@article{Olson_van der Mei_Lim_Yoon_Kull_Davila_2017, title={Monitoring child mental health related emergency department visits in New York City}, volume={9}, url={https://ojphi.org/ojs/index.php/ojphi/article/view/7720}, DOI={10.5210/ojphi.v9i1.7720}, abstractNote={<div style="left: 78.2727px; top: 296.356px; font-size: 12.3207px; font-family: sans-serif; transform: scaleX(1.0823);" data-canvas-width="55.467823232323234">Objective</div><div style="left: 91.3182px; top: 309.359px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.96349);" data-canvas-width="330.50912752525244">To assess the use of syndromic surveillance to assess trends in</div><div style="left: 78.2727px; top: 323.854px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02216);" data-canvas-width="344.94653207070695">mental health-related emergency department (ED) visits among</div><div style="left: 78.2727px; top: 338.349px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00518);" data-canvas-width="315.82900505050515">school-aged children and adolescents in New York City (NYC).</div><div style="left: 78.2727px; top: 365.932px; font-size: 12.3207px; font-family: sans-serif; transform: scaleX(1.11884);" data-canvas-width="71.86668434343434">Introduction</div><div style="left: 91.3182px; top: 378.935px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.976849);" data-canvas-width="330.4191863636365">From 2001-2011, mental health-related hospitalizations and ED</div><div style="left: 78.2727px; top: 393.43px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.994879);" data-canvas-width="342.02282828282824">visits increased among United States children nationwide [1]. During</div><div style="left: 78.2727px; top: 407.925px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.03591);" data-canvas-width="345.20033863636354">this period, mental health-related hospitalizations among NYC</div><div style="left: 78.2727px; top: 422.42px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00651);" data-canvas-width="342.39737777777776">children increased nearly 23% [2]. To estimate mental health-related</div><div style="left: 78.2727px; top: 436.915px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00593);" data-canvas-width="342.4195550505051">ED visits in NYC and assess the use of syndromic surveillance chief</div><div style="left: 78.2727px; top: 451.41px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.04424);" data-canvas-width="343.3103421717171">complaint data to monitor these visits, we compared trends from a</div><div style="left: 78.2727px; top: 465.905px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.99295);" data-canvas-width="341.9390474747475">near real-time syndromic system with those from a less timely, coded</div><div style="left: 78.2727px; top: 480.4px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00145);" data-canvas-width="89.31280555555556">ED visit database.</div><div style="left: 78.2727px; top: 507.983px; font-size: 12.3207px; font-family: sans-serif; transform: scaleX(1.07424);" data-canvas-width="50.65042676767676">Methods</div><div style="left: 91.3182px; top: 520.985px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.990021);" data-canvas-width="328.8519924242422">The NYC ED syndromic surveillance system receives anonymized</div><div style="left: 78.2727px; top: 535.48px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.01279);" data-canvas-width="342.662272979798">patient chief complaint and basic demographic data for nearly every</div><div style="left: 78.2727px; top: 549.975px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00998);" data-canvas-width="344.5362525252525">ED visit citywide to provide timely surveillance information to</div><div style="left: 78.2727px; top: 564.47px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02073);" data-canvas-width="345.04016944444453">health authorities. Using NYC ED syndromic surveillance data</div><div style="left: 78.2727px; top: 578.965px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.985045);" data-canvas-width="343.74772727272716">from 2003-2015, we applied previously developed definitions for</div><div style="left: 78.2727px; top: 593.46px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00167);" data-canvas-width="344.474648989899">general psychiatric syndromes. We aggregated ED visits by age</div><div style="left: 78.2727px; top: 607.955px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.96719);" data-canvas-width="343.6910520202019">group (5-12 years, 13-17 years, and 18-20 years), geography, and</div><div style="left: 78.2727px; top: 622.45px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.991706);" data-canvas-width="341.82446489898956">temporality. Syndromic data were compared with Statewide Planning</div><div style="left: 78.2727px; top: 636.945px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.0026);" data-canvas-width="342.1866936868687">and Research Collaborative System (SPARCS) data from 2006-2014</div><div style="left: 78.2727px; top: 651.44px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02166);" data-canvas-width="343.1748143939392">which reported mental health diagnosis (ICD-9), treatment, service,</div><div style="left: 78.2727px; top: 665.935px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.99824);" data-canvas-width="342.16328434343427">and basic demographics for patients visiting facilities in NYC. Using</div><div style="left: 78.2727px; top: 680.43px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.01947);" data-canvas-width="342.8310666666666">these two data sources, we compared daily visit patterns and annual</div><div style="left: 78.2727px; top: 694.925px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02619);" data-canvas-width="342.98630757575756">trends overall as well as stratified by age group, area-based poverty</div><div style="left: 78.2727px; top: 709.42px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00139);" data-canvas-width="142.69842929292932">(ZIP code), and time of visit.</div><div style="left: 78.2727px; top: 737.003px; font-size: 12.3207px; font-family: sans-serif; transform: scaleX(1.08542);" data-canvas-width="44.50239393939395">Results</div><div style="left: 91.3182px; top: 750.006px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.01789);" data-canvas-width="329.6762477272728">Both syndromic surveillance and SPARCS data for NYC showed</div><div style="left: 78.2727px; top: 764.501px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.961229);" data-canvas-width="343.3510005050506">an increasing trend during the period. While both showed relative</div><div style="left: 78.2727px; top: 778.996px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02491);" data-canvas-width="342.8840457070709">increases with similar slopes, mental health-related chief complaint</div><div style="left: 78.2727px; top: 793.491px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.969682);" data-canvas-width="343.6393050505051">data captured fewer overall visits than the ICD-9 coded SPARCS</div><div style="left: 78.2727px; top: 807.985px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.962246);" data-canvas-width="339.12746212121203">data. Trends in syndromic data during 2003-2015 differed by age-</div><div style="left: 78.2727px; top: 822.48px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02455);" data-canvas-width="342.9838434343435">group and area-based poverty, e.g., among children ages 5-12 years</div><div style="left: 78.2727px; top: 836.975px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.966259);" data-canvas-width="343.48899242424255">the annual proportion of mental health-related ED visits increased</div><div style="left: 78.2727px; top: 851.47px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.04423);" data-canvas-width="342.941953030303">roughly 3-fold from 1.2% to 3.8% in the poorest areas, which was</div><div style="left: 78.2727px; top: 865.965px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.977994);" data-canvas-width="341.564497979798">greater than the increase in the richest areas (1.7% to 2.6%). Seasonal,</div><div style="left: 78.2727px; top: 880.46px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.975573);" data-canvas-width="341.7271313131313">day-of-week, and school holiday patterns found far fewer visits during</div><div style="left: 78.2727px; top: 894.955px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00133);" data-canvas-width="247.74477777777773">the periods of NYC public school breaks (Figure).</div><div style="left: 78.2727px; top: 922.538px; font-size: 12.3207px; font-family: sans-serif; transform: scaleX(1.10408);" data-canvas-width="73.93656313131314">Conclusions</div><div style="left: 91.3182px; top: 935.541px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.01612);" data-canvas-width="331.7461265151515">We conclude that syndromic surveillance data can provide a</div><div style="left: 78.2727px; top: 950.036px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.990139);" data-canvas-width="344.18880858585845">reliable indicator of mental health-related ED visit trends. These</div><div style="left: 78.2727px; top: 964.531px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02895);" data-canvas-width="342.84461944444445">findings suggest potential benefit of syndromic surveillance data as</div><div style="left: 78.2727px; top: 979.026px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02147);" data-canvas-width="342.823674242424">they may help capture temporal and spatial clustering of events in a</div><div style="left: 78.2727px; top: 993.521px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.03901);" data-canvas-width="343.13169191919184">much more timely manner than the >1 year delay in availability of</div><div style="left: 78.2727px; top: 1008.02px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.0277);" data-canvas-width="342.90991919191936">ED discharge data. Next steps include a qualitative study exploring</div><div style="left: 78.2727px; top: 1022.51px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.945136);" data-canvas-width="343.13169191919184">the causes of these patterns and the role of various factors driving</div><div style="left: 78.2727px; top: 1037.01px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.0036);" data-canvas-width="342.3123648989901">them, as well as use of patient disposition and matched data to better</div>characterize ED visit patient outcomes.}, number={1}, journal={Online Journal of Public Health Informatics}, author={Olson, Don and van der Mei, Willem and Lim, Sungwoo and Yoon, Carol and Kull, Melissa and Davila, Marivel}, year={2017}, month={May} }