Query purpose:
To assist state, local, tribal, territorial, and federal public health practitioners in monitoring emergency department (ED) visits for suspected nonfatal heroin-involved overdoses using syndromic surveillance data.
Definition description:
The heroin overdose syndrome definition was designed to identify ED visits for suspected nonfatal heroin-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 was queried for terms indicating a heroin-involved overdose, and for relevant exclusion terms (e.g., denial of use, withdrawal without acute intoxication, etc., which would exclude ED visit records from this syndrome definition), and
- the discharge diagnosis parsed field is queried for International Classification of Diseases, Clinical Modification, 9th Revision (ICD-9-CM)1, 10th Revision (ICD-10-CM)2, and Systematized Nomenclature of Medicine – Clinical Terms (SNOMED-CT)3 diagnosis codes indicating an acute heroin 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:
CDC scientists first started developing the definition using lessons learned from
jurisdictions funded by CDC’s Enhanced State Opioid Overdose Surveillance (ESOOS) program and researching guidance documents from sources including the National Center for Health Statistics, the Council of State and Territorial Epidemiologists, and Substance Abuse and Mental Health Services Administration. First, ICD-10-CM, ICD-9-CM, and SNOMED-CT diagnosis codes indicating an acute heroin poisoning were identified; this was followed by identifying and adding overdose terms that could be presented in the chief complaint free text field. Finally, heroin chief complaint drug terms indicating that heroin was involved in the overdose were added.
How it works:
The 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 heroin poisoning of unintentional or undetermined intent is present, the ED visit is automatically included in the syndrome.
- Conditional inclusion:
- If the ED visit does not include a diagnosis code for heroin poisoning of unintentional or undetermined intent, 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
- 2) chief complaint text indicating heroin involvement.
- The list of exclusions is applied to the chief complaint text only when a discharge diagnosis code is not present for heroin poisoning of unintentional or undetermined intent.
For consideration:
The definition was developed to capture suspected heroin-involved overdoses treated in EDs. However, it is subject to both misclassification, overreporting, and underreporting for several reasons, including limited point-of-care confirmatory testing to identify whether heroin or other drug(s) were 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 heroin-involved overdose visits; the definition may incorrectly capture such encounters that were not for a true heroin-involved overdose and thus result in overreporting. The team attempted to identify all appropriate inclusion and exclusion terms to capture any suspected nonfatal heroin-involved overdoses while avoiding capturing encounters that were not for an acute heroin-involved overdose or poisoning, but it is possible that some of these encounters were erroneously captured, leading to overreporting.
(,^;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^,),)