2014.ISDS.Abstracts.Final.pdf


ISDS Annual Conference Proceedings 2014. This is an Open Access article distributed under the terms of the Creative Commons Attribution-
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ISDS 2014 Conference Abstracts

Using NC DETECT for Comprehensive Morbidity 
Surveillance on Poisoning and Overdose

Amy Ising*1, Katherine J. Harmon1, Anna E. Waller1, Scott Proescholdbell2 and Lana 
Deyneka2

1UNC Chapel Hill, Chapel Hill, NC, USA; 2North Carolina Division of Public Health, NC DHHS, Raleigh, NC, USA

Objective
Twelve new case definitions were added to the NC DETECT 

Web Application to facilitate timely surveillance for poisoning and 
overdose. The process for developing these case definitions and the 
most recent outputs are described.

Introduction
A retrospective analysis of emergency department data in NC for 

drug and opioid overdoses has been explained previously [1]. We 
built on this initial work to develop new poisoning and surveillance 
reports to facilitate near real time surveillance by health department 
and hospital users. In North Carolina, the availability for mortality 
and hospital discharge data are approximately one and two years after 
the event date, respectively. NC DETECT data are near real time and 
over 75% of ED visits receive at least one ICD-9-CM final diagnosis 
code within two weeks of the initial record receipt.

Methods
The case definitions were developed with input from the North 

Carolina Division of Public Health, the Injury Prevention Research 
Center at UNC Chapel Hill, the Carolina Center for Health Informatics 
in the UNC Department of Emergency Medicine, as well as feedback 
from end users. Case definitions from the Centers for Disease Control 
and Prevention, the Substance Abuse and Mental Health Services 
Administration, and the Safe States Injury Surveillance Workgroup 
were reviewed. Given the wide variation among the case definitions 
among these national groups, the NC expert group decided to develop 
case definitions for use in North Carolina, with the expectation 
that they may be revised over time and may eventually inform 
surveillance approaches in other states. The case definitions cover 
acute alcohol poisoning, poisoning, unintentional poisoning, heroin 
overdose, medication or drug overdose, methadone overdose, opioid 
overdose, prescription opioid analgesic overdose, Narcan/naloxone, 
and unintentional medication or drug overdose. All but the naloxone 
report search in the first six of up to 11 ICD-9-CM final diagnosis 
codes received for each ED visit in NC DETECT. Some of the reports 
include keyword searches as well and the Narcan/naloxone report is 
entirely keyword-based. The case definitions are available on the 
NC DETECT Website at http://ncdetect.org/images/pdf/fact_sheets/
NC_DETECT_ODPoisoning_Definitions_20140115.pdf

Results
The new case definitions were added to NC DETECT in May 

and June 2014. Authorized users can access detailed line listing 
information for all case definitions back to 2009. Local health 
department users can compare their counties at the aggregate level 
to other counties and the state. Figure 1 compares heroin-related 
ED visits by week from January to July 2013 and 2014. Figure 2 
compares weekly ED visits for medication or drug overdose from 
January to July 2013 and 2014.

Conclusions
Establishing poisoning and overdose reports in a near real time 

surveillance system allows local health departments to gather timely 

feedback on these issues to inform interventions and the work of 
partner agencies. Additional efforts are ongoing to improve the 
systematic dissemination of this information to those who are not NC 
DETECT users but are involved in overdose prevention efforts.

Figure 1

Figure 2

Keywords
poisoning; overdose; timely surveillance

Acknowledgments

NC DETECT is funded with federal funds by the North Carolina 
Division of Public Health, Public Health Emergency Preparedness Grant 
(PHEP), and managed through a collaboration between NC DPH and the 
UNC Department of Emergency Medicine Carolina Center for Health 
Informatics.

References

1. Harmon KJ, Proescholdbell S, Marshall S, Waller AE. Utilization of
Emergency Department Data for Drug Overdose Surveillance in North 
Carolina (Abstract). Online J Public Health Inform. 2014;6(1):e174.

*Amy Ising

E-mail: ising@ad.unc.edu    

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * (1):e136, 201