Developing, Evaluating, and Disseminating Definitions for Syndromic Surveillance in Public Health Practice: A Guidance Document

This document, released February 18, 2019, focuses on several key areas related to syndrome definition creation, including the basics behind a syndrome definition, steps to build a syndrome, evaluation of a new (or old) definition, and dissemination.

February 19, 2019

Syndrome definitions for drug overdose: How far down the rabbit hole do we go?

State and local jurisdictions have been exploring the use of SyS data to monitor suspected drug overdose outbreaks in their communities. With the increasing awareness and use of SyS systems, staff from the Centers for Disease Control and Prevention (CDC) worked to develop several queries that jurisdictions could use to better capture suspected drug overdose visits. In 2017, CDC released their first two queries on heroin overdose and opioid overdose, followed in 2018 by stimulant and all drug overdose queries.

June 18, 2019

Using Syndromic Surveillance Data to Study the Impact of Media Content on Self-harm

In 2016, a half million people were treated in U.S. emergency departments (EDs) as a result of self-harm. 1 Not only is self-harm a major cause of morbidity in the U.S., but it is also one of the best predictors of suicide. Given that approximately 40% of suicide decedents visited an ED in the year prior to their death and that the majority of medically-serious self-harm patients are treated in EDs2, EDs serve as a critical setting in which to monitor rates and trends of suicidal behavior.

June 18, 2019

Syndrome Development to Assess IDU, HIV, and Homelessness in MA Emergency Departments

In Massachusetts, syndromic surveillance (SyS) data have been used to monitor injection drug use and acute opioid overdoses within EDs. Currently, Massachusetts Department of Public Health (MDPH) SyS captures over 90% of ED visits statewide. These real-time data contain rich free-text and coded clinical and demographic information used to categorize visits for population level public health surveillance. Other surveillance data have shown elevated rates of opioid overdose related ED visits, Emergency Medical Service incidents, and fatalities in Massachusetts from 2014-20171,2,3.

June 18, 2019

Free-Text Mining to Improve Syndrome Definition Matching Across Emergency Departments

Standard syndrome definitions for ED visits in ESSENCE rely on chief complaints. Visits with more words in the chief complaint field are more likely to match syndrome definitions. While using ESSENCE, we observed geographic differences in chief complaint length, apparently related to differences in electronic health record (EHR) systems, which resulted in disparate syndrome matching across Idaho regions.

January 21, 2018

Exploring the Value of Learned Representations for Automated Syndromic Definitions

Comprehensive medical syndrome definitions are critical for outbreak investigation, disease trend monitoring, and public health surveillance. However, because current definitions are based on keyword string-matching, they may miss important distributional information in free text and medical codes that could be used to build a more general classifier. Here, we explore the idea that individual ICD codes can be categorized by examining their contextual relationships across all other ICD codes.

January 25, 2018

Can We Use Syndromic Surveillance Data to Identify Primary Care Visits to NYC EDs?

NYC EDs saw nearly 4 million visits in 2011. Studies have demon- strated that non-urgent visits can account for more than 50% of vis- its to EDs. Designed to provide rapid diagnosis and first-line treatment of serious illness, EDs often function as a primary care site due to their accessibility. Unfortunately, use of EDs for primary care may affect their ability to meet the needs of severely ill patients.

 

Objective

May 18, 2018

Using Syndromic Emergency Department Data to Augment Oral Health Surveillance

Using the chief complaint field from our established syndromic ED system, we developed definitions for potentially preventable oral health visits (OHV) and examined patterns in 2009-2011 data. Under the widest definition, OHV comprised about 1% of ED visits. Adults ages 18 to 29 had markedly higher OHV than other ages, as did certain neighborhoods/EDs. We found more than half of OHV occurred during daytime hours, suggesting opportunities for targeted outreach and education. With some caveats, syndromic ED data provide a useful complement to other oral health surveillance strategies.

July 17, 2018

Adopting a common influenza-like illness syndrome across multiple health jurisdictions

Syndromic surveillance systems were designed for early outbreak and bioterrorism event detection. As practical experience shaped development and implementation, these systems became more broadly used for general surveillance and situational awareness, notably influenza-like illness (ILI) monitoring. Beginning in 2006, ISDS engaged partners from state and local health departments to build Distribute, a distributed surveillance network for sharing de-identified aggregate emergency department syndromic surveillance data through existing state and local public health systems.

May 02, 2019

Evaluating Syndrome Definitions in the Extended Syndromic Surveillance Ontology

The Extended Syndromic Surveillance Ontology (ESSO) is an open source terminological ontology designed to facilitate the text mining of clinical reports in English [1,2]. At the core of ESSO are 279 clinical concepts (for example, fever, confusion, headache, hallucination, fatigue) grouped into eight syndrome categories (rash, hemorrhagic, botulism, neurological, constitutional, influenza-like-illness, respiratory, and gastrointestinal). In addition to syndrome groupings, each concept is linked to synonyms, variant spellings and UMLS Concept Unique Identifiers.

May 02, 2019

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