Abstract
The science of surveillance is rapidly evolving due to changes in public health information and preparedness as national security issues, new information technologies and health reform. As the Emergency Department has become a much more utilized venue for acute care, it has also become a more attractive data source for disease surveillance. In recent years, influenza surveillance from the Emergency Department has increased in scope and breadth and has resulted in innovative and increasingly accepted methods of surveillance for influenza and influenza-like-illness (ILI). We undertook a systematic review of published Emergency Department-based influenza and ILI syndromic surveillance systems. A PubMed search using the keywords “syndromic”, “surveillance”, “influenza” and “emergency” was performed. Manuscripts were included in the analysis if they described (1) data from an Emergency Department (2) surveillance of influenza or ILI and (3) syndromic or clinical data. Meeting abstracts were excluded. The references of included manuscripts were examined for additional studies. A total of 38 manuscripts met the inclusion criteria, describing 24 discrete syndromic surveillance systems. Emergency Department-based influenza syndromic surveillance has been described worldwide. A wide variety of clinical data was used for surveillance, including chief complaint/presentation, preliminary or discharge diagnosis, free text analysis of the entire medical record, Google flu trends, calls to teletriage and help lines, ambulance dispatch calls, case reports of H1N1 in the media, markers of ED crowding, admission and Left Without Being Seen rates. Syndromes used to capture influenza rates were nearly always related to ILI (i.e. fever +/− a respiratory or constitutional complaint), however, other syndromes used for surveillance included fever alone, “respiratory complaint” and seizure. Two very large surveillance networks, the North American DiSTRIBuTE network and the European Triple S system have collected large-scale Emergency Department-based influenza and ILI syndromic surveillance data. Syndromic surveillance for influenza and ILI from the Emergency Department is becoming more prevalent as a measure of yearly influenza outbreaks.
Highlights
Influenza is a perennial disease with the potential for yearly outbreaks
All abstracts recovered were reviewed by all four study personnel for the following inclusion criteria: the abstract described a syndromic surveillance system for which (1) patients presented to an Emergency Department, (2) clinical data or visit data were used for surveillance, and (3) at least one of the diseases under surveillance was influenza
Cross-referencing abstracts from the included manuscripts generated a total of 56 additional abstracts, of which 31 non-duplicated papers were reviewed and 8 met inclusion criteria
Summary
Approaches to surveillance of influenza activity and influenza-like-illness (ILI) in the community have traditionally been multifactorial, taking data from sentinel providers, such as primary care physicians, laboratory data, hospital admission rates and mortality data into account. These data sources, while important, historically lag one to two weeks behind real-world outbreaks. Uninsured or underinsured patient populations, may not have a primary care physician from whom they can seek care. The emergency department (ED) is open 24 hours a day, 7 days a week, and has the potential to capture a wider variety of patients, especially those who are not able to seek care elsewhere
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