1 Emergency Preparedness, Response, and Communicable Disease Surveillance, Tri-County Health Department, Greenwood Village, CO, USA.
2 Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Public Health Rep. 2019 Mar/Apr;134(2):132-140. doi: 10.1177/0033354919826562. Epub 2019 Feb 5.
In Colorado, legalization of recreational marijuana in 2014 increased public access to marijuana and might also have led to an increase in emergency department (ED) visits. We examined the validity of using syndromic surveillance data to detect marijuana-associated ED visits by comparing the performance of surveillance queries with physician-reviewed medical records.
We developed queries of combinations of marijuana-specific International Classification of Diseases, Tenth Revision (ICD-10) diagnostic codes or keywords. We applied these queries to ED visit data submitted through the Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE) syndromic surveillance system at 3 hospitals during 2016-2017. One physician reviewed the medical records of ED visits identified by ≥1 query and calculated the positive predictive value (PPV) of each query. We defined cases of acute adverse effects of marijuana (AAEM) as determined by the ED provider's clinical impression during the visit.
Of 44 942 total ED visits, ESSENCE queries detected 453 (1%) as potential AAEM cases; a review of 422 (93%) medical records identified 188 (45%) true AAEM cases. Queries using ICD-10 diagnostic codes or keywords in the triage note identified all true AAEM cases; PPV varied by hospital from 36% to 64%. Of the 188 true AAEM cases, 109 (58%) were among men and 178 (95%) reported intentional use of marijuana. Compared with noncases of AAEM, cases were significantly more likely to be among non-Colorado residents than among Colorado residents and were significantly more likely to report edible marijuana use rather than smoked marijuana use ( P < .001).
ICD-10 diagnostic codes and triage note keyword queries in ESSENCE, validated by medical record review, can be used to track ED visits for AAEM.
2014 年，科罗拉多州娱乐用大麻合法化增加了公众获取大麻的机会，这可能导致急诊部（ED）就诊人数增加。我们通过比较监测查询与医生审查的医疗记录，来检验使用症状监测数据检测与大麻相关的 ED 就诊的有效性。
我们开发了特定于大麻的国际疾病分类，第 10 版（ICD-10）诊断代码或关键词组合的查询。我们将这些查询应用于通过电子监测系统用于早期通知社区流行的综合征监测系统（ESSENCE）提交的 2016-2017 年 3 家医院的 ED 就诊数据。一名医生审查了至少一个查询识别的 ED 就诊的医疗记录，并计算了每个查询的阳性预测值（PPV）。我们将 ED 提供者在就诊期间的临床印象确定的急性大麻不良反应（AAEM）定义为病例。
在 44942 例总 ED 就诊中，ESSENCE 查询检测到 453 例（1%）可能为 AAEM 病例；对 422 例（93%）医疗记录的审查确定了 188 例（45%）真正的 AAEM 病例。在分诊记录中使用 ICD-10 诊断代码或关键词的查询识别出了所有真正的 AAEM 病例；PPV 因医院而异，范围为 36%至 64%。在 188 例真正的 AAEM 病例中，109 例（58%）为男性，178 例（95%）报告了故意使用大麻。与非 AAEM 病例相比，AAEM 病例中，非科罗拉多州居民明显多于科罗拉多州居民，且更有可能报告使用食用大麻而不是吸食大麻（P<0.001）。
ESSENCE 中的 ICD-10 诊断代码和分诊记录关键词查询通过医疗记录审查得到验证，可用于跟踪与 AAEM 相关的 ED 就诊。
