Impact of Extreme Heat Events on Emergency Department Visits in North Carolina (2007–2011)

Extreme heat is the leading cause of w eather-related mortality in the U.S. Extreme heat also affects human health through heat stress and can exacerbate underlying medical conditions that lead to increased morbidity and mortality. In this study, data on emergency department (ED) visits for heat-related illness (HRI) and other selected diseases were analyzed during three heat events across North Carolina from 2007 to 2011. These heat events were identified based on the issuance and verification of heat products from local National Weather Service forecast offices (i.e. Heat Advisory, Heat Watch, and Excessive Heat Warning). The observed number of ED visits during these events were compared to the expected number of ED visits during several control periods to determine excess morbidity resulting from extreme heat. All recorded diagnoses were analyzed for each ED visit, thereby providing insight into the specific pathophysiological mechanisms and underlying health conditions associated with exposure to extreme heat. The most common form of HRI was heat exhaustion, while the percentage of visits with heat stroke was relatively low (65 years of age) were at greatest risk for HRI during the early summer heat event (8.9 visits per 100,000), while young and middle age adults (18–44 years of age) were at greatest risk during the mid-summer event (6.3 visits per 100,000). Many of these visits were likely due to work-related exposure. The most vulnerable demographic during the late summer heat event was adolescents (15–17 years of age), which may relate to the timing of organized sports. This demographic also exhibited the highest visit rate for HRI among all three heat events (10.5 visits per 100,000). Significant increases (p < 0.05) in visits with cardiovascular and cerebrovascular diseases were noted during the three heat events (3–8 %). The greatest increases were found in visits with hypotension during the late summer event (23 %) and sequelae during the early summer event (30 %), while decreases were noted for visits with hemorrhagic stroke during the middle and late summer events (13–24 %) and for visits with aneurysm during the early summer event (15 %). Significant increases were also noted in visits with respiratory diseases (5–7 %). The greatest increases in this category were found in visits with pneumonia and influenza (16 %), bronchitis and emphysema (12 %), and COPD (14 %) during the early summer event. Significant increases in visits with nervous system disorders were also found during the early summer event (16 %), while increases in visits with diabetes were noted during the mid-summer event (10 %)

EMS injury cause codes more accurate than emergency department visit ICD-10-CM codes for firearm injury intent in North Carolina

Background The timeliness, accuracy, and completeness of data for firearm injury surveillance is crucial for public health surveillance efforts and informing injury prevention measures. While emergency department (ED) visit data can provide near real-time information on firearms injuries, there are concerns surrounding the accuracy of intent coding in these data. We examined whether emergency medical service (EMS) data provide more accurate firearm injury intent coding in comparison to ED data. Methods We applied a firearm injury definition to EMS encounter data in NC’s statewide syndromic surveillance system (NC DETECT), from January 1, 2021, through December 31, 2022. We manually reviewed each record to determine intent, and the corresponding manual classifications were compared to the injury cause codes entered in the EMS data and to ED visit records where EMS-ED record linkage was possible. We then calculated the sensitivity, specificity, positive and negative predictive values for each intent classification in SAS 9.4 using the manually reviewed intent classifications as the gold standard. Results We identified 9557 EMS encounters from January 1, 2021, through December 31, 2022 meeting our firearm injury definition. After removing false positives and duplicates, 8584 records were available for manual injury classification. Overall, our analysis demonstrated that manual and EMS injury cause code classifications were comparable. However, for the 3401 EMS encounters that could be linked to an ED visit record, sensitivity of the ED ICD-10-CM codes was low for assault and intentional self-harm encounters at 18.2% (CI 16.5–19.9%) and 22.2% (CI 16–28.5%), respectively. This demonstrates a marked difference in the reliability of the intent coding in the two data sources. Conclusions This study illustrates both the value of examining EMS encounters for firearm injury intent, and the challenges of accurate intent coding in the ED setting. EMS coding has the potential for more accurate intent coding than ED coding within the context of existing hospital-based coding guidance. This may have implications for future firearm injury research, especially for nonfatal firearm injuries

Linking Emergency Medical Services and Emergency Department Data to Improve Overdose Surveillance in North Carolina

Introduction Linking emergency medical services (EMS) data to emergency department (ED) data enables assessing the continuum of care and evaluating patient outcomes. We developed novel methods to enhance linkage performance and analysis of EMS and ED data for opioid overdose surveillance in North Carolina. Methods We identified data on all EMS encounters in North Carolina during January 1–November 30, 2017, with documented naloxone administration and transportation to the ED. We linked these data with ED visit data in the North Carolina Disease Event Tracking and Epidemiologic Collection Tool. We manually reviewed a subset of data from 12 counties to create a gold standard that informed developing iterative linkage methods using demographic, time, and destination variables. We calculated the proportion of suspected opioid overdose EMS cases that received International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes for opioid overdose in the ED. Results We identified 12 088 EMS encounters of patients treated with naloxone and transported to the ED. The 12-county subset included 1781 linkage-eligible EMS encounters, with historical linkage of 65.4% (1165 of 1781) and 1.6% false linkages. Through iterative linkage methods, performance improved to 91.0% (1620 of 1781) with 0.1% false linkages. Among statewide EMS encounters with naloxone administration, the linkage improved from 47.1% to 91.1%. We found diagnosis codes for opioid overdose in the ED among 27.2% of statewide linked records. Practice Implications Through an iterative linkage approach, EMS–ED data linkage performance improved greatly while reducing the number of false linkages. Improved EMS–ED data linkage quality can enhance surveillance activities, inform emergency response practices, and improve quality of care through evaluating initial patient presentations, field interventions, and ultimate diagnoses

Emergency Department Visits by Patients with Mental Health Disorders — North Carolina, 2008–2010

Patients with mental health disorders (MHDs) use the emergency department (ED) for acute psychiatric emergencies, for injuries and illnesses complicated by or related to their MHD, or when psychiatric or primary-care options are inaccessible or unavailable. An estimated 5% of ambulatory-care visits in the United States during 2007-2008 were made by patients with primary mental health diagnoses. To measure the incidence of ED visits in North Carolina with MHD diagnostic codes (MHD-DCs), the Carolina Center for Health Informatics (University of North Carolina at Chapel Hill) analyzed ED visits occurring during the period 2008-2010 captured by the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT). This report describes the results of that analysis, which indicated that nearly 10% of ED visits had one or more MHD-DCs assigned to the visit and the rate of MHD-DC-related ED visits increased seven times as much as the overall rate of ED visits in North Carolina during the study period. Those with an MHD-DC were admitted to the hospital from the ED more than twice as often as those without MHD-DCs. Stress, anxiety, and depression were diagnosed in 61% of MHD-DC-related ED visits. The annual rate of MHD-DC-related ED visits for those aged ≥65 years was nearly twice the rate of those aged 25-64 years; half of those aged ≥65 years with MHD-DCs were admitted to the hospital from the ED. Mental health is an important component of public health (4). Surveillance is needed to describe trends in ED use for MHDs to develop strategies to prevent hospitalization, improve access to ambulatory care, and develop new ways to provide ED care for the elderly with MHDs

Racial and ethnic disparities in motor vehicle crash-related outcomes in North Carolina surrounding the COVID-19 pandemic

Long-term impacts of the COVID-19 pandemic on racial and ethnic disparities in motor vehicle crash (MVC) injuries and death are poorly understood. This study aimed to characterize trends and investigate the heterogeneity of MVC-related disparities in North Carolina across several data sources. Crash reports, emergency department visit records, and death certificates from 2018 to 2021 were used to calculate monthly population-rates of MVC-related public health outcomes. We estimated trendlines using joinpoint regression and compared outcomes across racial and ethnic classifications. MVC and MVC-related injury rates declined in conjunction with NC’s stay-at-home order, while rates of severe outcomes remained unimpacted. By December 2021 rates of MVC-related outcomes met or exceeded pre-pandemic levels, with the highest rates observed among non-Hispanic Black individuals. Racial and ethnic disparities in MVC-related outcomes remained prevalent throughout the COVID-19 pandemic. These results highlight the importance of a holistic approach to traffic injury surveillance when assessing the impact of MVCs

Improvements in Timeliness Resulting from Implementation of Electronic Laboratory Reporting and an Electronic Disease Surveillance System

Electronic laboratory reporting (ELR) reduces the time between communicable disease diagnosis and case reporting to local health departments (LHDs). However, it also imposes burdens on public health agencies, such as increases in the number of unique and duplicate case reports. We assessed how ELR affects the timeliness and accuracy of case report processing within public health agencies

Influence of Urbanicity and County Characteristics on the Association between Ozone and Asthma Emergency Department Visits in North Carolina

Background: Air pollution epidemiologic studies, often conducted in large metropolitan areas because of proximity to regulatory monitors, are limited in their ability to examine potential associations between air pollution exposures and health effects in rural locations

Primary Care Availability and Emergency Department Use by Older Adults: A Population-Based Analysis

To assess the relationship between the number of primary care providers (PCPs) in an area and emergency department (ED) visits by older adults

Population-based burden of COPD-related visits in the ED: Return ED visits, hospital admissions, and comorbidity risks

Little is known about the population-based burden of ED care for COPD

A Potent and Selective Inhibitor of Cdc42 GTPase

Cdc42, a member of the Rho family of GTPases, has been shown to play a role in cell adhesion, cytoskeletal arrangement, phagocytosis and cell motility and migration, in addition to a host of other diverse biological processes. The function of Rho-family GTPases in disease pathogenesis has been well established and identification of small, cell permeable molecules that selectively and reversibly regulate Rho GTPases is of high scientific and potentially therapeutic interest. There has been limited success in identifying inhibitors that specifically interact with small Rho family GTPases. The identified probe, ML141 (CID-2950007), is demonstrated to be a potent, selective and reversible non-competitive inhibitor of Cdc42 GTPase suitable for in vitro assays, with low micromolar potency and selectivity against other members of the Rho family of GTPases (Rac1, Rab2, Rab7). Given the highly complementary nature of the function of the Rho family GTPases, Cdc42 selective inhibitors such as those reported here should help untangle the roles of the proteins in this family