Query purpose:
To assist state, local, tribal, territorial, and federal public health practitioners in monitoring emergency department (ED) visits for suspected nonfatal cocaine-involved overdose using syndromic surveillance data.
Definition description:
The CDC Cocaine Overdose v2 Parsed definition was designed to be used to identify ED visits for suspected nonfatal cocaine-involved overdoses of unintentional or undetermined intent. The query relies on data in two fields from ED visit records to identify encounters that meet the definition criteria:
- the chief complaint free text field, which is a processed version of the reported chief complaint and may include terms indicating a cocaine-involved overdose or poisoning, as well as relevant exclusion terms (e.g., terms indicating cocaine withdrawal without acute intoxication, etc., which would exclude ED visit records from this syndrome definition), and
- the discharge diagnosis parsed field, which includes International Classification of Diseases, Clinical Modification, 9th Revision (ICD-9-CM),1 International Classification of Diseases, Clinical Modification, 10th Revision (ICD-10-CM),2 or Systematized Nomenclature of Medicine – Clinical Terms (SNOMED-CT)3 diagnosis codes and may indicate an acute cocaine overdose or poisoning of unintentional or undetermined intent.
Within ESSENCE, the syndrome query is applied to the Chief Complaint Discharge Diagnosis (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 Cocaine Overdose v1 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 1 and 2 of the cocaine overdose syndrome definitions.
CDC scientists first started developing overdose definitions using lessons learned from jurisdictions funded by CDC’s Overdose Data to Action (OD2A) and Enhanced State Opioid Overdose Surveillance (ESOOS) Programs. First, International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) and 10th Revision, Clinical Modification (ICD-10-CM), and Systematized Nomenclature of Medicine – Clinical Terms (SNOMED-CT) diagnosis codes indicating an acute cocaine poisoning were identified; this was followed by identifying and adding overdose terms that could be presented in the chief complaint free text. Finally, overdose and cocaine terms that appeared in ED visit chief complaint text were iteratively added to the definition syntax and validated.
How it works:
The Chief Complaint Discharge Diagnosis (CCDD) Parsed field is used to query both the diagnosis codes and chief complaint free text with exclusions (as necessary) to develop the syndrome definition.
- Automatic inclusion:
- If a diagnosis code indicating a cocaine overdose/poisoning is present, the ED visit is automatically included in the syndrome.
- Conditional inclusion:
- If the ED visit does not include a diagnosis code for cocaine poisoning, then the visit is not automatically included in the syndrome.
- The visit is captured only if it includes two components:
- 1) chief complaint text indicating an overdose, poisoning, or symptoms of a potential cocaine-involved overdose AND
- 2) chief complaint text indicating cocaine involvement OR an ICD-10-CM code for cocaine abuse/dependence/use with intoxication (e.g., F14.12).
- The list of exclusions is applied to the chief complaint text only when a discharge diagnosis code is not present for cocaine overdose.
For consideration:
The nonfatal cocaine-involved syndrome definition was developed to capture suspected nonfatal cocaine-involved overdoses treated in EDs. However, it is subject to both misclassification and under/overreporting for several reasons, including limited point-of-care confirmatory testing to identify the drug(s) involved in the overdose, and reliance on self-report, bystander reports, and/or clinical presentations to determine the drug(s) involved in an overdose. 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. Additionally, some hospitals may enter all diagnosis codes from a patient’s entire medical history, including codes for previous cocaine-involved overdose visits; the definition may incorrectly capture such encounters that were not for a true cocaine-involved overdose and thus result in overreporting. It is not possible in syndromic data to determine the primary reason for a patient’s visit, as syndromic data lack a primary diagnosis field. Therefore, all terms and codes are considered equally (i.e., not in any priority) regardless of what order they are in the record. Finally, cocaine-involved overdoses may be more difficult to identify than opioid overdoses and thus reported in chief complaints due to the diverse range of associated symptoms, including some that may overlap with cardiovascular health and mental health-involved ED visits. Future studies where provider triage notes are available may help further validate the use of chief complaints and discharge diagnoses to identify nonfatal cocaine-involved overdose visits in syndromic data.
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