Using Syndromic Surveillance Data to Monitor Endocarditis and Sepsis among Drug Users

Lana Deyneka, Anne Hakenewerth, Zachary Faigen, Amy Ising, Clifton Barnett


ObjectiveTo describe how the state syndromic surveillance system(NC DETECT) was used to initiate near real time surveillance forendocarditis, sepsis and skin infection among drug users.IntroductionRecreational drug use is a major problem in the United States andaround the world. Specifically, drug abuse results in heavy use ofemergency department (ED) services, and is a high financial burdento society and to the hospitals due to chronic ill health and multipleinjection drug use complications. Intravenous drug users are at highrisk of developing sepsis and endocarditis due to the use of a dirty orinfected needle that is either shared with someone else or re-used. Itcan also occur when a drug user repeatedly injects into an inflamedand infected site or due to the poor overall health of an injection druguser. The average cost of hospitalization for aortic valve replacementin USA is about $165,000, and in order for the valve replacement tobe successful, patients must abstain from using drugs.MethodsWe examined temporal trends of drug-related visits to hospitalEDs, as well as drug-related related ED admissions complicated withendocarditis, bacteremia and sepsis.ResultsThe trends in Endocarditis/Sepsis and drug-related relatedadmissions appear to echo overdose related ED admissions increase.Patients ED return visits and hospitalizations for the same problem arealso growing compare to the previous years. We will discuss the NCDETECT case definition used to monitor drug overdose/dependenceand infection, case definition transition from ICD-9 to ICD-10 codes,and will share surveillance analysis results.ConclusionsNC DETECT’s system flexibility has been important in rapidlyestablishing surveillance of infections among drug users. Near realtime analysis on hospital, county and state levels can be performedusing NC DETECT system reports to provide state officials, hospitalsand LHDs with situational awareness. Limitations: Syndromicsurveillance ED data contains less accurate information about thediagnosis codes, procedures, length of stay, and severity comparingto the hospital discharge data.

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Online Journal of Public Health Informatics * ISSN 1947-2579 *