North Carolina Disease Event Tracking Research Articles

The most common types of nontraumatic dental conditions among emergency department visits in North Carolina before and during the COVID-19 pandemic

BackgroundThis study aimed to identify the most common types of nontraumatic dental conditions (NTDCs) before and during the COVID-19 pandemic and assess the variations in the most common NTDCs by patient age groups and rural or urban locations and the impact of COVID-19 on emergency department (ED) visits for NTDCs in North Carolina. MethodsThe authors conducted a retrospective data analysis of ED data from the North Carolina Disease Event Tracking and Epidemiology Collection Tool. The authors estimated the proportions of NTDCs of all ED visits in 2019 and 2021 and ranked the proportions of the major categories of NTDCs by age groups and rural or urban locations. They used a multiple logistic regression model to assess the impact of COVID-19 on NTDCs. ResultsBy the first diagnosis, the proportion of NTDCs dropped from 1.1% in 2019 to 0.99% in 2021 (P < .001). Caries was specified as the third most common NTDC. Oral infection was the top NTDC among young (≤ 17 years) and older patients (≥ 65 years). No significant differences were found in NTDCs between rural and urban areas (P = .68). Children younger than 2 years (adjusted odds ratio, 4.36) and adults aged 18 through 44 years (adjusted odds ratio, 4.54) were more likely to visit the ED for NTDCs than those 75 years and older. ConclusionsThe proportion of NTDCs seen at the ED was lower during the COVID-19 pandemic in 2021 than in 2019. The common NTDCs varied by age group but were similar in rural and urban areas. The most common NTDCs were related to toothache, oral infection, and caries. Practical ImplicationsMore efforts are needed to reduce ED visits for NTDCs.

Pregnancy and Emergency Department Utilization in North Carolina, 2016–2021: A Population-Based Surveillance Study

Pregnancy-associated complaints are a common reason for emergency department visits for women of reproductive age. Emergency department utilization during pregnancy is associated with worse birth outcomes for both mothers and infants. We used statewide North Carolina emergency department surveillance data between 2016 and 2021 to describe the sociodemographic factors associated with the use of emergency department for pregnancy-associated problems and subsequent hospital admission. North Carolina Disease Event Tracking and Epidemiologic Collection Tool is a syndromic surveillance system that includes all emergency department encounters at civilian acute-care facilities in North Carolina. We analyzed all emergency department visits between January 1, 2016 and December 31, 2021 for female patients aged 15-44 years residing in North Carolina with at least 1 ICD-10-CM code (analysis occurred in July 2021-October 2022). Each emergency department visit was categorized as pregnancy-associated if assigned ICD-10-CM code(s) indicated pregnancy. We stratified visits by age, race, ethnicity, county of residence, and insurance and compared them with estimated pregnant population proportions using 1-sample t-tests. We used multivariable logistic regression to determine whether pregnancy-associated visits were more likely to be associated with hospital admission and then to determine sociodemographic predictors of admission among pregnancy-associated emergency department visits. More than 6.4 million emergency department visits were included (N=6,471,197); 10.1% (n=655,476) were pregnancy-associated, significantly higher than the proportion of women estimated to be pregnant at any given time in North Carolina (4.6%, p<0.0001) and increased over time (8.6% in 2016 vs 11.1% in 2021, p<0.0001). Pregnancy-associated visits were lower than expected for ages 25-44 years and higher than expected for those aged 15-24 years, for those of Black race, and for patients residing in rural or suburban areas. The proportion admitted was higher for pregnancy-associated emergency department visits than for nonpregnancy associated (15.6% vs 7.0%, AOR=3.06 [95% CI=3.03, 3.09]). Pregnancy-associated emergency department visits for patients of Black race had 0.58 times (95% CI=0.57, 0.59) the odds of admission compared with White patients. Emergency department utilization during pregnancy is common. The proportion of pregnancy-associated emergency department visits among reproductive-age women is increasing, as are inpatient admissions from the emergency department for pregnancy-associated diagnoses. Use of public health surveillance databases such as the North Carolina Disease Event Tracking and Epidemiologic Collection Tool may help identify opportunities for improving disparities in maternal health care, especially related to access to care.

Feasibility of linking violent death decedents to prior-month emergency department visits in North Carolina, 2019–2020

ObjectiveLinking data between violent death decedents and other sources can provide valuable insight, highlighting opportunities for prevention of violent injury. This study investigated the feasibility of linking North Carolina Violent...

Evaluation of an Emergency Department Visit Data Mental Health Dashboard.

Local health departments (LHDs) need timely county-level and subcounty-level data to monitor health-related trends, identify health disparities, and inform areas of highest need for interventions as part of their ongoing assessment responsibilities; yet, many health departments rely on secondary data that are not timely and cannot provide subcounty insights. We developed and evaluated a mental health dashboard in Tableau for an LHD audience featuring statewide syndromic surveillance emergency department (ED) data in North Carolina from the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT). We developed a dashboard that provides counts, crude rates, and ED visit percentages at statewide and county levels, as well as breakdowns by zip code, sex, age group, race, ethnicity, and insurance coverage for 5 mental health conditions. We evaluated the dashboards through semistructured interviews and a Web-based survey that included the standardized usability questions from the System Usability Scale. Convenience sample of LHD public health epidemiologists, health educators, evaluators, and public health informaticians. Six semistructured interview participants successfully navigated the dashboard but identified usability issues when asked to compare county-level trends displayed in different outputs (eg, tables vs graphs). Thirty respondents answered all questions on the System Usability Scale for the dashboard, which received an above average score of 86. The dashboards scored well on the System Usability Scale, but more research is needed to identify best practices in disseminating multiyear syndromic surveillance ED visit data on mental health conditions to LHDs.

Regional Trends of COVID-19-Like Illness- Related Emergency Department Visits in North Carolina (March 1, 2020–November 30, 2020)

Background An evaluation of emergency department (ED) visits and the number of patients seeking care for COVID-19-like illness (CLI) during the initial phases of the SARS-CoV-2 (COVID-19) pandemic in North Carolina has not been exclusively described. Purpose To characterize CLI-related ED visits across North Carolina from March 1 to November 30, 2020. Methods This was a retrospective, descriptive study. Data from the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) and the US Census Bureau were used to calculate CLI-related ED visit rates for the North Carolina resident patient population, and to compare and describe regional trends (Eastern, Piedmont, and Western). Results A total of 133,193 CLI-related ED visits were evaluated. Across the 3 regions, CLI-related ED visits followed similar trends with the highest peaks being reported in mid-July and late November 2020. The Piedmont region experienced the highest percent (56.3%), while people aged 25–49 years accounted for the largest age group (35.0 %) of CLI-related ED visits. More CLI-related ED visits occurred for White individuals (47.8%), but the Eastern region had a far higher percent (44.8%) of reported CLI-related ED visits for Black and American Indian individuals compared to the rest of the state. Limitations ICD-10-CM codes were not available during the early weeks of the pandemic, which limited the ability to evaluate CLI-related data during this time. Discussion This evaluation summarizes regional trends of CLI-related ED visits across North Carolina during the first 9 months of the COVID-19 pandemic. These results provide useful information and insight for public health officials, health care administrators, and policymakers.

Age and sex trends among mental health-related emergency department visits in North Carolina

Whether patients present to the emergency department (ED) with physical ailments and comorbid psychiatric needs or primary psychiatric complaints, understanding differences in clinically relevant age and sex patterns over time is crucial to optimal psychiatric care in the ED setting. We used population-level surveillance data provided by the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) from January 1, 2008, through December 31, 2014. Mental health-related (MHR) ED visits were identified by International Classification of Diseases, Clinical Modification 9th revision (ICD-9-CM) codes analyzed in the Agency for Healthcare Research and Quality (AHRQ) clinical classification software groupings of related diagnostic categories. Trends were assessed based on total and average annual visit counts. We identified approximately 4 million MHR ED visits. The average number of visits per year was highest among 50-year-olds, while patients over the age of 90 had the highest proportion of their ED visits associated with an MHR code. Mood disorders were more prevalent among females, while substance use disorders were more prevalent among males. Within MHR categories, age-related peaks did not differ by sex except for suicide and self-inflicted injury. Whether it be a teenage boy presenting with suicidal ideation, a middle-aged man presenting with alcohol abuse, or an elderly female presenting with dementia, ED MHR visits’ needs vary across the lifespan. Understanding these trends is important to holistic patient care.

Linking Emergency Medical Services and Emergency Department Data to Improve Overdose Surveillance in North Carolina.

IntroductionLinking emergency medical services (EMS) data to emergency department (ED) data enables assessing the continuum of care and evaluating patient outcomes. We developed novel methods to enhance linkage performance and analysis of EMS and ED data for opioid overdose surveillance in North Carolina.MethodsWe identified data on all EMS encounters in North Carolina during January 1–November 30, 2017, with documented naloxone administration and transportation to the ED. We linked these data with ED visit data in the North Carolina Disease Event Tracking and Epidemiologic Collection Tool. We manually reviewed a subset of data from 12 counties to create a gold standard that informed developing iterative linkage methods using demographic, time, and destination variables. We calculated the proportion of suspected opioid overdose EMS cases that received International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes for opioid overdose in the ED.ResultsWe identified 12 088 EMS encounters of patients treated with naloxone and transported to the ED. The 12-county subset included 1781 linkage-eligible EMS encounters, with historical linkage of 65.4% (1165 of 1781) and 1.6% false linkages. Through iterative linkage methods, performance improved to 91.0% (1620 of 1781) with 0.1% false linkages. Among statewide EMS encounters with naloxone administration, the linkage improved from 47.1% to 91.1%. We found diagnosis codes for opioid overdose in the ED among 27.2% of statewide linked records.Practice ImplicationsThrough an iterative linkage approach, EMS–ED data linkage performance improved greatly while reducing the number of false linkages. Improved EMS–ED data linkage quality can enhance surveillance activities, inform emergency response practices, and improve quality of care through evaluating initial patient presentations, field interventions, and ultimate diagnoses.

A Mixed-Methods Comparison of a National and State Opioid Overdose Surveillance Definition.

We assessed the differences between the first version of the Centers for Disease Control and Prevention (CDC) opioid surveillance definition for suspected nonfatal opioid overdoses (hereinafter, CDC definition) and the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) surveillance definition to determine whether the North Carolina definition should include additional International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes and/or chief complaint keywords. Two independent reviewers retrospectively reviewed data on North Carolina emergency department (ED) visits generated by components of the CDC definition not included in the NC DETECT definition from January 1 through July 31, 2018. Clinical reviewers identified false positives as any ED visit in which available evidence supported an alternative explanation for patient presentation deemed more likely than an opioid overdose. After individual assessment, reviewers reconciled disagreements. We identified 2296 ED visits under the CDC definition that were not identified under the NC DETECT definition during the study period. False-positive rates ranged from 2.6% to 41.4% for codes and keywords uniquely identifying ≥10 ED visits. Based on uniquely identifying ≥10 ED visits and a false-positive rate ≤10.0%, 4 of 16 ICD-10-CM codes evaluated were identified for NC DETECT definition inclusion. Only 2 of 25 keywords evaluated, "OD" and "overdose," met inclusion criteria to be considered a meaningful addition to the NC DETECT definition. Quantitative and qualitative trends in coding and keyword use identified in this analysis may prove helpful for future evaluations of surveillance definitions.

Pelvic Inflammatory Disease Trends Among Emergency Department Visits in North Carolina, 2008 to 2017.

Pelvic inflammatory disease (PID) is an infection of the upper female reproductive organs that can lead to infertility and ectopic pregnancies. It is a reportable condition in North Carolina (NC) but is likely underreported. We aimed to quantify PID diagnoses in NC emergency department (ED) visits. The NC Disease Event Tracking and Epidemiology Collection Tool tracks all ED visits in NC. We identified PID diagnoses among women of reproductive age (15-44 years) between 2008 and 2017 using International Classification of Diseases, Ninth/Tenth Revision, Clinical Modification codes, and calculated the yearly proportion with PID diagnoses. We assessed the number of PID visits per patient each year, and the proportion of ED visits with a PID diagnosis by age, proportion of the patient's ZIP code living below the poverty line, insurance coverage, and NC provider region. The percent of women with PID decreased from 6189 (1.0%) in 2008 to 4337 (0.58%) in 2016 before increasing slightly to 4371 (0.61%) in 2017. We identified 54,502 (0.45%) ED visits among 51,847 (0.76%) women with ≥1 PID diagnosis code. Most (95.5%) women with PID had one ED visit during the calendar year. Each year, the proportion with PID was highest among women aged 20 to 24 years, covered under public insurance, from the most impoverished areas, and whose provider was in the Coastal region of NC. The percent with PID among women visiting EDs decreased between 2008 and 2017 in NC. Although this decline was observed across all demographics, disparities associated with PID continued to persist over time.

Abstract 045: Declines In Acute Myocardial Infarction And Stroke Emergency Department Visits Observed During Covid-19 Restrictions In North Carolina

Introduction: Efforts to control the COVID-19 pandemic brought sweeping social change, with stay-at-home orders and physical distancing mandates in 43 of 50 states by April 2020. Early on, isolated studies around the world described reduced hospital admissions. Reports from some US hospitals also described declines in catheterization laboratory activations, and acute myocardial infarction (AMI) and stroke admissions. However, there have been few population-based analyses of emergency department (ED) visits to verify these initial reports and describe longer term impacts of the pandemic on care seeking behavior. Hypothesis: We hypothesized that AMI and stroke ED visits in North Carolina (NC) would decrease substantially after a statewide stay-at-home order was announced on March 27, 2020. Methods: We analyzed all ED visits from January 5 to August 28, 2020 using data collected by the NC Disease Event Tracking and Epidemiologic Collection Tool, a syndromic surveillance system that automatically gathers ED data in near-real time for all EDs in NC. Counts of AMI and stroke/transient ischemic attack (TIA) were ascertained using ICD-10-CM diagnosis codes. We compared weekly 2020 ED visit data before and after NC’s stay-at-home order, and to 2019 ED visit data. Results: Overall ED volume declined by 44% in the weeks before and after the stay-at-home order ( Figure ) while the prior year’s ED volume stayed steady at ~100,000 visits per week. From January 5 to March 28, there were 593 AMI and 791 stroke/TIA visits per week on average. By April 11, ED visits reached a nadir at 426 AMI and 543 stroke/TIA visits per week, representing a 28% and 31% decrease, respectively. Since June, AMI and stroke/TIA ED visits have rebounded slightly but have yet to reach pre-pandemic levels. Conclusions: We observed swift declines in AMI and stroke/TIA ED visits following NC’s stay-at-home order. These findings potentially reflect the avoidance of medical care due to fears of COVID-19 exposure and may eventually result in higher associated case fatality.

The impact of the COVID-19 pandemic on the utilization of emergency department services for the treatment of injuries.

ContextThe global COVID-19 pandemic has had a major impact on the utilization of healthcare services; however, the impact on population-level emergency department (ED) utilization patterns for the treatment of acute injuries has not been fully characterized.ObjectiveThis study examined the frequency of North Carolina (NC) EDs visits for selected injury mechanisms during the first eleven months of the COVID-19 pandemic.MethodsData were obtained from the NC Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT), NC's legislatively mandated statewide syndromic surveillance system for the years 2019 and 2020. Frequencies of January – November 2020 NC ED visits were compared to frequencies of 2019 visits for selected injury mechanisms, classified according to International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) injury diagnosis and mechanism codes.ResultsIn 2020, the total number of injury-related visits declined by 19.5% (N = 651,158) as compared to 2019 (N = 809,095). Visits related to motor vehicle traffic crashes declined by a greater percentage (29%) and falls (19%) declined by a comparable percentage to total injury-related visits. Visits related to assault (15%) and self-harm (10%) declined by smaller percentages. Medication/drug overdose visits increased (10%), the only injury mechanism studied to increase during this period.ConclusionBoth ED avoidance and decreased exposures may have contributed to these declines, creating implications for injury morbidity and mortality. Injury outcomes exacerbated by the pandemic should be addressed by timely public health responses.

Examining Heat-Related Emergency Department Visits in North Carolina, 2009-2017

Background: Climactic changes in heat are expected to affect patterns of heat-related illness (HRI) in North Carolina. In order to understand patterns in HRI over time, we assessed the frequency and distribution of HRI emergency department (ED) visits across North Carolina during 2009-2017. Methods: Using a previously validated ICD-9/ICD-10 and chief complaint-based case definition, we identified visits from the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) from January 1, 2009 to December 31, 2017. The analysis used a generalized linear model for time series of counts with R package tscount. A poisson model was used with response variable as number of daily HRI ED visits. We assessed whether number of peaks (i.e., aberrations) increased annually from 2009 to 2017. Finally, to assess whether length of the heat season increased annually 2009 to 2017, the duration between date of the first peak and last peak were compared annually. Results: Most emergency department visits occurred during summer months. Monthly distributions for each year were similar. During 2010 and 2015, the monthly highs occurred slightly earlier than other years. In the Poisson model, controlling for maximum monthly temperature, the coefficient for year was positive with a significant p-value, suggesting an expected increase in the number of HRI ED visits over time. No significant distribution in the number of peaks by year or duration of heat season was observed. Conclusions: The model demonstrated a significant increase in the number of HRI ED visits over time. The results of this study reinforce the strong relationship between increasing temperatures and HRI, and suggests that as temperatures continue to increase, the incidence of HRI will likewise increase.

Evaluation of a Sick Employee Online Log System for Tracking Sick Hospital Employees During Two Influenza Seasons

Background: Since 2009, Vidant Health has used a Sick Employee Online Log (SEOL) system to track illnesses among employees and to capture this information in real time. The CDC assessed the 2017–2018 influenza season as a high-severity influenza season, whereas the 2018–2019 influenza season was of moderate severity. Objective: In this research project, we sought to determine whether the influenza season severity would affect either the hospital-based employee illness surveillance system results or would correlate with state influenza-like illness (ILI) visits. Methods: The SEOL system is an internet-based system initiated in December 2008. When a hospital employee calls in sick, the department manager records whether the employee reports the following symptoms: nausea, vomiting, diarrhea, upper respiratory infection, fever, sore throat, headache, conjunctivitis, rash, and/or cough. The information is confidential, with raw data access restricted to review by occupational health and infection control leadership. The correlation value was determined for each symptom using the North Carolina Division of Human Services (NC DHHS) percentage of ILI visits in statewide emergency departments.1 The data collection dates covered January 1–May 31 for each year. In this study, only symptoms related to influenza were included: upper respiratory infection, fever, influenza-like illness, cough and self-reported influenza. Correlation values were calculated using MS Excel software. Results: There were no breaks in confidentiality. All of the correlation values had a correlation value of 0.5 or better (Fig. 1), showing good correlation with the NC DHHS ILI data for both years; however, the more severe 2017–2018 influenza season had correlation values of 0.7 for all symptoms, versus 0.52–0.59 for URI and ILI, respectively, only during 2018–2019. Conclusions: The higher-severity influenza season did correlate with a higher r values when compared to North Carolina’s DHHS ILI emergency department data than did the influenza season of moderate severity. A possible explanation is that a higher-severity influenza season would correlate better than a moderate influenza season because it shows fewer ILI peaks and troughs. In conclusion, the SEOL system served as an early warning that influenza is present among our staff, and it correlates well with the state system for ILI surveillance. Potential limitations of SEOL are that respiratory symptoms are not specific to influenza; thus, they are subject to variation due to other respiratory viruses circulating among our employees.1. The North Carolina Disease Event Tracking and Epidemiologic Collection Tool. NC DETECT website. http://www.ncdetect.org. Accessed Nov 8, 2019.Funding: NoneDisclosures: None

Identifying Emergency Department Care in the Year Prior to Suicide Death

ObjectiveTo identify potential emergency department (ED) visits prior to suicide deaths in North Carolina (NC) and describe pre-suicide care-seeking in EDs.IntroductionSuicide is a leading cause of mortality in the United States, causing about 45,000 deaths annually1. Research suggests that universal screening in health care settings may be beneficial for prevention, but few studies have combined detailed suicide circumstances with ED encounter data to better understand care-seeking behavior prior to death.MethodsThis project used data from the NC Violent Death Reporting System (NC-VDRS), a repository of all violent deaths in North Carolina, and the NC Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT), which includes all visits to 24/7, acute-care, civilian, hospital-affiliated EDs in NC. We identified all suicide deaths recorded in the NC-VDRS between 1/1/2014 – 9/30/2015, and all NC DETECT ED visits between 1/1/2013 – 9/30/2015. Descriptive analyses were conducted for each data source, separately. For all NC-VDRS suicides, we identified ED visits likely made by the same individual within the 48 hours prior to death. We identified these ED visits based on the variables arrival date, sex, date of birth (DOB), county of residence, and a chief complaint consistent with self-harm/suicide; we refer to these as suicide-related ED visits. For the subset of NC-VDRS suicides with a suicide-related ED visit, made within 48 hours of death, we identified all ED visits associated with the decedent made to the same facility or healthcare system in the year prior to death. We then categorized the pre-suicide ED visits according to the primary reason healthcare was sought by the patient (e.g. mental health problem, substance abuse/overdose, pain, etc.).ResultsFrom 1/1/2014-9/30/2015, there were 2,953 suicide deaths captured in NC-VDRS data; 2,435 (82%) of these included DOB. Between 1/1/2013 – 9/30/2015, there were 13,463,345 ED visits captured by NC DETECT; 12,884,596 (96%) included DOB. For 961 suicides (32.5%), no ED visit was found with the same DOB, sex and county of residence. For the remaining 1,474 suicides, at least one ED visit was found for a patient with the same DOB, sex and county of residence and occurring on or before the date of death. For 406 suicides, a suicide-related ED visit was identified; 122 of these patients had at least one additional ED visit in the year prior to death. A total of 516 ED visits were identified for these 122 suicides, including the suicide-related ED visit, with an average of 3.2 (range: 1-25) visits.ConclusionsFor nearly a third of NC-VDRS suicides, no indication of any ED visit by a patient with the same DOB, sex, and county of residence was found. While it is likely we were unable to identify all ED visits prior to suicide, the findings from this pilot study suggest many suicide victims did not seek NC ED care in the year prior to death. Overall, a suicide-related ED visit was found for only 13.7% of NC suicides in the study period, indicating that most people who self-inflict fatal injury do not make it to an ED for care prior to death. ED visits in the year prior to death by suicide indicated a variety of diagnoses, but rarely depression or suicidality; this suggests that universal screening at ED visits would have been necessary to identify any suicide risk present. Limitations of this study include that we were unable to directly link suicide deaths and ED visits using patient identifiers. Additionally, we relied solely on secondary data used for public health surveillance and, therefore, had no access to medical record information that may have documented depression or suicidal ideation that was not coded as such. Findings from this pilot study can inform future work to identify ED visits prior to suicide.References1National Center for Injury Prevention and Control. Suicide Rising Across the US. Vital Signs, June 2018; Atlanta, GA: Centers for Disease Control and Prevention 2018. https://www.cdc.gov/vitalsigns/suicide/. Accessed Sept 25, 2018.

Characteristics of Prehospital Electrocardiogram Use in North Carolina Using a Novel Linkage of Emergency Medical Services and Emergency Department Data

Objective: Prehospital electrocardiography (ECG) is recommended for patients with suspected acute coronary syndrome (ACS), yet only 20–80% of chest pain patients receive a prehospital ECG. Less is known about prehospital ECG use in patients with less common complaints (e.g., fatigue) suspicious for ACS who are transported by emergency medical services (EMS). The aims of this study were to determine: (1) the proportion of patients with chest pain and less typical complaints, and (2) patient characteristics associated with prehospital ECG use in patients transported by EMS to emergency departments across North Carolina. Methods: A novel linked database was created between prehospital and emergency department (ED) patient care data from the North Carolina Prehospital Medical Information System and the North Carolina Disease Event Tracking and Epidemiologic Collection Tool. Institutional review board approval and a data use agreement were received prior to the start of the study. Patients ≥21 transported during 2010–14 by EMS with select variables were included. We examined patients’ complaints (symptoms), characteristics (e.g., race, ethnicity, final hospital diagnosis), and prehospital ECG use (yes/no). Analysis included descriptive statistics and mixed logistic regression. Results: During 2010–14, there were 1,967,542 patients with linked EMS-ED data (mean age: 56.9 [SD: 22.2], 43.2% male, 63.7% White). Of these, 643,174 (32.6%) received a prehospital ECG. Patients with prehospital ECG presented with the following complaints: 20% chest pain; 10% shortness of breath; 6% abdominal pain/problems; 6% altered level of consciousness; 5% syncope/dizziness; 4% palpitations; 12% other complaints; and 37% missing. Patients’ presenting complaints were the strongest predictor of prehospital ECG use, adjusting for age, sex, race, ethnicity, urbanicity, and date and time of EMS dispatch. Conclusions: Patients with chest pain were significantly more likely to receive a prehospital ECG compared to those with less typical but suspicious complaints for ACS. Patients with less common presentations remain disadvantaged for early triage, risk stratification, and intervention prior to the hospital.

Variability in Hospital Admission Rates for Neonates With Fever in North Carolina.

Background. Despite multiple guidelines recommending admission, there is significant variation among emergency departments (EDs) regarding disposition of neonates presenting with fever. We performed a statewide epidemiologic analysis to identify characteristics that may influence patient disposition in such cases within North Carolina. Methods. This study is a retrospective cohort study of infants 1 to 28 days old with a diagnosis of fever presenting to North Carolina EDs from October 1, 2010, to September 30, 2015, using data from the NC DETECT (North Carolina Disease Event Tracking and Epidemiologic Collection Tool) database. We analyzed various patient epidemiology characteristics and their associations with patients being admitted or discharged from the emergency room setting. Results. Of 2745 unique patient visits for neonatal fever, 1173 (42.7%) were discharged from the ED, while 1572 (57.3%) were either admitted or transferred for presumed admission. Age, sex, region within North Carolina, and the presence of a pediatric service did not significantly influence disposition. An abnormal documented ED temperature was associated with higher likelihood of admission (P < .01). The size of the hospital was also found to be significant when comparing large with small hospitals (P < .01). Government-funded insurance was associated with lower likelihood of admission (P < .01). Conclusions. A high number of neonates diagnosed with fever were discharged home, inconsistent with current recommendations. An association with a government-funded insurance represents a possible health care disparity. Further studies are warranted to further understand these variations in practice.

Snakebites Treated in North Carolina Emergency Departments, October 2013–September 2015

North Carolina (NC) is home to more than 30 species of indigenous venomous and nonvenomous snakes. Snakebites can cause debilitating and potentially fatal injuries. However, there is a lack of current information available describing the incidence of snakebites in NC. Therefore, we performed this study of snakebites treated in NC emergency departments (EDs) using the statewide syndromic surveillance system, the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT). This was a descriptive epidemiologic study characterizing NC ED visits collected by NC DETECT between October 1, 2013 and September 30, 2015 with an assigned International Classification of Diseases, 9th Revision, Clinical Modification code or keyword indicating a snakebite. Over the 2-year period, the absolute count of snakebite-related ED visits was 2080 visits with an incidence rate of 10.4 visits per 100 000 person-years (95% confidence interval: 10.0-10.9). The frequency of snakebite was highest during the summer months and evening hours. Men had higher incidence rates of snakebite-related ED visits than women, and residents of the Coastal Plain geographic region of NC had higher incidence rates than persons in other regions. The current study indicated that snakebites are common injuries treated at NC EDs, with a strong seasonal and geographic component. Additional research is needed to further characterize the circumstances associated with snakebites for the development of preventive measures and public health education.

Asthma-Related Emergency Department Visits in North Carolina, 2010-2014.

BACKGROUND The purpose of this study was to compare asthma-related emergency department (ED) visit rates across North Carolina. Results from this study can inform health planning while helping public health and health care professionals in identifying geographical areas and targeting age groups to reduce the asthma burden in North Carolina.METHODS This was a retrospective data analysis between 2010 and 2014 among North Carolina patients presenting to an ED with a first or second listed diagnosis code related to asthma (ICD-9-CM, 493.xx). Data was obtained from the North Carolina Disease Event Tracking and Epidemiology Collection Tool. Annual, age-adjusted rates were standardized to the 2000 US standard population using the direct method. Repeated measures ANOVA was conducted to compare differences between mean values of asthma-related ED visit rates in regions, urbanicity, and age groups across years.RESULTS Asthma ED rates were consistently higher in the east (85.1 per 10,000) compared with other regions. While most age group ED rates fluctuated over the study period, univariate test results indicated statistical increases in ED asthma visits among the groups aged 5 to 9 years (P < .01), and 65 and over (P < .03).CONCLUSION Public health officials should recognize the disproportionate burden of asthma-related ED visits, particularly among rural and impoverished counties in the eastern portion of North Carolina when prioritizing health concerns across North Carolina.

Emergency Department Visits by Older Adults with Mental Illness in North Carolina.

IntroductionWe analyzed emergency department (ED) visits by patients with mental health disorders (MHDs) in North Carolina from 2008–2010 to determine frequencies and characteristics of ED visits by older adults with MHDs.MethodsWe extracted ED visit data from the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT). We defined mental health visits as visits with a mental health ICD-9-CM diagnostic code, and organized MHDs into clinically similar groups for analysis.ResultsThose ≥65 with MHDs accounted for 27.3% of all MHD ED visits, and 51.2% were admitted. The most common MHD diagnoses for this age group were psychosis, and stress/anxiety/depression.ConclusionOlder adults with MHDs account for over one-quarter of ED patients with MHDs, and their numbers will continue to increase as the “boomer” population ages. We must anticipate and prepare for the MHD-related needs of the elderly.

A Descriptive Study of Farm-Related Injuries Presenting to Emergency Departments in North Carolina: 2008–2012

ABSTRACTFarming is among the most dangerous industries for fatal and nonfatal injuries. A comprehensive agricultural injury surveillance system is absent in North Carolina (NC), and data sets traditionally used to provide estimates of nonfatal farm injuries surveillance in the United States are relatively incomplete. In the absence of a comprehensive farm injury surveillance system, individual local administrative data sources can provide a useful profile of the epidemiology of injuries in a population. The objective of this study was to use emergency department data to help describe the burden of farm-related injuries in NC and explore its usefulness in conducting work-related injury surveillance. Emergency department data from the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) was utilized to identify farm injury cases. The study sample included all farm injury cases for the period of 2008–2012 that contained International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) E code 919.0 (agricultural machinery) or 849.1 (place of occurrence = farm; this E code excludes farm house and home premises of farm). Results indicated that an average of 459 cases of farm injury occurred annually from 2008 to 2012, with no significant change between years. Among the patients, 79.7% were male, 74.7% were between 18 and 64 years old, and 28.1% had no form of insurance coverage. Injuries were more heavily concentrated in the Piedmont and Coastal Plains regions (41.3% and 42.2%, respectively). Of farm-coded incidents, 73.2% were given injury- or poisoning-related primary diagnosis codes, and of these, the most frequent specific codes were related to open wounds of upper limbs (16.2%), contusions (12.0%), and sprains and strains (9.3%). Some significant relationships between diagnoses and sex, region, and age are also identified. Injuries occurring on a farm have been well documented and constitute a significant public health problem. Exploring emergency department data provides an opportunity to better characterize nonfatal farm-related injuries in NC for prevention purposes. The data provided by this study may serve to direct prevention programs, whereas the methods used offer a potential farm-related injury surveillance tool.