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ISDS Annual Conference Proceedings 2012. This is an Open Access article distributed under the terms of the Creative Commons Attribution-
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ISDS 2012 Conference Abstracts

Using Syndromic Emergency Department Data to
Augment Oral Health Surveillance
John P. Jasek*1, Nicole Hosseinipour1, Talia Rubin1 and Ramona Lall2

1NYC Department of Health and Mental Hygiene, Bureau of Health Care Access and Planning, Long Island City, NY, USA; 2NYC
Department of Health and Mental Hygiene, Bureau of Communicable Diseases, Long Island City, NY, USA

Objective
To utilize an established syndromic reporting system for surveil-

lance of potentially preventable emergency department (ED) oral
health visits (OHV) in New York City (NYC).

Introduction
NYC Department of Health and Mental Hygiene recently reori-

ented its oral health care strategy to focus on health promotion and ex-
panded surveillance. One surveillance challenge is the lack of timely
OHV data; few dental providers are in our electronic health record
project, and statewide utilization data are subject to delays. Prior re-
search has examined OHV using ICD-9-CM from ED records, and
has suggested that diagnostic specificity may be limited by ED
providers’ lack of training in dental diagnoses (1-3). We considered
our existing ED syndromic system as a complement to periodic pop-
ulation-based surveys. This system captures approximately 95% of all
ED visits citywide; 98% of records have a completed chief complaint
text field whereas only 52% contain an ICD-9-CM diagnosis.

Methods
We used chief complaint text to define OHV in two ways: (1) a

basic definition comprised of ‘TOOTH’ or ‘GUM’ in combination
with a pain term (e.g., ‘ACHE’); (2) a more inclusive definition of ei-
ther specific oral health diagnoses (e.g., ‘PULPITIS’) or definition
(1). For both definitions, we excluded visits likely to have stemmed
from trauma (e.g., ‘ACCIDENT’). Data from 2009-2011 were ana-
lyzed by facility, patient age and residential zip code, and day/time
using SAS v9.2 (SAS Institute; Cary, NC).

Results
OHV in 2009-2011 totaled 72,410 (def. 1) and 103,594 (def. 2), or

0.6% and 0.9% of all ED visits, respectively. OHV (def. 2) spiked at
age 18 and were highest among 18 to 29 year olds (Fig. 1). Neigh-
borhood OHV rates (def. 2) ranged from 74 to 965 per 100,000 per-
sons. 59% of OHV occurred between 8am and 6pm (Fig. 2). Highly
specific dental conditions were rare; terms such as “tooth ache” were
most common.

Conclusions
Findings suggest that OHV are a particular problem among ages 18

to 29. This pattern may reflect lower insurance coverage among
young adults. The proportion of daytime visits suggests that EDs are
substituting for regular dental treatment and there may be opportuni-
ties to promote daytime linkages to office-based dental providers. 

A well-established syndromic reporting system holds promise as a
method of OHV surveillance. Strengths include near complete chief
complaint reporting, rapid availability, and the potential to identify pop-
ulations and facilities that could benefit from expanded access and pre-
ventive education. Limitations include the need to gather site-specific
facility information (e.g., presence of dental residents, coding practices)
to better understand patterns. Also, the absence of some important fields
in the syndromic system (e.g., insurance coverage, income) limit as-
sessment of the degree to which cost barriers may be driving OHV.

Fig 1. OHV (def.2) by age, 2009-2011

Fig 2. OHV (def.2) by day/time, 2009-2011

Keywords
chief complaint; surveillance; syndrome definition; oral health

Acknowledgments

The authors would like to thank the Bureau of Communicable Diseases’
Data Analysis and Syndromic Surveillance Unit for data collection and
analytic guidance.

References

1. PEW Center on the States, “A Costly Dental Destination,” accessed
August 22, 2012, http://www.pewstates.org/research/reports/a-costly-
dental-destination-85899379755

2. Hong L, Ahmed A, McCunniff M, et al. Secular Trends in Hospital
Emergency Department Visits for Dental Care in Kansas City, Mis-
souri, 2001-2006. Public Health Reports; (March-April 2011) Vol 126,
No. 2, 210-219.

3. California Health Care Foundation, “Emergency Department Visits for
Preventable Dental Conditions in California,” accessed August 22,
2012, http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/
PDF/E/PDF%20EDUseDentalConditions.pdf

*John P. Jasek
E-mail: jjasek@health.nyc.gov

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 5(1):e112, 2013