Syndromes

Real-time emergency department (ED) data are currently received from 78 of 80 New Jersey acute care and satellite EDs by Health Monitoring Systems Inc.’s (HMS) EpiCenter system. EpiCenter collects, manages and analyzes ED registration data for syndromic surveillance, and provides alerts to state and local health departments for surveillance anomalies. After the 2012 Superstorm Sandy devastated parts of New Jersey, NJDOH initiated a plan to develop severe weather surveillance using EpiCenter to provide the Department with the ability to track both health and mental health concerns during adverse weather conditions to alert the public about emerging health hazards.

Objective

To describe the development and validation of a mental health classification to track emergency department visits for potential needed public health response during severe weather events.

Syndromic surveillance refers to the monitoring of disease related events, sets of clinical features (i.e. syndromes), or other indicators in a population. Tennessee obtains emergency department data for syndromic surveillance in standardized HL7 format following the field and value set standards published by the Public Health Information Network. Messages contain information previously unavailable to syndromic surveillance systems, including quantitative values such as recorded temperature. Data are received daily and processed by a Tennessee ESSENCE application and the national BioSense platform.

These systems use chief complaint keywords, ICD9 codes, and other algorithms to assign syndromes for each record. The differences between the BioSense and ESSENCE syndrome assignments have not been well defined. Detailed comparisons of syndrome assignment across tools are difficult to perform due to the intensity of the manual review required. However, definitions of fever can be easily confirmed in HL7 messages when the recorded temperature is provided. Currently, both the BioSense and ESSENCE syndrome definitions exclude recorded temperature from consideration when assigning syndromes.

To compare the performance of the fever syndromes used by BioSense and ESSENCE, recorded temperature data was used as the gold standard.

Objective

To objectively compare the BioSense and ESSENCE fever syndromes using recorded temperature as a gold standard.

As of October 1, 2015, all HIPAA covered entities transition from the use of International Classification of Diseases version 9 (ICD-9-CM) to version 10 (ICD-10-CM/PCS). Many Public Health surveillance entities receive, interpret, analyze, and report ICD-9 encoded data, which will all be significantly impacted by the transition. Public health agencies will need to modify existing database structures, extraction rules, and messaging guides, as well as revise established syndromic surveillance definitions and underlying analytic and business rules to accommodate this transition. Implementation challenges include resource, funding, and time constraints for code translation and syndrome classification, and developing statistical methodologies to accommodate changes to coding practices.

To address these challenges, the International Society for Disease Surveillance (ISDS), in consultation with the Centers for Disease Control and Prevention (CDC) and the Council of State and Territorial Epidemiologists (CSTE), has conducted a project to develop consensus-driven syndrome definitions based on ICD- 10-CM codes. The goal was to have the newly created ICD-9-CM to-ICD-10-CM mappings and corresponding syndromic definitions fully reviewed and vetted by the syndromic surveillance community, which relies on these codes for routine surveillance, as well as for research purposes. The mappings may be leveraged by other federal, state, and local public health entities to better prepare and improve the surveillance, analytics, and reporting activities impacted by the ICD-10-CM transition.

Objective

To describe the process undertaken to translate syndromic surveillance syndromes and sub-syndromes consisting of ICD-9 CM diagnostic codes to syndromes and sub-syndromes consisting of ICD-10-CM codes, and how these translations can be used to improve syndromic surveillance practice.

In 2012, an estimated 2.5 million people presented to the ED for a MVC injury in the U.S. National injury surveillance is commonly captured using E-codes. However, use of E-codes alone to capture MVC-related ED visits may result in a different picture of MVC injuries compared to using text searches of triage or chief compliant notes.

Objective

Identify and describe how the case definition used to identify MVC patients can impact results when conducting MVC surveillance using ED data. We compare MVC patients identified using external cause of injury codes (E-codes), text searches of triage notes and chief complaint, or both criteria together.

Assessing health disparities and access to healthcare has been an important issue for emergency preparedness and response efforts in the Denver metropolitan area. There have been several high profile MJ-related illness outbreaks in the US over the past 2 years. The legalization and retail sale of recreational MJ in Colorado necessitates enhanced surveillance for adverse effects from MJ use. TCHD and DPH coordinated to use syndromic surveillance data to provide situational awareness and timely outbreak detection related to MJ, including health disparities and overall impacts on population health.

Objective

Adverse health effects related to marijuana (MJ) use may disproportionately impact populations based on age or gender. To explore whether disparities exist among persons seeking emergency department (ED) care related to MJ use, Tri-County Health Department (TCHD) and Denver Public Health (DPH) developed MJ use case definitions, described patient demographics, mapped patients’ geographic distribution relative to marijuana dispensary locations, evaluated access to healthcare, and investigated the potential impact of MJ on pediatric health.

Nationally, deaths due to opioid overdose have continually increased for the past 15 years . Deaths specifically related to heroin increased more than four-fold between 2002 and 2014. Hospital inpatient discharge data provide information on non-fatal overdoses, but include a significant lag in reporting time. Syndromic ED visit data provide near real-time identification of public health issues and can be leveraged to inform public health actions on the emerging threat of drug overdose.

Objective

To develop and evaluate syndrome definitions for the identification of acute unintentional drug overdose events including opioid, heroin, and unspecified substances among emergency department (ED) visits in Virginia.

In 2016, the World Health Organization declared Zika virus a global public health emergency. Zika infection during pregnancy can cause microcephaly and other fetal brain defects. To facilitate clinicians’ ability to detect Zika, various syndrome definitions have been developed. 

Objective

To develop and validate a Zika virus disease syndrome definition within the GUARDIAN (Geographic Utilization of Artificial Intelligence in Real-Time for Disease Identification and Alert Notification) surveillance system.