Emergency Department (ED)

LAC hosted the 2015 Special Olympics (SO) which welcomed approximately 6,500 athletes from 165 countries, as well as 30,000 volunteers and 500,000 spectators from July 25 to August 2, 2015. International athletes were not required to show proof of vaccinations and were housed in dormitories for nine days, creating potential for infectious disease outbreaks. In response to these unique public health challenges, we describe how LAC’s syndromic surveillance system (SSS), which captures over 65% of all Emergency Department (ED) visits, was used to detect potential emerging health events congruent with SO games and pre-game events.

Objective

To describe how syndromic surveillance was used to monitor health outcomes in near real-time during the 2015 Special Olympics in Los Angeles County (LAC), California.

Near real-time emergency department chief complaint data is accessed through Florida’s syndromic surveillance system: Electronic Surveillance System for the Early Notification of Communitybased Epidemics-Florida (ESSENCE-FL). The Florida Department of Health relies heavily upon these data for timely surveillance of influenza and influenza-like illness (ILI). Hospital discharge data available from the Florida Agency for Health Care Administration (AHCA) captures information about influenza-associated ED visits and is considered complete. The delay in receiving the data (up to a year) hinders timely evidence-based decision making during the influenza season. Previous analyses (comparing the complete AHCA hospital discharge data to the ESSENCE-FL ILI syndrome and Influenza sub-syndrome) have shown ESSENCE-FL is a timely, effective tool to monitor influenza activity in the state and that the Influenza sub-syndrome most closely approximates influenza season activity in Florida. Adults > 65, pregnant women and children < 5 are at increased risk for morbidity and mortality from influenza infection. This investigation aims to determine if syndromic surveillance can be used to characterize in near real-time influenza infection in adults > 65, pregnant women, and children < 5 by comparing ED visits for influenza and ILI in ESSENCE-FL to historical AHCA records of people who incurred ED charges at a Florida hospital with diagnosed influenza.

Objective

To determine if emergency department (ED) based syndromic surveillance can be utilized to characterize in near real-time influenza infection in three high-risk populations: a) adults > 65, b) pregnant women, and c) children < 5.

Since 2004, the French syndromic surveillance system Oscour® has been implemented by the national institute for public health surveillance (InVS) and is daily used to detect and follow-up various public health events all over the territory [1]. Beginning with 23 ED in 2004, the coverage and data quality have permanently been increasing until including about 650 ED in August 2015. Initially based on a voluntary participation of ED, a mandatory transmission has been decided in July 2013, with major modification on the structural organization of the data transmission in some regions and on coding practices of the new ED. Besides this juridical context, the system is based on automatically data collection by ED physicians without recording added information for public health surveillance. This represents the main theorical condition to ensure stability and quality, even in case of occurrence of major public health events susceptible to drastically increase the workload [2].

Objective

Identification of the main factors influencing the stability and the quality of the French Emergency departments (ED) syndromic surveillance system.

While the link between excess winter mortality and winter respiratory diseases in the elderly is well described, the impact of the epidemic of influenza in the elderly is mainly assessed in France through specific surveillance in the general population. Syndromic surveillance data enables to monitor ED attendances and hospitalizations for various diagnostic codes groupings throughout the influenza epidemic, some of which often cited as influenza proxies, such as cardiorespiratory diagnostic groups.

In mainland France, the 2014-15 season was characterized by an intense influenza epidemic in the community (sub-type A(H3N2) dominant virus). Hospital overcrowding was early reported, partly linked to serious clinical presentations among the elderly, and leading to the triggering of a national emergency plan.

We hypothesized that ED numbers of clinical influenza cases underestimate the influenza burden among patients aged 65 years and over, especially when a A(H3N2) influenza subtype circulates.

Objective

To estimate the real burden of influenza epidemic on emergency departments (ED) attendances and hospitalizations among patients over 65 years in order to better understand determinants of overcrowding and mortality excess.

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.

Dengue fever is a dynamic infectious disease, allowing the patient to rapidly move from one stage to another during its course. Proper management of patients depends on early recognition of warning signs, continuous monitoring and re-staging cases and prompt fluid replacement. The telemedicine and Electronic Patient Records (EPR) belong to a series of advances of new features such as decision-making support systems including efforts on health monitoring, in view of the EPR as a support tool to allow the association of welfare activities as a database for the management of epidemiological information and monitoring. In addition, telemonitoring systems can be used for the monitoring of patients with chronic diseases in their homes which leads to cost savings in hospitalization and ensures appropriate care and the proper development of these patients. The continuous remote monitoring of these patients decreases the amount of hospital visits for monitoring procedures, also facilitating successful treatment, as in the fever dengue cases.

Objective

Report successful experience in fighting dengue fever in the Hospital and Emergency Services in São Bernardo do Campo, joining the flowchart included, telephone monitoring and Electronic Patient Records.

NSSP, a Centers for Disease Control and Prevention (CDC) surveillance system, allows timely detection of emergency department (ED) trends by matching chief complaint (CC) text or diagnosis (DX) codes to established syndrome criteria [1, 2]. No CDC syndrome definition currently exists for marijuana-related visits. Accidental child ingestions and over-consumption of edible products are an emerging concern [3, 4]. A validated marijuana syndrome will allow health departments with access to ED data to measure relative trends and disparities in marijuana-related ED visits.

Objective

To evaluate methods of measuring marijuana-related emergency department visits at Denver metropolitan area hospitals participating in the National Syndromic Surveillance Program (NSSP).