title: Assessing syndromic surveillance of cardiovascular outcomes from emergency department chief complaint data in New York City.
abstract: BACKGROUND
  Prospective syndromic surveillance of emergency department visits has been used for near-real time tracking of communicable diseases to detect outbreaks or other unexpected disease clusters. The utility of syndromic surveillance for tracking cardiovascular events, which may be influenced by environmental factors and influenza, has not been evaluated. We developed and evaluated a method for tracking cardiovascular events using emergency department free-text chief complaints.
  
  
  RESULTS
  There were three phases to our analysis. First we applied text processing algorithms based on sensitivity, specificity, and positive predictive value to chief complaint data reported by 11 New York City emergency departments for which ICD-9 discharge diagnosis codes were available. Second, the same algorithms were applied to data reported by a larger sample of 50 New York City emergency departments for which discharge diagnosis was unavailable. From this more complete data, we evaluated the consistency of temporal variation of cardiovascular syndromic events and hospitalizations from 76 New York City hospitals. Finally, we examined associations between particulate matter ≤2.5 µm (PM(2.5)), syndromic events, and hospitalizations. Sensitivity and positive predictive value were low for syndromic events, while specificity was high. Utilizing the larger sample of emergency departments, a strong day of week pattern and weak seasonal trend were observed for syndromic events and hospitalizations. These time-series were highly correlated after removing the day-of-week, holiday, and seasonal trends. The estimated percent excess risks in the cold season (October to March) were 1.9% (95% confidence interval (CI): 0.6, 3.2), 2.1% (95% CI: 0.9, 3.3), and 1.8% (95%CI: 0.5, 3.0) per same-day 10 µg/m(3) increase in PM(2.5) for cardiac-only syndromic data, cardiovascular syndromic data, and hospitalizations, respectively.
  
  
  CONCLUSIONS
  Near real-time emergency department chief complaint data may be useful for timely surveillance of cardiovascular morbidity related to ambient air pollution and other environmental events.
authors.affiliation: Bureau of Environmental Surveillance and Policy, New York City Department of Health and Mental Hygiene, New York, New York, United States of America. rmathes@health.nyc.gov
authors.forename: Robert W
authors.initials: RW
authors.lastname: Mathes
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Ito
authors.forename: Thomas
authors.initials: T
authors.lastname: Matte
mesh_terms: D000465:Algorithms; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D003625:Data Collection / Q000379:methods / Q000706:statistics & numerical data; D004630:Emergencies / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D038801:International Classification of Diseases / Q000592:standards / Q000706:statistics & numerical data; D009519:New York City / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D011159:Population Surveillance / Q000379:methods*; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013577:Syndrome