Advancing the Use of Emergency Department Syndromic Surveillance Data, New York City, 2012-2016

Abstract

Introduction: The use of syndromic surveillance has expanded from its initial purpose of bioterrorism detection. We present 6 use cases from New York City that demonstrate the value of syndromic surveillance for public health response and decision making across a broad range of health outcomes: synthetic cannabinoid drug use, heat-related illness, suspected meningococcal disease, medical needs after severe weather, asthma exacerbation after a building collapse, and Ebola-like illness in travelers returning from West Africa.

Materials and methods: The New York City syndromic surveillance system receives data on patient visits from all emergency departments (EDs) in the city. The data are used to assign syndrome categories based on the chief complaint and discharge diagnosis, and analytic methods are used to monitor geographic and temporal trends and detect clusters.

Results: For all 6 use cases, syndromic surveillance using ED data provided actionable information. Syndromic surveillance helped detect a rise in synthetic cannabinoid-related ED visits, prompting a public health investigation and action. Surveillance of heat-related illness indicated increasing health effects of severe weather and led to more urgent public health messaging. Surveillance of meningitis-related ED visits helped identify unreported cases of culture-negative meningococcal disease. Syndromic surveillance also proved useful for assessing a surge of methadone-related ED visits after Superstorm Sandy, provided reassurance of no localized increases in asthma after a building collapse, and augmented traditional disease reporting during the West African Ebola outbreak.

Practice implications: Sharing syndromic surveillance use cases can foster new ideas and build capacity for public health preparedness and response.

Keywords: emergency department; syndromic surveillance; use cases.

Figure 1.

Synthetic cannabinoid-related emergency department (ED) visit trends, New York City, January 2012 through May 2016. The periods highlighted with arrows indicate the initial detection of increases in cannabinoid-related ED visits (December 2013 to June 2014) and subsequent decreases in cannabinoid-related ED visits (July 2015–March 2016) after an intervention that included removal of synthetic cannabinoid products through a multiagency response.

Figure 2.

Partial emergency department (ED) line list of a cluster of patients exposed to meningitis on a single day, identified using the word analysis of the ED chief complaints, New York City, July 23, 2013. Abbreviations: HOSP, hospital; NOS, not otherwise specified.

Figure 3.

Syndromic surveillance of medical needs trends of patients visiting New York City emergency departments (EDs) after Superstorm Sandy (October 28 and 29, 2012), as reported through ED chief complaint data, October 1 to December 31, 2012.