Emergency Department (ED)

Underage drinking is a significant public health problem in the United States as well as in Nebraska1-2. Alcohol consumption among underage youth accounts for approximately 5,000 deaths each year in the United States, including motor vehicle crash related deaths, homicides and suicides1. In Nebraska, 23% of 12-20 year olds have reported alcohol use during the past 30 days3. In 2010, the estimated total costs of underage drinking in Nebraska were $423 million. These costs included medical care, work loss along with pain and suffering2. The health consequences of underage drinking include alcohol-related motor vehicle crashes and other unintentional injuries, physical and sexual assault, suicide, self-inflicted injury, death from alcohol poisoning, and abuse of other drugs1, 4. The monitoring of near-real–time ED data could help underage drinking prevention efforts by providing timelier actionable public health information.

Objective

The objective of this pilot study was to develop and evaluate syndromic definitions for the monitoring of alcohol-related emergency department (ED) visits in near-real–time syndromic surveillance (SyS) data. This study also evaluates the utility of SyS ED data for the monitoring of underage drinking.

Shootings with multiple victims are a concern for public safety and public health. The precise impact of such events and the trends associated with them is dependent on which events are counted. Some reports only consider events with multiple deaths, typically four or more, while other reports also include events with multiple victims and at least one death. Underreporting is also a concern. Some commonly cited databases for these events are based on media reports of shootings which may or may not capture the complete set of events that meet whatever criteria are being considered. Many gunshot wounds are treated in the emergency department setting. Emergency department registrations routinely collected for syndromic surveillance will capture all of those visits. Analysis of that data may be useful as a supplement to mass shooting databases by identifying unreported events. In addition, clusters of gunshot wound incidents which are not the result of a single shooting event but still represent significant public safety and public health concerns may also be identified.

Objective

To determine whether mass casualty shooting events are captured via syndromic surveillance data.

SOS Médecins France (SOS Med) is the first private and permanent network of general practitioners providing emergency care in France. Besides Hospital emergency departments (HED), SOS Med is therefore a major source of data for detecting and measuring nearreal-time health phenomena. The emergency services provided by the SOS Med have been subject to important changes in the recent years. Their services are enriched by a medical consultation center together with extended working hours. Besides, the south of the region is markedly affected by a declining number of medical practitioners This study was conducted to analyze the regional population coverage of emergency healthcare data provided by HED and SOS Med to the French syndromic surveillance system (SurSaUD®) taking into account distance, health care offer, demographic factors and ecological deprivation factors.

Objective

To analyse population coverage of syndromic surveillance(SS) based on emergency care data by studying i)the attractiveness of respectively SOS Médecins (Emergency care general practitioners) and Hospital emergency departments in the Centre-Val de Loire region and ii) the contribution of ecological deprivation factors in emergency access to healthcare.

The primary goal of syndromic surveillance is early recognition of disease trends, in order to identify and control infectious disease outbreaks, such as influenza. For surveillance of influenza-like illness (ILI), public health departments receive data from multiple sources with varying degrees of patient acuity, including outpatient clinics and emergency departments. However, the lack of standardization of these data sources may lead to varying baseline levels of ILI activity within a local area.

Objective

To examine the baseline influenza-like illness (ILI) rates in the emergency departments (ED) of a large academic medical center (AMC), community hospital (CH), and neighboring adult and pediatric primary care clinics.

The 9th IOIG took place in Reunion Island from July 31 to August 9, 2015. This sport event gathered approximatively 1 640 athletes, 2 000 volunteers and several thousand spectators from seven islands:Comoros, Madagascar, Maldives, Mauritius, Mayotte, Seychelles and Reunion.In response to the import risk of infectious diseases from these countries where some of them are endemics, the syndromic surveillance system, which captures 100% of all Emergency Department visits, was enhanced in order to detect any health event.

Objective

To describe how syndromic surveillance was enhanced to detect health events during the 9th Indian Ocean Island Games (IOIG) in Reunion Island.

On July 22, 2016, the Sand Fire began burning in the Santa Clarita Valley of Los Angeles County (LAC), CA. This urban-adjacent wildfire breached the city limits of Santa Clarita (population 180,000). Fueled by record heat and an ongoing exceptional drought, the Sand Fire burned over 40,000 acres in 13 days and caused a large increase in the air concentration of fine particulate matter. The syndromic surveillance team was tasked with reporting on possible health effects from the fire. Fire, asthma, and heat related data were monitored until the fire was reported as 98% contained. The team prepared and distributed a daily special summary report to key stakeholders in the LAC Department of Public Health. 

Objective

To detect increases in health complaints resulting from the July 2016 Sand Fire near Santa Clarita, CA using syndromic surveillance and complementary systems. 

The first travel-associated cases of Zika virus infection in New York City (NYC) were identified in January 2016. Local transmission of Zika virus from imported cases is possible due to presence of Aedes albopictus mosquitos. Timely detection of local Zika virus transmission could inform public health interventions and mitigate additional spread of illness. Daily emergency department (ED) visit surveillance to detect individual cases and spatio-temporal clusters of locally-acquired Zika virus disease was initiated in June 2016. 

Objective

Case and cluster identification of emergency department visits related to local transmission of Zika virus. 

From 2001-2011, mental health-related hospitalizations and ED visits increased among United States children nationwide. During this period, mental health-related hospitalizations among NYC children increased nearly 23%. To estimate mental health-related ED visits in NYC and assess the use of syndromic surveillance chief complaint data to monitor these visits, we compared trends from a near real-time syndromic system with those from a less timely, coded ED visit database. 

Objective

To assess the use of syndromic surveillance to assess trends in mental health-related emergency department (ED) visits among school-aged children and adolescents in New York City (NYC). 

Human MERS-CoV was first reported in September 2012. Globally, all reported cases have been linked through travel to or residence in the Arabian Peninsula with the exception of cases associated with an outbreak involving multiple health care facilities in the Republic of Korea ending in July 2015. While the majority of MERS-CoV cases have been reported in the Arabian Peninsula, several cases have been reported outside of the region. Most cases are believed to have been acquired in the Middle East and then exported elsewhere, with no or rare instances of secondary transmission. Two cases of MERS-CoV were exported to the United States and identified in May 2014. One of these cases traveled from Saudi Arabia to Florida.

DOH conducts regular surveillance for MERS-CoV through the investigation of persons with known risk factors. PUIs have most often been identified by physicians reporting directly to local health departments and by DOH staff regularly querying ED and UCC chief complaint data in ESSENCE-FL. ESSENCE-FL currently captures data from 265 EDs and UCCs statewide and has been useful in identifying cases associated with reportable disease and emerging pathogens. 

Objective

To retrospectively identify initial emergency department (ED) and urgent care center (UCC) visits for Florida’s Middle East respiratory syndrome coronavirus disease (MERS-CoV) patients under investigation (PUIs) in the Florida Department of Health’s (DOH) syndromic surveillance system, the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE-FL), using information gathered from PUI case report forms and corresponding medical records for the purpose of improving syndromic surveillance for MERS-CoV. The results of this study may be further utilized in an effort to evaluate the current MERS-CoV surveillance query. 

In July 2016, 77% of ED data was transmitted daily via Health Level 7 (HL7) messages, compared to only 27% in July 2015 (Figure). During this same period, chief complaint (CC) word count has increased from an average of 3.8 words to 6.0 words, with a twenty-fold increase in the appearance of the word “denies” in the chief complaint (Figure). While HL7 messages provide robust chief complaint data, this may also introduce errors that could lead to symptom and syndrome misclassification. 

Objective

To describe the effect of symptom negation in emergency department (ED) chief complaint data received by the New York City (NYC) Department of Health and Mental Hygiene (DOHMH), and to devise a solution to avoid syndrome and symptom misclassification for commonly used negations using SAS Perl Regular Expression (PRX) functions.