Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island.
Substance Use Epidemiology Program, Rhode Island Department of Health, Providence.
JAMA Netw Open. 2023 Jun 1;6(6):e2320789. doi: 10.1001/jamanetworkopen.2023.20789.
Health departments have used a variety of methods for overdose surveillance, and the Centers for Disease Control and Prevention (CDC) is implementing a standardized case definition to improve overdose surveillance nationally. The comparative accuracy of the CDC opioid overdose case definition vs existing state opioid overdose surveillance systems is unknown.
To evaluate the accuracy of the CDC opioid overdose case definition and existing Rhode Island Department of Health (RIDOH) state opioid overdose surveillance system.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study of ED opioid overdose visits was conducted at 2 EDs in Providence, Rhode Island, at the state's largest health system from January to May 2021. Electronic health records (EHRs) were reviewed for opioid overdoses identified by the CDC case definition and opioid overdoses reported to the RIDOH state surveillance system. Included patients were those at study EDs whose visit met the CDC case definition, was reported to the state surveillance system, or both. True overdose cases were confirmed by EHR review using a standard case definition; 61 of 460 EHRs (13.3%) were double reviewed to estimate classification accuracy. Data were analyzed from January through May 2021.
Accurate identification of an opioid overdose was assessed by estimating the positive predictive value of the CDC case definition and state surveillance system using results from the EHR review.
Among 460 ED visits that met the CDC opioid overdose case definition, were reported to the RIDOH opioid overdose surveillance system, or both (mean [SD] age, 39.7 [13.5] years; 313 males [68.0%]; 61 Black [13.3%], 308 White [67.0%], and 91 other race [19.8%]; and 97 Hispanic or Latinx [21.1%] among each patient visit), 359 visits (78.0%) were true opioid overdoses. For these visits, the CDC case definition and RIDOH surveillance system agreed that 169 visits (36.7%) were opioid overdoses. Of 318 visits meeting the CDC opioid overdose case definition, 289 visits (90.8%; 95% CI, 87.2%-93.8%) were true opioid overdoses. Of 311 visits reported to the RIDOH surveillance system, 235 visits (75.6%; 95% CI, 70.4%-80.2%) were true opioid overdoses.
This cross-sectional study found that the CDC opioid overdose case definition more often identified true opioid overdoses compared with the Rhode Island overdose surveillance system. This finding suggests that using the CDC case definition for opioid overdose surveillance may be associated with improved data efficiency and uniformity.
卫生部门已经使用了各种方法来进行过量用药监测，疾病控制与预防中心（CDC）正在实施标准化的病例定义，以在全国范围内改善过量用药监测。CDC 阿片类药物过量病例定义与现有州阿片类药物过量监测系统的比较准确性尚不清楚。
评估 CDC 阿片类药物过量病例定义和现有的罗德岛卫生署（RIDOH）州阿片类药物过量监测系统的准确性。
设计、地点和参与者：这是一项在罗德岛州普罗维登斯市的两家 ED 进行的 ED 阿片类药物过量就诊的横断面研究，在该州最大的医疗系统中，从 2021 年 1 月至 5 月进行。对符合 CDC 病例定义的阿片类药物过量和向 RIDOH 州监测系统报告的阿片类药物过量进行电子健康记录（EHR）审查。纳入的患者是在研究 ED 就诊的患者，其就诊符合 CDC 病例定义，或同时符合州监测系统的报告。通过使用标准病例定义的 EHR 审查来确认真实的过量用药病例；为了估计分类准确性，对 460 份 EHR 中的 61 份（13.3%）进行了双重审查。数据于 2021 年 1 月至 5 月进行分析。
通过使用 EHR 审查结果来估计 CDC 病例定义和州监测系统的阳性预测值，评估阿片类药物过量的准确识别。
在符合 CDC 阿片类药物过量病例定义、向 RIDOH 阿片类药物过量监测系统报告或同时符合这两种情况的 460 次 ED 就诊中（平均[标准差]年龄，39.7[13.5]岁；313 名男性[68.0%]；61 名黑人[13.3%]，308 名白人[67.0%]，91 名其他种族[19.8%]；每位患者就诊中有 97 名西班牙裔或拉丁裔[21.1%]），359 次就诊（78.0%）为真实的阿片类药物过量。对于这些就诊，CDC 病例定义和 RIDOH 监测系统均认为 169 次就诊（36.7%）为阿片类药物过量。在符合 CDC 阿片类药物过量病例定义的 318 次就诊中，289 次就诊（90.8%；95%CI，87.2%-93.8%）为真实的阿片类药物过量。在向 RIDOH 监测系统报告的 311 次就诊中，235 次就诊（75.6%；95%CI，70.4%-80.2%）为真实的阿片类药物过量。
这项横断面研究发现，与罗德岛州过量用药监测系统相比，CDC 阿片类药物过量病例定义更常识别真实的阿片类药物过量。这一发现表明，使用 CDC 病例定义进行阿片类药物过量监测可能与提高数据效率和一致性有关。
