Abstract
BackgroundAlthough fatal opioid poisonings tripled from 1999 to 2008, data describing nonfatal poisonings are rare. Public health authorities are in need of tools to track opioid poisonings in near real time.MethodsWe determined the utility of ICD-9-CM diagnosis codes for identifying clinically significant opioid poisonings in a state-wide emergency department (ED) surveillance system. We sampled visits from four hospitals from July 2009 to June 2012 with diagnosis codes of 965.00, 965.01, 965.02 and 965.09 (poisoning by opiates and related narcotics) and/or an external cause of injury code of E850.0-E850.2 (accidental poisoning by opiates and related narcotics), and developed a novel case definition to determine in which cases opioid poisoning prompted the ED visit. We calculated the percentage of visits coded for opioid poisoning that were clinically significant and compared it to the percentage of visits coded for poisoning by non-opioid agents in which there was actually poisoning by an opioid agent. We created a multivariate regression model to determine if other collected triage data can improve the positive predictive value of diagnosis codes alone for detecting clinically significant opioid poisoning.Results70.1 % of visits (Standard Error 2.4 %) coded for opioid poisoning were primarily prompted by opioid poisoning. The remainder of visits represented opioid exposure in the setting of other primary diseases. Among non-opioid poisoning codes reviewed, up to 36 % were reclassified as an opioid poisoning. In multivariate analysis, only naloxone use improved the positive predictive value of ICD-9-CM codes for identifying clinically significant opioid poisoning, but was associated with a high false negative rate.ConclusionsThis surveillance mechanism identifies many clinically significant opioid overdoses with a high positive predictive value. With further validation, it may help target control measures such as prescriber education and pharmacy monitoring.
Highlights
Fatal opioid poisonings tripled from 1999 to 2008, data describing nonfatal poisonings are rare
Case definition emergency department (ED) visits containing one or more of the ICD-9-CM diagnosis codes listed in Table 1 were characterized as either opioid poisoning-related or non-opioid poisoning-related based on the diagnosis code
Weighted statistics were calculated, adjusting for the random sampling at University Hospital 2, by multiplying the proportions measured in University Hospital 2 by the total number of visits observed over the number of visits sampled (236/141), so that final statistics reflect the whole population of the two health systems over the study period
Summary
Fatal opioid poisonings tripled from 1999 to 2008, data describing nonfatal poisonings are rare. Public health authorities are in need of tools to track opioid poisonings in near real time. In 2010, there were 25,036 opioid poisoning-related emergency department (ED) visits in North Carolina (NC), using International Classification of Disease, 9th edition Clinical Modification (ICD-9-CM) diagnosis and external cause codes [2]. These figures were almost twofold higher than extrapolations of estimated poisonings from the United States National Electronic Injury Surveillance System (NEISS) [5]. While NEISS is useful for state-level estimates and comparisons of injury and poisoning rates, it does not have the level of detail that is helpful for state public health workers for planning prevention activities. There is an urgent need for validated tools to track the incidence of nonfatal poisonings
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