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BACKGROUND: National studies estimate that Respiratory Syncytial Virus (RSV) is responsible for one in 38 emergency department (ED) visits for children <5. CSTE position statement (13-ID-07): “RSV-Associated Pediatric Mortality” advocates for improved RSV surveillance including monitoring of RSV-associated pediatric mortality and hospitalizations to establish prevaccine baselines to evaluate vaccine effectiveness should one become available. This analysis determines whether syndromic data accessed via ESSENCE-FL can monitor RSV and RSV-associated hospitalizations in children <5 in a timely way. Hospitalization data (both visits to EDs and inpatient hospitalizations) on children <5 with RSV infection are recorded but available only after long (3-9 months) delay through the Florida Agency for Healthcare Administration (AHCA) hospital discharge data set. This delay hinders timely evidence-based decision making about health promotion and pre-approval of prophylactic treatment to those at greater risk of severe health outcomes from RSV infection.
METHODS: The AHCA hospital discharge data were queried for ED visits and hospital admissions from 2010-2013 for children <5 diagnosed with RSV (ICD9-CM Code: 079.6, 466.11 or 480.1). RSV related visits were identified via ESSENCE-FL by querying ED visits from 2010-2013 to children<5 with “RSV,” “bronchiolitis,” or “syncytial” listed in their discharge diagnosis or chief complaints. Chief complaint and discharge diagnosis ESSENCE-FL queries were compared to AHCA hospital discharge data to determine best match for season onset, peak and end.
RESULTS: In the ACHA data, 52,240 children <5 were identified who were either admitted or visited the ED at Florida hospitals with RSV. In ESSENCE-FL 23,208 visits from children<5 to EDs with a discharge diagnosis of RSV were identified. Trend analysis showed that despite accounting for less than half of the children diagnosed with RSV in the AHCA data, ED visits to children <5 with discharge diagnoses of RSV identified in ESSENCE-FL followed similar patterns for both timing and volume of the children <5 with RSV recorded in the ACHA hospital discharge data.
CONCLUSIONS: These analyses found that, ESSENCE-FL can be used as a proxy to effectively monitor RSV in children<5 in Florida. While complete, the 3-9 month hospital discharge data delays do not support timely decision-making during RSV season. Furthermore, ESSENCE-FL can be a predictive tool to approximate the number of children <5 admitted to the ED in an at-risk population. The methods described here can be used by other states to evaluate the quality of their syndromic surveillance systems for the timely monitoring of RSV activity.