Query purpose:
To assist state, local, tribal, territorial, and federal public health practitioners in monitoring emergency department (ED) visits for suspected nonfatal fentanyl-involved overdoses using syndromic surveillance.
Definition description:
The CDC Fentanyl Overdose v2 Parsed syndrome definition was designed to be used to identify ED visits for suspected nonfatal fentanyl-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 fentanyl-involved overdose or poisoning, as well as relevant exclusion terms (e.g., terms indicating fentanyl administration by medical personnel, 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, 10th Revision (ICD-10-CM)1 and/or Systematized Nomenclature of Medicine - Clinical Terms (SNOMED-CT)2 diagnosis codes, with descriptive text removed, and which may indicate an acute fentanyl-involved 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 revision was developed to adapt the CDC Fentanyl Overdose v14 definition syntax to query the newly developed CCDD Parsed field which removes extraneous test from the discharge diagnosis portion of the CCDD. CDC NSSP staff used R code to update the syntax to meet CCDD Parsed field requirements. The CDC DOSE team reviewed the revisions and compared total visits captured by CCDD and CCDD Parsed versions of the definition, with a focus on diagnosis codes, to ensure correct restructuring. CDC scientists in the Division of Overdose Prevention (DOP) developed the CDC Fentanyl Overdose v1 definition by building from the CDC Opioid Overdose v3 syndrome definition5 to capture only overdoses that indicated fentanyl involvement. First, ICD-10-CM and SNOMED-CT diagnosis codes indicating acute fentanyl poisoning of unintentional or undetermined intent were identified. Next, overdose terms and fentanyl-specific terms that could be presented in the chief complaint free text field were identified. 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 a fentanyl-involved overdose.
How it works:
The CCDD Parsed field is used to query both the Discharge Diagnosis Parsed and Chief Complaint Free Text fields.
- Automatic inclusion:
- The ED visit is automatically included in the syndrome definition if the ED visit includes:
- If a diagnosis code indicating an acute fentanyl poisoning of unintentional or undetermined intent is present, and/or
- If the chief complaint includes a fentanyl term and a naloxone term.
- The ED visit is automatically included in the syndrome definition if the ED visit includes:
- Conditional inclusion:
- If the ED visit does not include a diagnosis code for fentanyl poisoning of unintentional or undetermined intent, or a fentanyl term and naloxone term within the chief complaint field, then the visit is not automatically included. In these instances, the visit is captured only if it includes the following two components and no exclusion terms:
- 1) chief complaint text indicating fentanyl involvement AND
- 2) chief complaint text indicating an overdose or poisoning.
- The exclusion terms are applied to the chief complaint text only when the automatic inclusion criteria are not met.
- If the ED visit does not include a diagnosis code for fentanyl poisoning of unintentional or undetermined intent, or a fentanyl term and naloxone term within the chief complaint field, then the visit is not automatically included. In these instances, the visit is captured only if it includes the following two components and no exclusion terms:
For consideration:
The definition was developed to capture suspected nonfatal fentanyl-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 fentanyl-involved overdose visits; the definition may incorrectly capture such encounters that were not for a true fentanyl-involved overdose and thus result in overreporting if codes for historic drug use/abuse/dependence are included. 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, fentanyl is often administered by medical personnel in the ED setting or by emergency medical services technicians en route to the ED to treat severe pain, and this information may be included in the chief complaint field. The team attempted to identify all possible exclusion terms to avoid capturing encounters that were not for a fentanyl-involved overdose, but it is possible that some of these encounters were erroneously captured, leading to overreporting.
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