definition is not meant to differentiate opioid-involved overdoses due to prescription versus illegal drugs. Also, this definition is not designed to differentiate fentanyl and fentanyl analogs from other opioids. Opioid-involved overdoses involving fentanyl and fentanyl analogs are included if they mention fentanyl in the chief complaint or have a discharge diagnosis code for fentanyl poisoning (CDC also maintains a separate fentanyl overdose-specific syndrome). Additionally, this definition is not meant to measure the burden of opioid-involved overdoses, but rather to detect trends in nonfatal opioid-involved overdoses presenting to EDs. It also does not specifically measure opioid use or opioid prescription trends; it is only for surveillance of suspected, nonfatal opioid-involved overdoses. Also, visits with a mention of Narcan or naloxone terms are classified as opioid-involved overdoses, but it is not always documented in the chief complaint whether the patient was responsive to naloxone administration. After record reviews, it was determined that a large majority of the records containing Narcan and naloxone were true opioid-involved overdoses. The codes provided in the discharge diagnosis field from the ED visit record do not necessarily represent the final diagnosis of a patient and should be considered preliminary. Finally, some hospitals may enter all diagnosis codes from a patient’s entire medical history that were not indicative of the current visit; this may result in overreporting. The team attempted to identify all appropriate inclusion and exclusion terms to capture any suspected nonfatal opioid-involved overdoses while avoiding capturing encounters that were not for an acute opioid-involved overdose or poisoning, but it is possible that some of these encounters were erroneously captured, which may also lead to slight overreporting.
(,^narcan^,OR,^naloxo^,OR,^;T40[012346][X0129][14]A^,OR,^;F11[129]2^,OR,^;9650[0129];^,OR,^;E850[012]^,OR,^;295174006;^,OR,^;295175007;^,OR,^;295176008;^,OR,^;295165009;^,OR,^;242253008;^,OR,^;297199006;^,OR,^;295213004;^,OR,^;295196000;^,OR,^;295194002;^,OR,^;295193008;^,OR,^;290204003;^,OR,^;290202004;^,OR,^;290201006;^,),OR,(,(,(,^poison^,OR,^verdo[se][se]^,OR,^over dose^,OR,^overose^,OR,^ovrdose^,OR,^nodding^,OR,!nod!,OR,^snort^,OR,^in[gj]est^,OR,^intoxic^,OR,^unresponsiv^,OR,^loss of consciousness^,ANDNOT,(,^without loss of consciousness^,OR,^no loss of consciousness^,OR,^denie[sd] loss of consciousness^,OR,^negative loss of consciousness^,),OR,(,^shortness of breath^,OR,^short of breath^,),ANDNOT,(,^denies short^,OR,^no shortness^,),OR,^altered mental status^,),AND,(,^her[io][oi]n^,OR,!hod!,OR,^speedball^,OR,^speed ball^,OR,^dope^,OR,^opioid^,OR,^op[io][oi]d^,OR,^opiate^,OR,^opate^,OR,^op[iu][ui]m^,OR,^opum^,OR,^methadone^,OR,^suboxone^,OR,(,(,^oxymor^,OR,^oxyco^,OR,^oxyco^,OR,^oxyi^,OR,!oxy!,),ANDNOT,(,!oxy sat!,OR,!oxy state!,OR,^oxy high^,OR,^oxy low^,OR,!oxy mask!,OR,^oxy given^,OR,!given oxy!,OR,^oxy clean^,OR,!low oxy!,OR,!high oxy!,OR,!placed on oxy!,OR,!pulse oxy!,OR,^oxy deep cleaner^,OR,!not enough oxy!,OR,^oxy level^,),),OR,^percoc^,OR,^vicod^,OR,^fent^,ANDNOT,(,^received fentanyl^,OR,^administered fentanyl^,OR,^given fentanyl^,OR,^fentanyl en route^,OR,^fentanyl enrt^,OR,^fent en route^,OR,^fentanyl given^,OR,^fentynl given^,OR,^gave fent^,OR,^gave fentanyl^,OR,^given fentanly^,OR,^mcg fentanyl^,OR,^mcg fent^,OR,^mcg of fent^,OR,^fentanyl 75^,OR,^fentanyl 50^,OR,^50 fentanyl^,OR,^fentanyl 100^,OR,^100 fentanyl^,OR,^fentanyl 150^,OR,^120 fent given^,OR,^intranasal fent^,OR,^milligram fent^,OR,^milligram of fentanyl^,OR,!fenton!,OR,^fent pta^,OR,^fentanyl pta^,OR,!fentynl 100!,OR,^fentynyl 100^,OR,^fentynal 50^,OR,^fentynl 50^,OR,^fent 50^,OR,^fent 100^,OR,^fent 150^,OR,^diffently^,OR,!received fent!,OR,!recieved fent!,OR,!given 50!,OR,!given 100!,OR,!given 150!,OR,!gave 50!,OR,!gave 100!,OR,!gave 150!,OR,!doses of fent!,),OR,^phent^,ANDNOT,(,^stephentown^,OR,^phentermine^,OR,^phentxr^OR,^phentemine^,),OR,^hydrocod^,OR,^morphin^,ANDNOT,(,^given morphin^,OR,^gave morphin^,OR,^10 milligram of morphin^,OR,^milligram morphin^,OR,^4 morphin^,OR,^rec[ei][ei]ved morphin^,),OR,^cod[ei][ie]n^,OR,^codene^,OR,^dilaud^,OR,^hydromor^,OR,^tramad^,OR,^suboxin^,OR,^buprenorphine^,OR,^Abstral^,OR,^Actiq^,OR,^Avinza^,OR,^Butrans^,OR,^Demer[oa]l^,OR,^Dolophine^,OR,^Duragesic^,OR,^Fentora^,OR,^Hysingla^,OR,^Methadose^,OR,^Morphabond^,OR,^Nucynta^,OR,^Onsolis^,OR,^Oramorph^,OR,^Oxaydo^,OR,^Roxanol^,OR,^Sublimaze^,OR,^Xtampza^,OR,^Zohydro^,OR,^Anexsia^,OR,^CoGesic^,OR,^Cogesic^,OR,!Embeda!,OR,^Exalgo^,OR,^Hycet^,OR,^Hycodan^,OR,^Hydromet^,OR,^Ibudone^,OR,^Kadian^,OR,^Liquicet^,OR,^Lorcet^,OR,^Lortab^,OR,^Maxidone^,OR,!MS Contin!,OR,^Norco^,ANDNOT,(,^norco 10 milligram^,OR,^Norcotic^,),OR,!Opana!,OR,^Oxycet^,OR,^Palladone^,OR,^Percodan^,OR,^Reprexain^,OR,^Rezira^,OR,^Roxicet^,OR,^Targiniq^,OR,^TussiCaps^,OR,!Tussione!,OR,^Tuzistra^,OR,^Vicoprofen^,OR,^Vituz^,OR,^Xartemis^,OR,^Xodol^,OR,^Zolvit^,OR,^Zutripro^,OR,^Zydone^,OR,^Ultram^,OR,^;F11[129]0^,),),ANDNOT,(,^denie[sd] her[io][oi]n^,OR,^deny her[io][oi]n^,OR,^denying her[io][oi]n^,OR,^denie[sd] drug^,OR,^deny drug^,OR,^denying drug^,OR,^denies any drug^,OR,^with dra^,OR,^withdra^,OR,^deto[sxz]^,OR,^dtox^,OR,^sedat^,),),or,(,^;T401X1A^,OR,^;T401X4A^,OR,^;96501;^,OR,^;E8500^,OR,^;295174006;^,OR,^;295175007;^,OR,^;295176008;^,),OR,(,(,(,^narcan^,OR,^naloxo^,OR,^poison^,OR,^verdo[se][se]^,OR,^over dose^,OR,^overose^,OR,^nodding^,OR,!nod!,OR,^snort^,OR,^in[gj]est^,OR,^intoxic^,OR,(,^unresponsiv^,OR,^loss of consciousness^,OR,^syncop^,),ANDNOT,(,^no loss of consciousness^,OR,^denie[sd] loss of consciousness^,OR,^negative loss of consciousness^,OR,^denies any loss of consciousness^,),OR,(,(,^shortness of breath^,OR,^short of breath^,),ANDNOT,^denies short^,),OR,^altered mental status^,),AND,(,^her[io][oi]n^,OR,!hod!,OR,^speedball^,OR,^speed ball^,OR,^dope^,),),ANDNOT,(,^denie[sd] her[io][oi]n^,OR,^deny her[io][oi]n^,OR,^denying her[io][oi]n^,OR,^denie[sd] drug^,OR,^deny drug^,OR,^denying drug^,OR,^denies any drug^,OR,^with dra^,OR,^withdra^,OR,^detoxification^,OR,^detos^,OR,^detoz^,OR,^dtox^,),),or,(,^;T40411A^,OR,^;T40414A^,OR,^;290201006;^,OR,^;290202004;^,OR,^;290204003;^,OR,^;295193008;^,OR,^;295194002;^,OR,^;295196000;^,),OR,(,(,^f[ea]nt^,OR,^ph[ea]nt^,),AND,(,^naloxo^,OR,^narcan^,OR,^evzio^,),),OR,(,(,(,^f[ea]nt^,OR,^ph[ea]nt^,),AND,(,^poison^,OR,^verdo[sez][se]^,OR,^over dose^,OR,^overose^,OR,^ nod^,OR,^snort^,OR,^in[gj]est^,OR,^intoxic^,OR,^unresponsive^,OR,^loss of consciousness^,OR,^unconscious^,OR,^syncop^,OR,^shortness of breath^,OR,^short of breath^,OR,^altered mental status^,OR,^agonal breath^,OR,^agonal resp^,OR,^stopped breathing^,OR,^pinpoint^,OR,^dilated pupil^,OR,^slump^,OR,^cyanosis^,OR,^blue lips^,OR,^hypoxia^,),),ANDNOT,(,^administered f[ea]nt^,OR,^f[ea]nt[aiyn][nly][aioyl][ln] administered^,OR,^f[ea]nt[aiyn][nly][aioyl] administered^,OR,^f[ea]nt[aiyn][nly] administered^,OR,^f[ea]nt[aiyn] administered^,OR,^f[ea]nt administered^,OR,^given f[ea]nt^,OR,^f[ea]nt[aiyn][nly][aioyl][ln] given^,OR,^f[ea]nt[aiyn][nly][aioyl] given^,OR,^f[ea]nt[aiyn][nly] given^,OR,^f[ea]nt[aiyn] given^,OR,^f[ea]nt given^,OR,^gave f[ea]nt^,OR,^got f[ea]nt^,OR,^rec[ei]ved f[ea]nt^,OR,^pta f[ea]nt^,OR,^f[ea]nt[aiyn][nly][aioyl][ln] [ie]n route^,OR,^f[ea]nt[aiyn][nly][aioyl] [ie]n route^,OR,^f[ea]nt[aiyn][nly] [ie]n route^,OR,^f[ea]nt[aiyn] [ie]n route^,OR,^f[ea]nt [ie]n route^,OR,^f[ea]nt[aiyn][nly][aioyl][ln] [ie]nroute^,OR,^f[ea]nt[aiyn][nly][aioyl] [ie]nroute^,OR,^f[ea]nt[aiyn][nly] [ie]nroute^,OR,^f[ea]nt[aiyn] [ie]nroute^,OR,^f[ea]nt [ie]nroute^,OR,^f[ea]nt[aiyn][nly][aioyl][ln] route^,OR,^f[ea]nt[aiyn][nly][aioyl] route^,OR,^f[ea]nt[aiyn][nly] route ^,OR,^f[ea]nt[aiyn] route^,OR,^f[ea]nt route^,OR,^f[ea]nt[aiyn][nly][aioyl][ln] by EMS^,OR,^f[ea]nt[aiyn][nly][aioyl] by EMS^,OR,^f[ea]nt[aiyn][nly] by EMS^,OR,^f[ea]nt[aiyn] by EMS^,OR,^ f[ea]nt by EMS^,OR,^f[ea]nt[aiyn][nly][aioyl][ln] on board^,OR,^f[ea]nt[aiyn][nly][aioyl] on board^,OR,^f[ea]nt[aiyn][nly] on board^,OR,^f[ea]nt[aiyn] on board^,OR,^f[ea]nt on board^,OR,^f[ea]nt[aiyn][nly][aioyl][ln] [123456789][0257][05 ]^,OR,^f[ea]nt[aiyn][nly][aioyl] [123456789][0257][05 ]^,OR,^f[ea]nt[aiyn][nly] [123456789][0257][05 ]^,OR,^f[ea]nt[aiyn] [123456789][0257][05 ]^,OR,^f[ea]nt [123456789][0257][05 ]^,OR,^[123456789][0257][05] f[ea]nt^,OR,^[123456789][05] f[ea]nt^,OR,^[123456789][0257][05] of f[ea]nt^,OR,^[123456789][05] of f[ea]nt^,OR,^doses of f[ea]nt^,OR,^mcg f[ea]nt^,OR,^mcgs f[ea]nt^,OR,^mcg of f[ea]nt^,OR,^mcgs of f[ea]nt^,OR,^mg of f[ea]nt^,OR,^milligram f[ea]nt^,OR,^milligram of f[ea]nt^,OR,^mcq f[ea]nt^,OR,^mcq of f[ea]nt^,OR,^mcf f[ea]nt^,OR,^mcf of f[ea]nt^,OR,^mcb f[ea]nt^,OR,^mcb of f[ea]nt^,OR,^mch f[ea]nt^,OR,^mch of f[ea]nt^,OR,^intranasal f[ea]nt^,OR,^intramuscular f[ea]nt^,OR,^diffent^,OR,^fenton^,OR,^phantom^,OR,^phentermine^,OR,^phentrimine^,OR,^fentermine^,OR,^phenteramine^,OR,^fanting^,OR,^fanted^,OR,^elephant^,OR,^elphant^,OR,^infant^,OR,^no loss of conscious^,OR,^denie[sd] loss of consciousness^,OR,^negative loss of consciousness^,OR,^with dra^,OR,^withdra^,OR,^withraw^,OR,^detox^,OR,^dtox^,OR,^detos^,OR,^denies sob^,OR,^nodule^,OR,^node^,OR,^accifent^,OR,^signifantly^,OR,^ibuprofent^,OR,^bonfante^,),)