Query purpose:
To assist state, local, tribal, territorial, and federal public health practitioners in monitoring emergency department (ED) visits for suspected nonfatal methamphetamine-involved overdoses.
Definition description:
The Methamphetamine Overdose v1 Parsed syndrome definition was designed to identify ED visits for suspected nonfatal methamphetamine-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:
- (1) the chief complaint free text field, which is a processed version of the reported chief complaint, may include terms indicating a methamphetamine-involved overdose or poisoning, as well as relevant exclusion terms (e.g., terms such as withdrawal without acute
- (2) 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, with descriptive code text removed, may indicate an acute methamphetamine-involved overdose or poisoning of unintentional or undetermined intent.
Within CDC’s National Syndromic Surveillance Program (NSSP) ESSENCE the syndrome query is applied to the Chief Complaint Discharge Diagnosis (CCDD) Parsed field, which combines these two fields of interest. Additional ED visit records may be identified by this query if they include both a chief complaint free text term indicating methamphetamine involvement and a diagnostic code that indicates an acute drug or stimulant overdose or poisoning.
How it was developed:
Members of the CDC’s Drug Overdose Surveillance and Epidemiology (DOSE) team in the Division of Overdose Prevention (DOP) developed this definition by building off the Stimulants v3 syndrome definition4 to capture only overdoses that indicated methamphetamine involvement. First, ICD-10-CM diagnosis codes indicating acute methamphetamine poisoning of unintentional or undetermined intent were identified. Additional ICD-10-CM, ICD-9-CM and SNOMED-CT diagnosis codes indicating acute stimulant or psychostimulant poisoning of unintentional or undetermined intent were identified. Next, overdose terms and methamphetamine-specific terms that could be presented in the chief complaint free text field were identified. Lastly, exclusion terms were identified (e.g., terms indicating withdrawal without acute intoxication, etc.) to avoid incorrectly capturing encounters that were not due to a methamphetamine-involved overdose.
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 an acute methamphetamine poisoning of unintentional or undetermined intent is present, the ED visit is automatically included.
- Conditional inclusion:
- If the ED visit does not include a diagnosis code for methamphetamine poisoning, 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 methamphetamine involvement AND
- 2a) chief complaint text indicating an overdose or poisoning OR
- 2b) diagnosis code indicating a stimulant/amphetamine overdose or poisoning or diagnosis code indicating poisoning by unspecified drugs (T50.901A or T50.904A).
- 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 methamphetamine poisoning, 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 methamphetamine-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 methamphetamine-involved overdose visits; the definition may incorrectly capture such encounters that were not for a true methamphetamine-involved overdose and thus result in overreporting. Finally, methamphetamine-involved overdoses may be more difficult to identify than overdoses involving opioids due to a wide range of associated symptoms, including some that may overlap with mental health disorders. The team attempted to identify all appropriate inclusion and exclusion terms to capture any suspected nonfatal methamphetamine-involved overdoses while avoiding capturing encounters that were not for an acute methamphetamine-involved overdose or poisoning, but it is possible that some of these encounters were erroneously captured, leading to overreporting.
(,^;T4365[14]A^,OR,(,(,(,^;T5090[14]A^,OR,^;9697[029];^,OR,^;9700;^,OR,^;97089;^,OR,^;9709;^,OR,^;E854[23]^,OR,^;T436[029][14]A^,OR,^;29629000[56];^,OR,^;61803000;^,OR,^abdominal pain^,OR,^agitat^,OR,^aggitat^,OR,^aggressive^,OR,^altered mental status^,OR,^arrhythmia^,OR,^bad reaction^,OR,^bad trip^,OR,^bizz^,OR,^bizar^,OR,^bugs^,OR,^chest pain^,ANDNOT,(,^denies chest pain^,OR,^no chest pain^,),OR,^chest pressure^,OR,^chest tight^,OR,^combat^,OR,^delusion^,OR,^delirium^,ANDNOT,^delirium tremen^,OR,^delirum^,ANDNOT,^delirum tremen^,OR,^diaphoretic^,OR,^disoriented^,OR,^dizz^,OR,^erra[td]ic^,OR,^feels bad^,OR,^feels weird^,OR,^fidg^,OR,^flight of ideas^,OR,^formication^,OR,^hallucinat^,OR,^hearing voices^,OR,^heart attack^,OR,^heart pap^,OR,^heart racing^,OR,^high blood pressure^,OR,^hyperverbal^,OR,^incoh^,OR,^in[gj]est^,OR,^intoxic^,OR,^lightheaded^,OR,^manic^,OR,^nausea^,OR,^not feeling well^,OR,^not right^,OR,^not sleeping^,OR,^numb^,OR,^verdo[se][es]^,OR,^overose^,OR,^over dose^,OR,^palp^,OR,^parano^,OR,^poison^,OR,^racing heart^,OR,^restless^,OR,^seeing snakes^,OR,^seeing things^,OR,^shak^,OR,^shot up^,OR,^shoot up^,OR,^shooting up^,OR,^shoots up^,OR,(,(,^shortness of breath^,OR,^short of breath^,),ANDNOT,(,^denie[sd] short^,OR,^no short^,),),OR,^snort^,OR,^seiz^,OR,^sores all over^,OR,^picking at skin^,OR,^scratching^,OR,^sycho^,OR,^tach[iy]^,OR,^tingl^,OR,^tight chest^,OR,^tremulous^,OR,!tripping!,OR,^trouble sleeping^,OR,^twitch^,or,^vomiting^,OR,^violent^,OR,^weakness^,),AND,(,^desoxyn^,OR,(,(,!meth!,OR,^methamphetamine^,OR,^on mth^,),ANDNOT,(,^meth recovery^,OR,^clean from meth^,OR,^rsh on mth^,OR,^meth gas^,OR,^history of meth^,OR,^stopped smoking meth^,OR,^stopped meth^,OR,^stopped using meth^,OR,^no meth^,OR,^deny meth^,OR,^denie[sd] meth^,OR,^quit meth^,OR,^meth germ^,OR,^meth gmt^,OR,^meth odist^,OR,^meth obstet^,OR,^meth group^,OR,^meth south^,OR,^seen at meth^,OR,^meth gtown^,OR,^went to meth^,OR,^meth north^,OR,^meth univ^,),),OR,(,!crank!,ANDNOT,(,^hand crank^,OR,^doctor crank^,OR,^using a crank^,),),OR,(,(,^gram of ice^,OR,!on ice!,OR,!smoking ice!,OR,!smoked ice!,OR,!line of ice!,OR,!used ice!,OR,!using ice!,OR,!ingested ice!,OR,!ingesting ice!,OR,^admits to ice^,OR,!ice use!,OR,^in[gj]ect^ ice^,),ANDNOT,(,^nose bleeding ice^,OR,^laying on ice^,OR,^bump on ice^,OR,^player on ice^,OR,^iceyhot^,OR,^using ice with no relief^,OR,^using ice with relief^,OR,^on ice with relief^,OR,^no ice used^,OR,^choked on ice^,OR,^ice heat^,OR,^spun around on ice^,OR,^hit face on ice^,OR,^fal on ice^,OR,^lost control on ice^,OR,^walking on ice^,OR,^de icer^,OR,^elevation ice^,OR,^using ice heat^,or,^landed on ice^,OR,^ice melt salt^,OR,^black ice^,OR,^chew^ice^,OR,^ice chip^,OR,^ice cube^,OR,^ice^f[ae]ll^,OR,^f[ae]ll^ice^,OR,^sli[pd]^ice^,OR,^spice^,OR,^appl^ice^,OR,^ice^appl^,OR,^ice pack^,OR,^ice cream^,OR,^ice bath^,OR,^ice coffee^,OR,^ice to area^,OR,^doctor ice^,OR,^smirnoff ice^,OR,^ice skat^,OR,^ice water^,OR,^ice cold^,OR,^pushed down on ice^,OR,^ice hockey^,OR,^head on ice^,OR,^ice patch^,OR,^bag of ice^,OR,^ice machine^,OR,^dry ice^,OR,^ibuprofen^,OR,^vehicle on ice^,),),OR,^overamping^,OR,(,!speed!,ANDNOT,(,^driver speed^,OR,^city speed^,OR,^fast speed^,OR,^dr speed^,OR,^fan speed^,OR,^residential speed^,OR,^slurred speed^,OR,^stand still speed^,OR,^unknown exact speed^,OR,^speed up^,OR,^up to speed^,OR,^car speed^,OR,^speed limit^,OR,^marked speed^,OR,^medium speed^,OR,^unknow speed^,OR,^normal speed^,OR,^changed speed^,OR,^full speed^,OR,^unknwon speed^,OR,^hight speed^,OR,^highway speed^,OR,^MPH^speed^,OR,^speed^heart^,OR,^speed^MPH^,OR,^speed sign^,OR,^low speed^,OR,^moderate speed^,OR,^high speed^,OR,^nknown speed^,OR,^unsure of speed^,OR,^interstate speed^,OR,^practice speed^,OR,^speed process up^,OR,^walking speed^,OR,^speed unk^,OR,^speed bump^,OR,^rate of speed^,OR,^hwy speed^,OR,^uknown speed^,),),OR,(,^tweak^,ANDNOT,(,^tweak^ on left^,OR,^tweak^ on right^,OR,^tweaked^,OR,^tweak^ it^,),),),),ANDNOT,(,^denie[sd] drug^,OR,^deny drug^,OR,^denying drug^,OR,^denie[sd] any drug^,OR,^jail clearance^,OR,!with draw!,OR,^withdra^,OR,^deto[xsz]^,OR,^dtox^,OR,^rehab^,OR,^wants refer^,),),)