BACKGROUND: In New Jersey, emergency department (ED) data are received from EDs by Health Monitoring Systems Inc.’s (HMS) EpiCenter, which collects, manages and analyzes ED registration data for syndromic surveillance, and provides alerts to health departments for surveillance anomalies. EpiCenter receives chief complaint data from 78 of 80 EDs. The need for more specific information raises the possibility that other data elements such as triage notes can be of utility in detecting outbreaks. This study evaluates triage notes in EpiCenter to detect a recent increase in synthetic cannabinoids usage. At the time of this evaluation, three hospitals were providing triage notes.
METHODS: In April 2015, the New Jersey Poison Information and Education System (NJPIES) reported an increase in calls to their center regarding synthetic cannabinoid reactions in ED patients. This increase in calls resembled an outbreak, so the Department of Health (DOH) staff used the opportunity to compare chief complaints data from 78 EDs and triage notes data from 3 EDs to NJPIES call data. NJDOH created a custom classification using chief complaint data. Staff included the keywords black magic, black mamba, cloud 9, cloud 10, incense, k2, legal high, pot potpourri, spice, synthetic marijuana, voodoo doll, wicked x, and zombie which were obtained from the New York City Department of Health and Mental Hygiene. Staff also included the keywords agitation, k-2, moon rocks, seizure, skunk, and yucatan. NJDOH performed a text search using the same keywords in the triage notes from three EDs currently providing that data to evaluate the synthetic cannabinoid related ED visits.
RESULTS: Using the keywords, out of 50 NJPIES calls, 18 (36%) were identified via chief complaint data and 32 (64%) of the ED visits were not captured due to the non-specificity of the information. Of the 50 calls, 6 ED visits were admitted to hospitals that submitted triage notes data. Using the same keywords in a triage notes query, 5 (83 %) out of 6 ED visits were identified. Based on the chief complaints and triage notes from three EDs, triage notes were able to provide more information about synthetic cannabinoid related ED visits between March 27 and May 16, 2015.
CONCLUSIONS: Review of NJPIES calls suggests that triage notes included more specific keywords. Additional data is expected to lead to earlier detection of health events like Ebola and drug overdose. Currently, NJDOH and HMS have been working with 9 EDs to submit additional data to EpiCenter.