title: National and Regional Representativeness of Hospital Emergency Department Visit Data in the National Syndromic Surveillance Program, United States, 2014.
abstract: We examined the representativeness of the nonfederal hospital emergency department (ED) visit data in the National Syndromic Surveillance Program (NSSP).
  
  
  
  We used the 2012 American Hospital Association Annual Survey Database, other databases, and information from state and local health departments participating in the NSSP about which hospitals submitted data to the NSSP in October 2014. We compared ED visits for hospitals submitting data with all ED visits in all 50 states and Washington, DC.
  
  
  
  Approximately 60.4 million of 134.6 million ED visits nationwide (~45%) were reported to have been submitted to the NSSP. ED visits in 5 of 10 regions and the majority of the states were substantially underrepresented in the NSSP. The NSSP ED visits were similar to national ED visits in terms of many of the characteristics of hospitals and their service areas. However, visits in hospitals with the fewest annual ED visits, in rural trauma centers, and in hospitals serving populations with high percentages of Hispanics and Asians were underrepresented.
  
  
  
  NSSP nonfederal hospital ED visit data were representative for many hospital characteristics and in some geographic areas but were not very representative nationally and in many locations. Representativeness could be improved by increasing participation in more states and among specific types of hospitals. (Disaster Med Public Health Preparedness. 2016;10:562-569).
authors.affiliation: 1Center for Surveillance,Epidemiology and Laboratory Services,Centers for Disease Control and Prevention,Atlanta,Georgia.
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Coates
authors.affiliation: 1Center for Surveillance,Epidemiology and Laboratory Services,Centers for Disease Control and Prevention,Atlanta,Georgia.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Pérez
authors.affiliation: 2Department of Public Health - Seattle & King County,Seattle,Washington.
authors.forename: Atar
authors.initials: A
authors.lastname: Baer
authors.affiliation: 1Center for Surveillance,Epidemiology and Laboratory Services,Centers for Disease Control and Prevention,Atlanta,Georgia.
authors.forename: Hong
authors.initials: H
authors.lastname: Zhou
authors.affiliation: 1Center for Surveillance,Epidemiology and Laboratory Services,Centers for Disease Control and Prevention,Atlanta,Georgia.
authors.forename: Roseanne
authors.initials: R
authors.lastname: English
authors.affiliation: 1Center for Surveillance,Epidemiology and Laboratory Services,Centers for Disease Control and Prevention,Atlanta,Georgia.
authors.forename: Michael
authors.initials: M
authors.lastname: Coletta
authors.affiliation: 1Center for Surveillance,Epidemiology and Laboratory Services,Centers for Disease Control and Prevention,Atlanta,Georgia.
authors.forename: Achintya
authors.initials: A
authors.lastname: Dey
mesh_terms: D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D011159:Population Surveillance / Q000379:methods*; D012107:Research Design / Q000592:standards*; D013577:Syndrome; D014481:United States
keywords: public health preparedness; situational awareness; syndromic surveillance