Katherine J. Harmon

The Epidemiology of Traumatic Brain Injuries Treated in Emergency Departments in North Carolina, 2010–2011

BACKGROUND Traumatic brain injuries (TBIs) are a leading cause of injury morbidity and mortality in the United States. An estimated 1.7 million TBIs occur each year, and TBIs may lead to severe lifelong disability and death; even mild-to-moderate TBIs may have long-term consequences. North Carolinas population-wide data on TBIs are limited, so it is important to analyze the available data regarding TBI-related emergency department (ED) visits. METHODS Statewide data on TBI-related ED visits were obtained from the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT), an electronic public health surveillance system. Counts and rates were produced by sex, age, county of residence, disposition, mode of transport, and mechanism of injury. RESULTS In 2010–2011, there were 140,234 TBI-related ED visits in North Carolina, which yields a rate of 7.3 ED visits per 1,000 person-years. The rate was higher for men (7.9 visits per 1,000 person-years) than for women (6.8 visits per 1,000 person-years). Rates were highest in individuals aged 0–4 years (13.1 visits per 1,000 person-years), 15–19 years (10.6 visits per 1,000 person-years), 75–79 years (11.3 visits per 1,000 person-years), 80–84 years (17.9 visits per 1,000 person-years), and 85 years or older (30.6 visits per 1,000 person-years). TBI-related ED visits were principally the result of falls (39.0%), being struck by a person or object (17.6%), or motor vehicle traffic–related crashes (14.1%). LIMITATIONS This study used data collected primarily for administrative purposes, such as hospital billing. CONCLUSIONS TBIs are a common cause of ED visits in North Carolina. These descriptive statistics demonstrate needs for statewide ED surveillance to monitor the incidence of TBIs and for the development of prevention strategies.

Use of syndromic surveillance data to monitor poisonings and drug overdoses in state and local public health agencies

Background The incidence of poisoning and drug overdose has risen rapidly in the USA over the last 16 years. To inform local intervention approaches, local health departments (LHDs) in North Carolina (NC) are using a statewide syndromic surveillance system that provides timely, local emergency department (ED) and Emergency Medical Services (EMS) data on medication and drug overdoses. Objective The purpose of this article is to describe the development and use of a variety of case definitions for poisoning and overdose implemented in NCs syndromic surveillance system and the impact of the system on local surveillance initiatives. Design, setting, participants Thirteen new poisoning and overdose-related case definitions were added to NCs syndromic surveillance system and LHDs were trained on their use for surveillance purposes. Twenty-one LHDs were surveyed on the utility and impact of these new case definitions. Results/Conclusions Ninety-one per cent of survey respondents (n = 29) agreed or strongly agreed that their ability to access timely ED data was vital to inform community-level overdose prevention work. Providing LHDs with access to local, timely data to identify pockets of need and engage stakeholders facilitates the practice of informed injury prevention and contributes to the reduction of injury incidence in their communities.

Utilization of Emergency Department Data for Drug Overdose Surveillance in North Carolina

The United States is in the midst of a drug overdose epidemic, primarily due to opioid analgesics. Emergency department data are an important source of morbidity data for public health surveillance. This population-based study will describe visits to North Carolina emergency departments for drug, and more specifically, opioid overdoses.

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

INTRODUCTION 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). METHODS 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. RESULTS 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. CONCLUSIONS 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.

Begin risk assessment for falls in women at 45, not 65

The clinical and epidemiological literature provides guidelines for fall prevention starting at age 65; however, the focus on age ≥65 is not evidence based. Therefore, this study examined state-wide North Carolina emergency department visit data to examine the characteristics of falls across the age spectrum, identify the age at which the incidence of fall-related emergency department visits started to increase and determine whether these trends were similar for men and women. We determined that incidence rates of fall-related emergency department visits began to increase in early middle age, particularly for women. Since fall risk assessment and prevention activities should be initiated prior to an injurious fall, we recommend beginning these activities before age 65.

Lessons Learned from the Transition to ICD-10-CM: Redefining Syndromic Surveillance Case Definitions for NC DETECT

On October 1, 2015, all US hospitals will be required to transition from using ICD-9-CM codes to ICD-10-CM codes for billing and administrative purposes. This study describes the lessons learned from a statewide syndromic surveillance system, NC DETECT, for handling the transition. This study describes the updating of existing surveillance case definitions to ICD-10-CM, the development of new ICD-10-CM case definitions, the challenges and rewards of the transition to ICD-10-CM, and an assessment of the updated case definitions used in syndromic surveillance of emergency department data.

Motorcycle crash-related emergency department visits and hospitalizations for traumatic brain injury in North Carolina.

Objective:To examine statewide emergency department (ED) visit data for motorcycle crash morbidity and healthcare utilization due to traumatic brain injuries (TBIs) and non-TBIs. Setting:North Carolina ED data (2010-2012) and hospital discharge data (2009-2011). Population:Statewide ED visits and hospitalizations due to injuries from traffic-related motorcycle crashes stratified by TBI status. Design:Descriptive study. Main Measures:Descriptive statistics include age, sex, mode of transport, disposition, expected source of payment, hospital length of stay, and hospital charges. Results:Over the study period, there were 18 780 ED visits and 3737 hospitalizations due to motorcycle crashes. Twelve percent of ED visits for motorcycle crashes and 26% of hospitalizations for motorcycle crashes had a diagnosis of TBI. Motorcycle crash-related hospitalizations with a TBI diagnosis had median hospital charges that were nearly

Use of diagnosis codes for detection of clinically significant opioid poisoning in the emergency department: A retrospective analysis of a surveillance case definition

9000 greater than hospitalizations without a TBI diagnosis. Conclusions:Emergency department visits and hospitalizations due to motorcycle crashes with a TBI diagnosis consumed more healthcare resources than motorcycle crash-related ED visits and hospitalizations without a TBI diagnosis. Increased awareness of motorcyclists by other road users and increased use of motorcycle helmets are 2 strategies to mitigate the incidence and severity of motorcycle crash injuries, including TBIs.