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On May 21, 2012, shipments of contaminated Methylprednisone Acetate from the New England Compounding Center (NECC) were received by providers in Escambia County, Florida. On October 4, the Escambia County Health Department (ECHD) and implicated clinics began contacting patients who possibly received contaminated injections. Escambia County has two emergency departments (EDs) sending data to the Florida Department of Health (FDOH) syndromic surveillance system, ESSENCE-FL. Both report ED visit chief complaint and discharge disposition; one sends discharge diagnosis. After October 4, FDOH Bureau of Epidemiology (BOE) and ECHD used ESSENCE-FL ED data to prospectively monitor cases presenting for follow-up. Escambia County EDs used specific chief complaint language to indicate over 30 visits between October 5 and November 5 that were possibly outbreak-associated. Additionally, ESSENCE-FL data were retrospectively reviewed to search for individuals presenting for care prior to the identification of the outbreak.
METHODS:
ESSENCE-FL queries were constructed to search for visits between May 21 and October 4, 2012. Chief complaint queries included headache, neck, back, or joint pain, altered mental status, abscess, meningitis and stroke. Resulting visits were reviewed for admissions that could be outbreak-associated. Once possible outbreak-related visits were identified, medical records from the admitted patients were obtained and abstracted for laboratory results, final diagnosis, and outcome. Names were cross-referenced with patient lists from clinics who received NECC product.
RESULTS:
Eight chief complaint queries returned over 200 visits in the given time frame. Chief complaints and (when available) discharge diagnoses were reviewed for possible links with contaminated injections. For example, if a chief complaint of “back pain” had a discharge diagnosis of “meningitis”, it was added to the follow-up, while a discharge diagnosis of “accidental fall” was excluded. For one-word chief complaints like “headache,” a sample of visits were randomly selected for follow-up. Fifty-six medical records were requested and abstracted. No visits before October 4 were found to be outbreak associated, and no names from the review matched names of patients from the implicated clinics.
CONCLUSIONS:
ESSENCE-FL ED chief complaint data assisted in timely outbreak monitoring, and retrospective review showed no unrecognized ED visits due to contaminated injections. Retrospective case identification was more difficult when discharge diagnosis was unavailable through ESSENCE-FL, as discharge diagnosis was especially useful when chief complaints were common or vague. ESSENCE-FL allowed investigators to quickly create queries, review data retrospectively and in real time, and identify visits for further review during a complex, large-scale outbreak investigation.