title: Emergency department surveillance as a proxy for the prediction of circulating respiratory viral disease in Eastern Ontario.
abstract: BACKGROUND
  Seasonal outbreaks of winter respiratory viruses are responsible for increases in morbidity and mortality in the community. Previous studies have used hospitalizations, intensive care unit and emergency department (ED) visits as indicators of seasonal influenza incidence.
  
  
  OBJECTIVE
  To evaluate whether ED visits can be used as a proxy to detect respiratory viral disease outbreaks, as measured by laboratory confirmation.
  
  
  METHODS
  An Emergency Department Syndromic Surveillance system was used to collect ED chief complaints in Eastern Ontario from 2006 to 2010. Comparable laboratory-confirmed cases of respiratory viral infections were collected from the Public Health Ontario Laboratory in Kingston, Ontario. Correlations between ED visits and laboratory-confirmed cases were calculated.
  
  
  RESULTS
  Laboratory-confirmed cases of selected respiratory viruses were significantly correlated with ED visits for respiratory and fever/influenza-like illness. In particular, respiratory syncytial virus (Spearman's rho = 0.593), rhinovirus (Spearman's rho = 0.280), influenza A (Spearman's rho = 0.528), influenza B (Spearman's rho = 0.426) and pH1N1 (Spearman's rho = 0.470) increased laboratory test levels were correlated with increased volume of ED visits across a number of age demographics. For the entire study population and all studied viruses, the Spearman's rho was 0.702, suggesting a strong correlation with ED visits. Laboratory-confirmed cases lagged in reporting by between one and two weeks for influenza A and pH1N1 compared with ED visit volume.
  
  
  CONCLUSIONS
  These findings support the use of an Emergency Department Syndromic Surveillance system to track the incidence of respiratory viral disease in the community. These methods are efficient and can be performed using automated electronic data entry versus the inherent delays in the primary care sentinel surveillance system, and can aid the timely implementation of preventive and preparatory health interventions.
authors.affiliation: Department of Medicine, Queen's University.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Hall
authors.affiliation: Department of Pathology and Molecular Medicine, Queen's University.
authors.forename: Thomas
authors.initials: T
authors.lastname: Krahn
authors.forename: Adam
authors.initials: A
authors.lastname: Van Dijk
authors.affiliation: Department of Medicine, Queen's University.
authors.forename: Gerald
authors.initials: G
authors.lastname: Evans
authors.affiliation: Kingston, Frontenac, Lennox and Addington Public Health, Kingston, Ontario.
authors.forename: Kieran
authors.initials: K
authors.lastname: Moore
authors.affiliation: Kingston, Frontenac, Lennox and Addington Public Health, Kingston, Ontario.
authors.forename: Allison
authors.initials: A
authors.lastname: Maier
authors.forename: Anna
authors.initials: A
authors.lastname: Majury
keywords: Emergency department surveillance; Respiratory; Syndromic surveillance; Viral disease