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Using an Emergency Department Syndromic Surveillance System to investigate the impact of extreme cold weather events
Abstract
This report describes the development of novel syndromic cold weather public health surveillance indicators for use in monitoring the impact of extreme cold weather on attendances at EDs, using data from the 2010–11 and 2011–12 winters.
A number of new surveillance indicators were created specifically for the identification and monitoring of cold weather related ED attendances, using the diagnosis codes provided for each attendance in the Emergency Department Syndromic Surveillance System (EDSSS), the first national syndromic surveillance system of its kind in the UK. Using daily weather data for the local area, a time series analysis to test the sensitivity of each indicator to cold weather was undertaken.
Diagnosis codes relating to a health outcome with a potential direct link to cold weather were identified and assigned to a number of ‘cold weather surveillance indicators’. The time series analyses indicated strong correlations between low temperatures and cold indicators in nearly every case. The strongest fit with temperature was cold related fractures in females, and that of snowfall was cold related fractures in both sexes.
Though currently limited to a small number of sentinel EDs, the EDSSS has the ability to give near real-time detail on the magnitude of the impact of weather events. EDSSS cold weather surveillance fits well with the aims of the Cold Weather Plan for England, providing information on those particularly vulnerable to cold related health outcomes severe enough to require emergency care. This timely information aids those responding to and managing the effects on human health, both within the EDs themselves and in the community as a whole.
... 9 The use of ED data lends itself particularly well to the syndromic surveillance of non-infectious public health events, with patients seeking attention for a range of acute conditions. [10][11][12] Previous investigation of periods of poor AQ have shown associated increases in health seeking behaviour as evidenced by syndromic surveillance, particularly for asthma and/ or difficulty breathing and heart failure, 13-15 although not for myocardial infarction. 15 Aims During March and early April 2014, there was a period of widespread poor AQ across Europe. ...
... 19 Both DAQI and Citeair systems monitor and report on multiple pollutants; however, each index is reported using different methodology. Therefore, the daily pollution levels across both London and Paris were standardised here, using the reported levels of PM 2.5 and PM 10 . The city-wide average value for each PM on each calendar day was calculated as a mean of the maximum values reported for each monitoring station on that day, in that city. ...
... The normal levels of overall ED attendances observed during periods of poor AQ, although travel was discouraged, contrasts with the reduced overall ED attendances in the English EDSSS seen during extreme cold weather when transportation is not physically possible for most people. 10 By using percentage of attendances, the impact of events, such as periods of poor AQ, can be clearly seen in terms of changes in ED workload, such as changes in case mix and/or age groups attending. ...
Introduction
Poor air quality (AQ) is a global public health issue and AQ events can span across countries. Using emergency department (ED) syndromic surveillance from England and France, we describe changes in human health indicators during periods of particularly poor AQ in London and Paris during 2014.
Methods
Using daily AQ data for 2014, we identified three periods of poor AQ affecting both London and Paris. Anonymised near real-time ED attendance syndromic surveillance data from EDs across England and France were used to monitor the health impact of poor AQ. Using the routine English syndromic surveillance detection methods, increases in selected ED syndromic indicators (asthma, difficulty breathing and myocardial ischaemia), in total and by age, were identified and compared with periods of poor AQ in each city. Retrospective Wilcoxon-Mann-Whitney tests were used to identify significant increases in ED attendance data on days with (and up to 3 days following) poor AQ.
Results
Almost 1.5 million ED attendances were recorded during the study period (27 February 2014 to 1 October 2014). Significant increases in ED attendances for asthma were identified around periods of poor AQ in both cities, especially in children (aged 0–14 years). Some variation was seen in Paris with a rapid increase during the first AQ period in asthma attendances among children (aged 0–14 years), whereas during the second period the increase was greater in adults.
Discussion
This work demonstrates the public health value of syndromic surveillance during air pollution incidents. There is potential for further cross-border harmonisation to provide Europe-wide early alerting to health impacts and improve future public health messaging to healthcare services to provide warning of increases in demand.
... The use of syndromic surveillance data to estimate the burden of weather-related events has proven beneficial [16][17][18][19][20][21]. In England, the Department of Health along with Public Health England, have created a cold weather plan, which aims to reduce morbidity and mortality due to severe cold weather through a series of cold weather alerts broadcasted to the area experiencing the hazardous weather and through public health actions such as long-term planning and preparation for these types of weather events and the mobilization of resources for emergency response [16]. ...
... The use of syndromic surveillance data to estimate the burden of weather-related events has proven beneficial [16][17][18][19][20][21]. In England, the Department of Health along with Public Health England, have created a cold weather plan, which aims to reduce morbidity and mortality due to severe cold weather through a series of cold weather alerts broadcasted to the area experiencing the hazardous weather and through public health actions such as long-term planning and preparation for these types of weather events and the mobilization of resources for emergency response [16]. As part of the cold weather plan, "cold weather indicators" were developed and integrated into routine surveillance in the country's Emergency Department Syndromic Surveillance System (EDESS). ...
... This analysis concentrated on injuries related to either falls or transport related injuries. Previous research has included respiratory conditions (asthma, trouble breathing) and cardiac conditions (myocardial infarction) in their analysis of weather-related conditions [16]. For this analysis, these conditions were not included as they had the potential to cause false positives in the relationship between chief complaint and diagnosis codes for cold weather-related incidents [16]. ...
Objective
This report describes the development of a novel syndromic cold weather syndrome for use in monitoring the impact of cold weather events on emergency department attendance.
Methods
Syndromic messages from seven hospitals were analyzed for ED visits that occurred over a 12-day period. A cold weather syndrome was defined using terms in the self-reported chief complaint field as well as specific ICD-10-CM codes related to cold weather. A κ statistic was calculated to assess the overall agreement between the chief complaint field and diagnosis fields to further refine the cold weather syndrome definition.
Results
Of the 3,873 ED visits that were reported, 487 were related to the cold weather event. Sixty-three percent were identified by a combination of diagnosis codes and chief complaints. Overall agreement between chief complaint and diagnosis codes was moderate (κ = 0.50; 95% confidence interval = 0.48–0.52).
Conclusion
Due to the near real-time reporting of syndromic surveillance data, analysis results can be acted upon. Results from this analysis will be used in the state's emergency operations plan (EOP) for cold weather and winter storms. The EOP will provide guidance for mobilization of supplies/personnel, preparation of roadways and pedestrian walkways, and the coordination efforts of multiple state agencies.
... This graph shows the epidemiological curve of lab-confirmed cases and deaths (recorded within 28 days of positive test) due to SARS-CoV-2 in England (30/01/2020-24/05/2020), showing the introduction of non-pharmaceutical interventions at three significant dates, which are used as reference points in subsequent Figs. 2, 3, 4, 5, 6 [9] awareness, and monitor the emergence and spread of common infectious diseases and the public health impact of non-infectious diseases through the population. The important role of syndromic surveillance has been demonstrated during both major emergencies and mass gathering events, e.g. the 2009 global influenza pandemic [13,14], during periods of extreme hot [15,16] and cold [17] weather, and events such as the London 2012 Olympic and Paralympic Games [18]. COVID-19 has generated several new challenges for the syndromic surveillance systems, including: the impact of media reporting and social distancing measures on healthcareseeking behaviour, changes in healthcare system delivery, and an increased demand for rapid analysis and dissemination of findings [19]. ...
... Data from the five PHE national syndromic surveillance systems were included in this study: remote health advice (NHS 111) calls and online assessments; GP In Hours consultations (GPIH); GP Out-of-Hours consultations (GPOOH); emergency department attendances (Emergency Department Syndromic Surveillance System (ED)); and ambulance calls [17]. The systems differ in their coding systems, range of indicators, and coverage across England (Table 1) [13,21,22]. ...
Background
Since the end of January 2020, the coronavirus (COVID-19) pandemic has been responsible for a global health crisis. In England a number of non-pharmaceutical interventions have been introduced throughout the pandemic, including guidelines on healthcare attendance (for example, promoting remote consultations), increased handwashing and social distancing. These interventions are likely to have impacted the incidence of non–COVID-19 conditions as well as healthcare seeking behaviour. Syndromic Surveillance Systems offer the ability to monitor trends in healthcare usage over time.
Methods
This study describes the indirect impact of COVID-19 on healthcare utilisation using a range of syndromic indicators including eye conditions, mumps, fractures, herpes zoster and cardiac conditions. Data from the syndromic surveillance systems monitored by Public Health England were used to describe the number of contacts with NHS 111, general practitioner (GP) In Hours (GPIH) and Out-of-Hours (GPOOH), Ambulance and Emergency Department (ED) services over comparable periods before and during the pandemic.
Results
The peak pandemic period in 2020 (weeks 13–20), compared to the same period in 2019, displayed on average a 12% increase in NHS 111 calls, an 11% decrease in GPOOH consultations, and a 49% decrease in ED attendances. In the GP In Hours system, conjunctivitis consultations decreased by 64% and mumps consultations by 31%. There was a 49% reduction in attendance at EDs for fractures, and there was no longer any weekend increase in ED fracture attendances, with similar attendance patterns observed across each day of the week. There was a decrease in the number of ED attendances with diagnoses of myocardial ischaemia.
Conclusion
The COVID-19 pandemic drastically impacted healthcare utilisation for non-COVID-19 conditions, due to a combination of a probable decrease in incidence of certain conditions and changes in healthcare seeking behaviour. Syndromic surveillance has a valuable role in describing and understanding these trends.
... Impacts on health service activity arising from cold waves include increased rates of consultation and treatment for respiratory conditions and emergency treatment for injuries resulting from falls in ice and snow and the risks, especially among older people [55][56][57]. However, hospital admissions due to cardiovascular diseases have not been observed to increase due to coldwaves, although cardiovascular mortality rates do increase [58]. ...
... Risk registers allowing community groups and professional carers to locate individual vulnerable people are important, but increasingly difficult to maintain as service provision becomes fragmented among various agencies in the UK, raising questions about data sharing, confidentiality and compatibility [113,120]. Data from real time surveillance systems may become important to assess changes in the health and social care system, issuing alerts prompting more effective response to extreme conditions [44,57]. ...
This review, commissioned by the Research Councils UK Living With Environmental Change (LWEC) programme, concerns research on the impacts on health and social care systems in the United Kingdom of extreme weather events, under conditions of climate change. Extreme weather events considered include heatwaves, coldwaves and flooding. Using a structured review method, we consider evidence regarding the currently observed and anticipated future impacts of extreme weather on health and social care systems and the potential of preparedness and adaptation measures that may enhance resilience. We highlight a number of general conclusions which are likely to be of international relevance, although the review focussed on the situation in the UK. Extreme weather events impact the operation of health services through the effects on built, social and institutional infrastructures which support health and health care, and also because of changes in service demand as extreme weather impacts on human health. Strategic planning for extreme weather and impacts on the care system should be sensitive to within country variations. Adaptation will require changes to built infrastructure systems (including transport and utilities as well as individual care facilities) and also to institutional and social infrastructure supporting the health care system. Care sector organisations, communities and individuals need to adapt their practices to improve resilience of health and health care to extreme weather. Preparedness and emergency response strategies call for action extending beyond the emergency response services, to include health and social care providers more generally.
Electronic supplementary material
The online version of this article (10.1186/s12940-017-0324-3) contains supplementary material, which is available to authorized users.
... Heat waves and increased climate variability negatively affect human health and lead to higher mortality and morbidity [2]. Emergency departments constitute the first point of contact in managing diseases affected or exacerbated by extreme weather events, resulting in a considerable increase in emergency room visits (EV) during and after such conditions [3]. ...
Purpose
Extreme weather events are rising due to the accelerating pace of climate change. These events impact human health and increase emergency room visits (EV) for many morbidities. Tinnitus is a common cause of EVs within otolaryngology in Germany and Austria. The effect of extreme weather conditions on tinnitus-related EVs is unknown.
Methods
A total of 526 tinnitus-related EVs at a tertiary care hospital in Vienna were identified. A distributed lag non-linear model with a maximum lag period of 14 days was fitted to investigate the immediate and delayed effect of single-day and prolonged (three-day) extreme atmospheric pressure, relative humidity, mean temperature, precipitation and mean wind speed on EV rates. Extreme conditions were defined as the 1st, 5th, 95th, and 99th percentile of the meteorological variables. Relative risk (RR) is defined as risk for tinnitus-related EVs at an extreme condition compared to the risk at the median weather condition. Cumulative RR (cRR) is the total cumulated EV risk for a given time period.
Results
High relative humidity increased same-day RR for tinnitus-related EVs to 1.75. Both low and high atmospheric pressure raised cRR as early as three days after an event to a maximum of 3.24. Low temperatures mitigated cRR within 4 days, while high temperatures tended to increase risk. Prolonged precipitation reduced cRR within one day.
Conclusion
Extreme meteorological conditions are associated with tinnitus-related EV rates. Further investigation into potential causative links and underlying pathophysiological mechanisms is warranted.
... surveillance using routine emergency department data can be a fast approach to report and detect changes in healthcare utilisation, without creating an additional administrative burden. In the United Kingdom (UK) [9], France [10] and other countries, syndromic surveillance systems based on emergency department data have been established [11,12], and have previously provided timely public health insight upon extraordinary events such as extreme weather occurrence [13], mass gatherings (e.g. the Olympic Games in 2012 [14]), or during the COVID-19 pandemic [15]. ...
Background
The COVID-19 pandemic expanded the need for timely information on acute respiratory illness at population level.
Aim
We explored the potential of routine emergency department data for syndromic surveillance of acute respiratory illness in Germany.
Methods
We used routine attendance data from emergency departments, which continuously transferred data between week 10 2017 and 10 2021, with ICD-10 codes available for > 75% of attendances. Case definitions for acute respiratory infection (ARI), severe acute respiratory infection (SARI), influenza-like illness (ILI), respiratory syncytial virus infection (RSV) and COVID-19 were based on a combination of ICD-10 codes, and/or chief complaints, sometimes combined with information on hospitalisation and age.
Results
We included 1,372,958 attendances from eight emergency departments. The number of attendances dropped in March 2020 during the first COVID-19 pandemic wave, increased during summer, and declined again during the resurge of COVID-19 cases in autumn and winter of 2020/21. A pattern of seasonality of respiratory infections could be observed. By using different case definitions (i.e. for ARI, SARI, ILI, RSV) both the annual influenza seasons in the years 2017–2020 and the dynamics of the COVID-19 pandemic in 2020/21 were apparent. The absence of the 2020/21 influenza season was visible, parallel to the resurge of COVID-19 cases. SARI among ARI cases peaked in April–May 2020 (17%) and November 2020–January 2021 (14%).
Conclusion
Syndromic surveillance using routine emergency department data can potentially be used to monitor the trends, timing, duration, magnitude and severity of illness caused by respiratory viruses, including both influenza viruses and SARS-CoV-2.
... Syndromic surveillance using routine emergency department data can be a fast approach to report and detect changes in healthcare utilization, without creating an additional administrative burden. In the United Kingdom (9), France (10) and other countries, syndromic surveillance systems based on emergency department data have been established (11,12), and have previously provided timely public health insight at extraordinary times such as extreme weather events (13) or mass gatherings (e.g. the Olympic Games in 2012 (14)), as well as during the COVID-19 pandemic (15). ...
Introduction: To better assess the epidemiological situation of acute respiratory illness in Germany over time, we used emergency department data for syndromic surveillance before and during the COVID-19 pandemic.
Methods: We included routine attendance data from emergency departments who continuously transferred data between week 10-2017 and 10-2021, with ICD-10 codes available for >75% of the attendances. Case definitions for acute respiratory illness (ARI), severe ARI (SARI), influenza-like illness (ILI), respiratory syncytial virus disease (RSV) and Coronavirus disease 2019 (COVID-19) were based on a combination of ICD-10 codes, and/or chief complaints, sometimes combined with information on hospitalisation and age.
Results: We included 1,372,958 attendances from eight emergency departments. The number of attendances dropped in March 2020, increased during summer, and declined again during the resurge of COVID-19 cases in autumn and winter of 2020/2021. A pattern of seasonality of acute respiratory infections could be observed. By using different case definitions (i.e. for ARI, SARI, ILI, RSV) both the annual influenza seasons in the years 2017-2020 and the dynamics of the COVID-19 pandemic in 2020-2021 were apparent. The absence of a flu season during the fall and winter of 2020/2021 was visible, in parallel to the resurge of COVID-19 cases. The proportion of SARI among ARI cases peaked in April-May 2020 and November 2020-January 2021.
Conclusion: Syndromic surveillance using routine emergency department data has the potential to monitor the trends, timing, duration, magnitude and severity of illness caused by respiratory viruses, including both influenza and SARS-CoV-2.
... At present, the meteorological warning has received considerable attention in public health planning and preventive health care (Casanueva et al. 2019). For example, the UK has developed a monitoring system that can monitor the impact of severe winter weather on the demand for emergency departments in near real time (Hughes et al. 2014). In Canada, when freezing rain is expected to be ≥2 h or is expected to cause harm to transportation or property, Environment Canada will issue an official freezing rain warning (Yan et al. 2020). ...
Despite the significant economic cost of falls and injuries to individuals and communities, little is known about the impact of meteorological factors on the incidence of fall-related injuries (FRIs). Therefore, a time-series study was conducted to explore the effects of meteorological factors on FRIs in Ma’anshan City, East China. Injury data from 2011 to 2017 were collected from the National Injury Monitoring Station in Ma’anshan City. A distributed lag nonlinear model was used in this study to evaluate the correlation between ambient temperature and fall injuries. The results showed a significant exposure-response relationship between temperature and FRIs in Ma’anshan City. The high temperatures increased the risk of FRIs (RR = 1.110; 95% CI, 1.005–1.225; lag 0). The lag effect appeared at lag 10 (RR = 1.032; 95% CI, 1.003–1.063), and then gradually remained stable after lag 25 (RR = 1.077; 95% CI, 1.045–1.110). The effect of ambient temperature varied with age and gender. The lag effect of high temperature appeared in the male group after lag 15 (RR = 1.042; 95% CI, 1.006–1.079). In contrast, the effect of the female group appeared for the first time at lag 0 (RR = 1.187; 95% CI, 1.042–1.352). And the ≥ 60 years subgroup seemed to be more sensitive in low temperature (RR = 1.017; 95% CI, 1.004–1.031; lag 0; RR = 1.003; 95% CI, 1.000–1.007; lag 25). The cumulative result is similar to the single-day effect. From the results, this study would help the establishment of fall-related injury prediction and provide evidence for the formulation and implementation of preventive strategies and measures in the future.
... Data are combined into syndromic indicators and analyzed by teams composed of scientists from Public Health England and the academe (Elliot et al. 2017). It has been used to monitor influenza trends across the UK, the 2012 London Olympics, and extreme cold events (Elliot 2009;Elliot et al. 2013;Hughes et al. 2014). ...
The thesis describes the use of syndromic surveillance in the Philippines to analyze health impacts inflicted by climatological, hydrological, meteorological hazards, and complex emergencies for the enhancement of hazard risk reduction. The thesis looks at two systems, an established syndromic surveillance for disasters, Surveillance in Post Extreme Emergencies and Disasters or SPEED, and a routine health information system, eHealth Tablet for Informed Decision Making of Local Government Units or eHATID LGU. First, the thesis describes the trends observed in SPEED in terms of syndromes and diseases in health facilities, age groups, and time periods seen in the aftermath of disasters in 2013. Second, the thesis looks at eHATID LGU trends in diseases seen across 2016 in a municipality in the Philippines and their relation to weather variables. This is a pilot demonstration of the use of routine health information systems to monitor and analyze climate-sensitive diseases. Lastly, the thesis discusses the governance implications of the use of health information systems for decision-making in research areas such as health emergency and disaster risk management (H-EDRM) and climate resilient health systems. The first section (Introduction) gives an overview of the different frameworks used in disease surveillance, H-EDRM, and climate resilient health systems. This section introduces syndromic surveillance and different examples of its use in different countries. It also gives the specific objectives of the thesis. The second section (Methods) gives the different analytical methods and indicators used to describe the two databases, SPEED and eHATID LGU. The third section (Results) describes the output of the statistical analysis of the databases. It is divided into four subsections: (1) SPEED in three natural hazards in 2013, (2) SPEED in typhoon Haiyan, (3) SPEED in the Zamboanga armed conflict, and (4) eHATID in San Jose de Buenavista, Antique. The fourth section (Discussion) describes the implications of the results of the study to common diseases in disasters, deaths in disasters, trends across time, health facilities used, health systems resilience, correlation with weather data, limitations, health information system use, research, and policy.
... A specific characteristic of syndromic data is seasonality, in machine learning also known as cyclic drift [30], a special form of concept drift, in which the target concept changes over time with respect to a fixed time frame. For example, Hughes et al. [31] and Dirmyer [32] show that the cold weather in winter has an influence on the symptoms of the people arriving in emergency departments. Johnson et al. [33] capture seasonal patterns in emergency department data due to respiratory illnesses. ...
Monitoring the development of infectious diseases is of great importance for the prevention of major outbreaks. Syndromic surveillance aims at developing algorithms which can detect outbreaks as early as possible by monitoring data sources which allow to capture the occurrences of a certain disease. Recent research mainly concentrates on the surveillance of specific, known diseases, putting the focus on the definition of the disease pattern under surveillance. Until now, only little effort has been devoted to what we call non-specific syndromic surveillance, i.e., the use of all available data for detecting any kind of infectious disease outbreaks. In this work, we give an overview of non-specific syndromic surveillance from the perspective of machine learning and propose a unified framework based on global and local modeling techniques. We also present a set of statistical modeling techniques which have not been used in a local modeling context before and can serve as benchmarks for the more elaborate machine learning approaches. In an experimental comparison of different approaches to non-specific syndromic surveillance we found that these simple statistical techniques already achieve competitive results and sometimes even outperform more elaborate approaches. In particular, applying common syndromic surveillance methods in a non-specific setting seems to be promising.
... Daily data are monitored and assessed using epidemiological and statistical processes to detect unusual activity. They are particularly valuable for detecting the impact of seasonal infections and environmental incidents, including extreme heat and coldHughes et al., 2014;Morbey et al., 2015). The combined approach facilitates monitoring of a series of health outcomes with different symptom severity: GP calls and NHS Direct helpline calls refer to heat stress, heat-and sunstroke or the impact of heat in general, while cause-specific ER visits account for more severe outcomes.Similarly, in France the national syndromic surveillance system is used to assess heat-wave impacts and to support HHAP implementation and evaluation. ...
This publication collates and summarizes the most relevant evidence published on heatwaves, heat and public health prevention thereof since 2008, focusing primarily on the 53 Member States in the WHO European Region. Findings are organized around the elements the original guidance document identified as “core” to a comprehensive heat–health action plan (HHAP), and these are complemented in each chapter with the results of a WHO survey of heat–health action planning in 2019, where relevant to the topic covered.
Available online at:
https://www.euro.who.int/en/health-topics/environment-and-health/Climate-change/publications/2021/heat-and-health-in-the-who-european-region-updated-evidence-for-effective-prevention-2021
... Floods of all magnitude are known to have potential health impacts on population [1], both at short, medium and long term both on physical (injuries, diarrhoeal disease, Carbon Monoxyde poisoning, vector-borne disease) and mental health. Extreme cold weather have also the potential to further impact on human health through direct exposure to lower temperatures, and associat ed adverse conditions, such as snow and ice [2]. Such situations may be particularly associated to direct impact like hypothermia, frostbite and selected bone/joint injuries). ...
Objective
The presentation describes the results of the daily monitoring of health indicators conducted by the French public health agency during the major floods and the cold wave that occurred in January 2018 in France, in order to early identify potential impact of those climatic events on the population.IntroductionThe Seine River rises at the north-East of France and flows through Paris before emptying into the English Channel. On January 2018 (from 22th January to 11th February, Weeks 4 to 6), major floods occurred in the Basin of Seine River, after an important rainy period. This period was also marked by the occurrence on the same area of a first cold wave on Week 6 (from 5th to 7th February), including heavy snowfall and ice conditions from 9th to 10th February. A second similar cold wave occured from 28th February and 1st March.Floods of all magnitude are known to have potential health impacts on population [1], both at short, medium and long term both on physical (injuries, diarrhoeal disease, Carbon Monoxyde poisoning, vector-borne disease) and mental health. Extreme cold weather have also the potential to further impact on human health through direct exposure to lower temperatures, and associated adverse conditions, such as snow and ice [2]. Such situations may be particularly associated to direct impact like hypothermia, frostbite and selected bone/joint injuries).Methods
Since 2004, the French Public Health Agency (Santé publique France) set up a national syndromic surveillance system SurSaUD, enabling to ensure morbidity and mortality surveillance [3]. In 2018, morbidity data were daily collected from a network involving about 700 emergency departments (ED) and 58 emergency general practitioners’ associations SOS Médecins. 92% of the national ED attendances and 95% of national SOS Médecins visits are caught by the system.Both demographic (age and gender), administrative (date and location of consultation, transport) and medical information (chief complaint, medical diagnosis using ICD10 codes in ED and specific thesauri in SOS Médecins associations, severity, hospitalization after discharge) are recorded for each patient.The daily and weekly evolution of the number of all-cause ED attendances and SOS Médecins consultations during the flooding period were compared to the evolution on the two previous years. The number of hospitalisations after ED discharge was also monitored. The immediate health impact of floods and cold waves was assessed by monitoring eight syndromic indicators: gastroenteritis, carbon monoxide poisoning, burnt, stress, faintness, drowning, injuries and hypothermia.Analyses were performed by age group (<15 years, 15-64 years, more than 65 years) and at different geographical levels (national, Paris region and districts located in the Basin of Seine River).ResultsIn 2018, syndromic surveillance did not show any major impact on all-cause ED attendances and SOS Médecins consultations from week 4 to week 6, neither in Paris area nor in other areas along the Seine River. The recorded numbers were comparable to the two precedent years in all age groups.A decrease of the all-cause ED attendances was observed during the 1st day with ice conditions in Normandy and Paris, mainly in children and adults aged 15-64 years.During week 6 in Paris area, an increase of ED attendances was observed for injuries (+4% compared to the past weeks – figure 1) and to a lesser extent for hypothermia and frostbite (16 attendances compared to less than 9 for the past weeks). Similar increase in injuries were observed in Normandy during the second cold wave (Figure 1).Conclusions
During the flood episode, the rising water level was slow with foreseeable evolution, compared to other sudden flood events occurring in south of France in 2010 due to violent thunderstorms. This progressive evolution allows French authority to deploy wide specific organization in order to mitigate impact on concerned populations. That may explain the absence impact observed in ED at regional and national levels during the flood disaster. The evolution of injuries during 2018 episode is attributable to the cold wave that occurred simultaneously.As the French syndromic surveillance system is implemented on the whole territory and collects emergency data routinely since several years, it constitutes a reactive tool to assess the potential public health impact of both sudden and predictable disasters. It can either contribute to adapt management action or reassure decision makers if no major impact is observed.References[1] Ahern M, Kovats S. The health impacts of floods. In: Few R, Matthies F, eds. Flood hazards and health: responding to present and future risks. London, Earthscan, 2006:28–53.[2] Hughes H, Morbey R, Hughes T. et al. Using an Emergency Department Syndromic Surveillance System to investigate the impact of extreme cold weather events Public Health. 2014 Jul;128(7):628-35.[3] Caserio-Schönemann C, Bousquet V, Fouillet A, Henry V. The French syndromic surveillance system SurSaUD (R). Bull Epidémiol Hebd 2014;3-4:38-44.
... The SSS provide particular value in describing the impact of influenza on a variety of health care settings and were widely used to detect and monitor the H1N1(pdm09) pandemic (Box 2) [8]. Over the years the systems have been used to monitor the impact of a wide range of infectious and non-infectious hazards including seasonal norovirus activity, heatwaves, extreme cold weather, mass gatherings, air pollution events (Box 2) [9][10][11][12]. During the London 2012 Olympic and Paralympic Games, the SSS were used daily alongside enhanced microbiological and event-based surveillance to detect public health incidents, and also to particularly provide reassurance about lack of outbreaks across London and the rest England (Box 2) [13,14]. ...
Syndromic surveillance is a form of surveillance that generates information for public health action by collecting, analysing and interpreting routine health-related data on symptoms and clinical signs reported by patients and clinicians rather than being based on microbiologically or clinically confirmed cases. In England, a suite of national real-time syndromic surveillance systems (SSS) have been developed over the last 20 years, utilising data from a variety of health care settings (a telehealth triage system, general practice and emergency departments). The real-time systems in England have been used for early detection (e.g. seasonal influenza), for situational awareness (e.g. describing the size and demographics of the impact of a heatwave) and for reassurance of lack of impact on population health of mass gatherings (e.g. the London 2012 Olympic and Paralympic Games).We highlight the lessons learnt from running SSS, for nearly two decades, and propose questions and issues still to be addressed. We feel that syndromic surveillance is an example of the use of ‘big data’, but contend that the focus for sustainable and useful systems should be on the added value of such systems and the importance of people working together to maximise the value for the public health of syndromic surveillance services.
... Low temperatures have also been associated with raised risks in morbidity outcomes in the UK, including emergency hospital admissions for respiratory diseases [13] and myocardial infarctions, [14] GP consultations for respiratory problems, [15] activation of implantable cardioverter defibrillators among cardiac patients, [16] and delayed ambulance call response times [17]. Most recently, the utility of using data from the Emergency Department Syndromic Surveillance System was demonstrated to provide timely indication of public health impacts in relation to cold weather [18]. ...
Cold-related mortality and morbidity remains an important public health problem in the UK and elsewhere. Health burdens have often reported to be higher in the UK compared to other countries with colder climates, however such assessments are usually based on comparison of excess winter mortality indices, which are subject to biases. Daily time-series regression or case-crossover studies provide the best evidence of the acute effects of cold exposure. Such studies report a 6% increase in all-cause deaths in England & Wales for every 1 °C fall in daily mean temperature within the top 5% of the coldest days. In major Scottish cities, a 1 °C reduction in mean temperature below 11 °C was associated with an increase in mortality of 2.9%, 3.4%, 4.8% and 1.7% from all-causes, cardiovascular, respiratory, and non-cardio-respiratory causes respectively. In Northern Ireland, a 1 °C fall during winter months led to reductions of 4.5%, 3.9% and 11.2% for all-cause, cardiovascular and respiratory deaths respectively among adults. Raised risks are also observed with morbidity outcomes. Hip fractures among the elderly are only weakly associated with snow and ice conditions in the UK, with the majority of cases occurring indoors. A person's susceptibility to cold weather is affected by both individual- and contextual-level risk factors. Variations in the distributions of health, demographic, socio-economic and built-environment characteristics are likely to explain most differences in cold risk observed between UK regions. Although cold-related health impacts reduced throughout much of the previous century in UK populations, there is little evidence on the contribution that milder winters due to climate change may have made to reductions in more recent decades. Intervention measures designed to minimise cold exposure and reduce fuel poverty will likely play a key role in determining current and future health burdens associated with cold weather.
... The EDSSS provided a valuable contribution to overall surveillance during the London 2012 Olympic and Paralympic Games and continued to develop after the Olympics were over, remaining as a public health legacy of the Games, contributing to national surveillance programs and vaccineimpact studies, and supporting the response to public health incidents. [6][7][8][9][10] By December 2016, 35 EDs in England and Northern Ireland were reporting to the EDSSS. 11 Five additional EDs had reported previously; however, because of the bespoke nature of the EDSSS data transfer setup, whenever a software system in a reporting ED changes-resulting in differences in the local data set format and storage-the EDSSS data transfer setup for EDSSS is no longer valid, and the ED is lost from the EDSSS. ...
... The identified association between inclement weather and fall-related ED visits is not surprising. Other studies documented an increase in traumatic injuries after snow or ice storms, 17,19,20 and falls were the most common cause. 4 In our study, nearly 8% of all ED visits on high-fall days were related to falls, which was approximately twice as many as on control days. ...
Objectives:
Following a surge in fall-related visits to local hospital emergency departments (EDs) after a severe ice storm, the Philadelphia Department of Public Health examined the association between inclement winter weather events and fall-related ED visits during a 5-year period.
Methods:
Using a standardized set of keywords, we identified fall-related injuries in ED chief complaint logs submitted as part of Philadelphia Department of Public Health's syndromic surveillance from December 2006 through March 2011. We compared days when falls exceeded the winter fall threshold (ie, "high-fall days") with control days within the same winter season. We then conducted matched case-control analysis to identify weather and patient characteristics related to increased fall-related ED visits.
Results:
Fifteen high-fall days occurred during winter months in the 5-year period. In multivariable analysis, 18- to 64-year-olds were twice as likely to receive ED care for fall-related injuries on high-fall days than on control days. The crude odds of ED visits occurring from 7:00 am to 10:59 am were 70% higher on high-fall days vs control days. Snow was a predictor of a high-fall day: the adjusted odds of snow before a high-fall day as compared with snow before a control day was 13.4.
Conclusions:
The association between the number of fall-related ED visits and weather-related fall injuries, age, and timing suggests that many events occurred en route to work in the morning. Promoting work closures or delaying openings after severe winter weather would allow time for better snow or ice removal, and including "fall risk" in winter weather advisories might effectively warn morning commuters. Both strategies could help reduce the number of weather-related fall injuries.
... Several previous studies have described the utility of ED syndromic surveillance data for bioterrorism-related early aberration detection, 10 for routine surveillance of infectious 2,11-13 and noninfectious [14][15][16][17] diseases, and for surveillance during emergencies. [18][19][20][21] As these studies found, ED syndromic surveillance data are a valuable resource for understanding a wide range of diseases, conditions, and patient needs. ...
Introduction:
The use of syndromic surveillance has expanded from its initial purpose of bioterrorism detection. We present 6 use cases from New York City that demonstrate the value of syndromic surveillance for public health response and decision making across a broad range of health outcomes: synthetic cannabinoid drug use, heat-related illness, suspected meningococcal disease, medical needs after severe weather, asthma exacerbation after a building collapse, and Ebola-like illness in travelers returning from West Africa.
Materials and methods:
The New York City syndromic surveillance system receives data on patient visits from all emergency departments (EDs) in the city. The data are used to assign syndrome categories based on the chief complaint and discharge diagnosis, and analytic methods are used to monitor geographic and temporal trends and detect clusters.
Results:
For all 6 use cases, syndromic surveillance using ED data provided actionable information. Syndromic surveillance helped detect a rise in synthetic cannabinoid-related ED visits, prompting a public health investigation and action. Surveillance of heat-related illness indicated increasing health effects of severe weather and led to more urgent public health messaging. Surveillance of meningitis-related ED visits helped identify unreported cases of culture-negative meningococcal disease. Syndromic surveillance also proved useful for assessing a surge of methadone-related ED visits after Superstorm Sandy, provided reassurance of no localized increases in asthma after a building collapse, and augmented traditional disease reporting during the West African Ebola outbreak.
Practice implications:
Sharing syndromic surveillance use cases can foster new ideas and build capacity for public health preparedness and response.
... Cold weather is also associated with an increase in GP consultations . Emergency department activity increases during cold spells, and fractures among older people showed an increase after a drop in winter temperatures (Hughes et al., 2014) or during heavy snowfall . Emergency hospital admissions due to injuries from falls on snow and ice vary significantly from year to year and reached 16,604 in England in the relatively severe winter of 2009/10, costing an estimated £42 million in NHS inpatient care (Beynon et al., 2011). ...
... Syndromic surveillance plays a part in this plan: emergency department cold weather indicators have been developed and are used each winter to assess the impact of cold weather on public health. 4 Air pollution During March/April 2014 an air pollution event affected large parts of the UK; syndromic surveillance was used to assess the public health impact. Indicators for the presentation of asthma, difficulty breathing and wheeze all showed marked and significant increases during the air pollution episode, illustrating the impact of the episode. ...
This paper describes the national syndromic surveillance delivered by the Public Health England Real-time Syndromic Surveillance Team. We demonstrate how this service is increasingly responding to, and providing public health support for, a range of environmental incidents. Case studies of a number of incidents are illustrated.
Background
Syndromic surveillance, which provides real-time data, may provide timely drowning surveillance compared with hospital discharge data where the release of data may be delayed. We compared data on hospital visits for unintentional drowning identified in hospital discharge and syndromic surveillance data sets for accuracy and completeness.
Methods
We compared data for hospital visits for unintentional drowning identified in the Texas Health Care Information Collection hospital discharge and syndromic surveillance data sets for metropolitan Houston, Texas, USA from 2019 to 2021. Hospital visits included emergency department-only visits and hospital admissions. We compared time-series visualisation of hospital visits between data sets. Injury burden, demographics and intercounty distribution of drowning patients were compared using the Pearson correlation coefficient for continuous data and the Pearson χ ² goodness-of-fit test for categorical data.
Results
We identified 860 hospital discharge visits and 929 syndromic surveillance visits (quarterly median (IQR): 64.0 (26.8–117.5); 54.5 (28.0–132.3), respectively) for unintentional drowning. Time-series visualisation showed a high correlation between syndromic surveillance and hospital discharge visits (correlation coefficient: 0.93 (95% CI: 0.77 to 0.98)). There were small differences by race, ethnicity and county for all ages and for paediatrics and large differences by sex for all ages in the number of unintentional drowning hospital visits identified within the data sets.
Conclusions
Regional unintentional drowning burden and trends are highly correlated between syndromic surveillance and hospital discharge data. Small differences by race, ethnicity and county and large differences by sex in the number of unintentional drowning hospital visits were identified between data sets. Syndromic surveillance is useful for real-time surveillance of unintentional drowning.
Data from a paediatric intensive care transport service based in the South East of England between 2006 and 2018 are studied using generalized additive models to investigate the effects of extreme weather on demand in winter. Noticeable increases in daily demand for the service are uncovered after periods of extreme weather, and can be partitioned into two characteristically different phenomena, most pronounced at 2 days and 7 days after a period of particularly low temperature combined with either high or low humidity. The effect is more visible when virus prevalence is accounted for, showing that demand can increase by as much as 30% 7 days after a period of low temperature and low humidity, and 20% 2 days after a period of low temperature and high humidity.
This chapter reviews current knowledge about the health effects of several environmental conditions on home fuel poverty, including physiological and epidemiological aspects of cold and heat related illness, and epidemiological studies on excess morbidity and mortality. the inadequate home concept has been addressed with further contributions that have on mental health, asthma (dampness and mould), noise, CO poisoning and lung cancer for radon exposure. Measures for reducing cold and heat related mortality and morbidity related to poor energy housing include appropriate urban planning and housing design. this contributes confirm that poor housing quality is a significant public health issue. However, to realize a large health potential associated with adequate, safe and healthy homes, joint action on health and nonhealth sectors is required. the development of specific guidelines for general and healthcare practitioners to better manage information on patients living in bad situations of fuel poverty is desirable.
Objectives:
The aims of the present study were to describe the distribution of Systematised Nomenclature of Medicine - Clinical Terms (SNOMED-CT) codes used in the current New South Wales Emergency Department Data Collection (NSW EDDC) and classify duplicate and redundant terms into clinically meaningful sub-groups for future analyses.
Methods:
This was an analysis of ED diagnosis codes using a large state-wide administrative ED dataset between 2015 and 2018.
Results:
A total of 7.4 million (77%) of ED episode diagnoses were coded with SNOMED-CT. Of those coded with SNOMED-CT, 12 152 unique codes were identified. Around 1000 of the most frequently used codes accounted for 90% of the presentations coded with SNOMED-CT and 5000 codes accounted for 99.8% of these. Around 7000 codes were deemed to be redundant, and duplication in terms exists across all sub-groups.
Conclusion:
The use of SNOMED-CT in the NSW EDDC has resulted in substantial use of non-specific, duplicate and redundant codes, limiting the capacity of the NSW EDDC to be used for effective data analysis.
À partir des données du Programme de médicalisation des systèmes d'information (PMSI), l'Agence nationale de sécurité du médicament et des produits de santé (ANSM) a émis en 2015 une alerte relative à l'augmentation des hospitalisations pour ingestion de cannabis chez l'enfant. L'objectif de l'étude était de décrire les admissions liées au cannabis dans les services d'urgence de la région Provence-Alpes-Côte d'Azur (Paca) à partir des résumés de passages aux urgences (RPU). Sur la période 2009-2014, 15 services d'urgence ont transmis des RPU de façon constante avec un diagnostic principal renseigné pour plus de 95% des patients. Parmi ces 2 948 980 passages, 1 182 correspondaient à une intoxication au cannabis (IC), soit 4,1/10 000 passages. Cette proportion était maximale chez les personnes âgées de 15 à 18 ans (20,4/10 000). Parmi les patients admis pour IC, 4,1% (n=49) avaient moins de 8 ans, dont 81,7% avaient moins de 2 ans. Chez les moins de 8 ans, le taux d'hospitalisation était plus élevé (75,5% avant 8 ans vs 12,7% après 8 ans), ainsi que la proportion d'admissions en réanimation (4,1% avant 8 ans vs 0,2% après 8 ans). Entre les périodes 2009-2010 et 2013-2014, on note une augmentation de la proportion d'IC dans les RPU, sauf chez les personnes de plus de 55 ans. Elle est plus marquée chez les moins de 8 ans et entre 8 et 15 ans. Ces résultats suggèrent que les RPU constituent un outil performant de surveillance des admissions liées aux IC dans les services d'urgence. Based on data from the French National Hospital Database (PMSI), the French National Agency for Medicines and Health Products (ANSM) sent an alert on 2015 on the increase in children hospitalizations for cannabis poisoning (CP). This study aimed to describe cannabis-related emergency admissions in southern France (Provence-Alpes–Côte-d'Azur region), using electronic emergency department abstracts (EEDA) directly available from patients' computerized medical files. From 2009 to 2014, 15 emergency departments located in southern France regularly reported EEDA with >95% reports of diagnosis codes. Among these 2,948,980 admissions , 1,182 (4.1/10,000 admissions) were coded CP. The proportion reached a peak among young people aged 15-18 years (20.4/10,000 admissions). Among them, 4.1% of CP were observed in children < 8 years (49 children , 81.7% <2 years). In children <8 years, hospitalization rate was higher (75.5% before 8 years versus 12.7% after 8 years) as well as intensive care unit admissions (4.1%, versus 0.2% if >8 years). Between 2009-2010 and 2013-2014, CP admissions increased in all age groups under 55 years of age, but mostly in age groups <15 years of age. EEDA seem to be a useful tool for drug-related emergency admissions real-time surveillance.
Background and objectives:
The potential association of external factors such as time of day, lunar phases or specific weather conditions on the daily management and outcome of trauma emergencies remains under debate. We undertook this trauma centre investigation to detect possible worthwhile factors of influence in order to optimize the organizational structure of trauma admissions.
Materials and methods:
Retrospective cohort analysis over the years 2010-2013, including all emergency trauma admissions with a new injury severity score (NISS) ≥8 (major trauma) treated in a teaching hospital in the lowland of Switzerland (uni- and multivariable analysis; p < 0.05).
Results:
During the study period, 1178 major trauma patients were admitted to the hospital. The mean age of trauma victims was 53 ± 23 and the average ISS was 14 ± 8. More patients arrived within the summer months than during the rest of the year (p < 0.001). Higher energy trauma was found to correlate with higher daytime temperature, longer duration of sunshine (each p < 0.001), and change in weather conditions (p = 0.008). In contrast, snowfall and lunar phases did not demonstrate any association with the number or characteristics of trauma admissions. Multivariable analysis demonstrated that altogether longer sunshine, higher minimum daytime temperature and lower air humidity, compared to the previous day, accounted for 31 % of major trauma admissions. We could not find any impact of the investigated external factors on the outcome of patients.
Conclusions:
The study shows a significant relationship between specific weather conditions, such as higher daytime temperature or change in circulation, and the admission of major trauma patients. Due to the small effect in our setting, our results do not implicate any according change in the management of resources. Nevertheless, for hospitals in other geographic or more exposed weather regions, such effects could indeed be relevant and therefore should be tested.
List of publications included in data collection.
(PDF)
Objective:
Following Hurricane Superstorm Sandy, the New Jersey Department of Health (NJDOH) developed indicators to enhance syndromic surveillance for extreme weather events in EpiCenter, an online system that collects and analyzes real-time chief complaint emergency department (ED) data and classifies each visit by indicator or syndrome.
Methods:
These severe weather indicators were finalized by using 2 steps: (1) key word inclusion by review of chief complaints from cases where diagnostic codes met selection criteria and (2) key word exclusion by evaluating cases with key words of interest that lacked selected diagnostic codes.
Results:
Graphs compared 1-month, 3-month, and 1-year periods of 8 Hurricane Sandy-related severe weather event indicators against the same period in the following year. Spikes in overall ED visits were observed immediately after the hurricane for carbon monoxide (CO) poisoning, the 3 disrupted outpatient medical care indicators, asthma, and methadone-related substance use. Zip code level scan statistics indicated clusters of CO poisoning and increased medicine refill needs during the 2 weeks after Hurricane Sandy. CO poisoning clusters were identified in areas with power outages of 4 days or longer.
Conclusions:
This endeavor gave the NJDOH a clearer picture of the effects of Hurricane Sandy and yielded valuable state preparation information to monitor the effects of future severe weather events. (Disaster Med Public Health Preparedness. 2016;page 1 of 9).
weather predictions are a useful tool for informing public health planning and prevention strategies for non-injury health outcomes, but the association between winter weather warnings and fall-related injuries has not been assessed previously.
to examine the association between fall-related injuries among older adults and government-issued winter weather warnings.
using a dynamic cohort of individuals ≥65 years of age who lived in Montreal between 1998 and 2006, we identified all fall-related injuries from administrative data using a validated set of diagnostic and procedure codes. We compared rates of injuries on days with freezing rain or snowstorm warnings to rates observed on days without warnings. We also compared the incidence of injuries on winter days to non-winter days. All analyses were performed overall and stratified by age and sex.
freezing rain alerts were associated with an increase in fall-related injuries (incidence rate ratio [IRR] = 1.20, 95% confidence interval [CI]: 1.08-1.32), particularly among males (IRR = 1.31, 95% CI: 1.10-1.56), and lower rates of injuries were associated with snowstorm alerts (IRR = 0.89, 95% CI: 0.80-0.99). The rate of fall-related injuries did not differ seasonally (IRR = 1.00, 95% CI: 0.97-1.03).
official weather warnings are predictive of increases in fall-related injuries among older adults. Public health agencies should consider using these warnings to trigger initiation of injury prevention strategies in advance of inclement weather.
© The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
Objective
To examine the effects of temperature on cardiovascular-related (CVD) morbidity and mortality among New York City (NYC) residents.
Introduction
Extreme temperatures are consistently shown to have an effect on CVD-related mortality [1, 2]. A large multi-city study of mortality demonstrated a cold-day and hot-day weather effect on CVD-related deaths, with the larger impact occurring on the coldest days [3]. In contrast, the association between weather and CVD-related morbidity is less clear [4, 5]. The purpose of this study is to characterize the effect of temperature on CVD-related emergency department (ED) visits, hospitalizations, and mortality on a large, heterogeneous population. Additionally, we conducted a sensitivity analysis to determine the impact of air pollutants, specifically fine particulates (PM2.5) and ozone (O3), along with temperature, on CVD outcomes.
Methods
We analyzed daily weather conditions, ED visits classified as CVD-related based on chief complaint text, hospitalizations, and natural cause deaths that occurred in NYC between 2002 and 2006. ED visits were obtained from data reported daily to the city health department for syndromic surveillance. Inpatient admissions were obtained from the Statewide Planning and Research Cooperative System, a data reporting system developed by New York State. Mortality data were obtained from the NYC Office of Vital Statistics. Data for PM2.5 and O3 were obtained from all available air quality monitors within the five boroughs of NYC. To estimate risk of CVD morbidity and mortality, we used generalized linear models using a Poisson distribution to calculate relative risks (RR) and 95% confidence intervals (CI). A non-linear distributed lag was used to model mean temperature in order to allow for its effect on the same day and on subsequent days. Models were fit separately for cold season (October through March) and warm season (April through September) given season may modify the effect on CVD outcomes. For our sensitivity analysis, we included PM2.5 and O3 in our model.
Results
During the cold season, CVD-related ED visits and hospitalizations increased, while mortality decreased, with increasing mean temperature on the same day and lagged days. Extremely cold temperature was associated with a small increase of same day in-hospital mortality though generally cold temperatures did not appear to be associated with higher mortality. The opposite was observed in the warm season as ED visits and hospitalizations decreased, and mortality increased, with increasing mean temperature on the same day and on lagged days. Our sensitivity analysis, in which we controlled for PM2.5 and O3, demonstrated little effect of these air pollutants on the relationship between temperature and CVD outcomes.
Conclusions
Our results suggest a decline in risk of a CVD-related ED visit and hospitalization during extreme temperatures on the same day and on recent day lags for both cold and warm seasons. In contrast, our findings for mortality indicate an increase in risk of CVD-related deaths during hot temperatures. No mortality effect was observed during cold temperatures. The effects of extreme temperatures on CVD-related morbidity may be explained by behavioral patterns, as people are more likely to stay indoors on the coldest and hottest days.
Although there has been some research on the impact of extreme weather on the number of ambulance call-out incidents, especially heat waves, there has been very little research on the impact of cold weather on ambulance call-outs and response times. In the UK, there is a target response rate of 75% of life threatening incidents (Category A) that must be responded to within 8 min. This paper compares daily air temperature data with ambulance call-out data for Birmingham over a 5-year period (2007-2011). A significant relationship between extreme weather and increased ambulance call-out and response times can clearly be shown. Both hot and cold weather have a negative impact on response times. During the heat wave of August 2003, the number of ambulance call-outs increased by up to a third. In December 2010 (the coldest December for more than 100 years), the response rate fell below 50% for 3 days in a row (18 December-20 December 2010) with a mean response time of 15 min. For every reduction of air temperature by 1°C there was a reduction of 1.3% in performance. Improved weather forecasting and the take up of adaptation measures, such as the use of winter tyres, are suggested for consideration as management tools to improve ambulance response resilience during extreme weather. Also it is suggested that ambulance response times could be used as part of the syndromic surveillance system at the Health Protection Agency.
In the UK, the 2009/10 winter was characterised by sustained low temperatures; grit stocks became depleted and surfaces left untreated. We describe the relationship between temperature and emergency hospital admissions for falls on snow and ice in England, identify the age and gender of those most likely to be admitted, and estimate the inpatient costs of these admissions during the 2009/10 winter.
Hospital Episode Statistics were used to identify episodes of emergency admissions for falls on snow and ice during winters 2005/06 to 2009/10; these were plotted against mean winter temperature. By region, the logs of the rates of weekly emergency admissions for falls on snow and ice were plotted against the mean weekly temperature for winters 2005/06 to 2009/10 and a linear regression analysis undertaken. For the 2009/10 winter the number of emergency hospital admissions for falls on snow and ice were plotted by age and gender. The inpatient costs of admissions in the 2009/10 winter for falls on snow and ice were calculated using Healthcare Resource Group costs and Admitted Patient Care 2009/10 National Tariff Information.
The number of emergency hospital admissions due to falls on snow and ice varied considerably across years; the number was 18 times greater in 2009/10 (N = 16,064) than in 2007/08 (N = 890). There is an exponential increase [Ln(rate of admissions) = 0.456 - 0.463*(mean weekly temperature)] in the rate of emergency hospital admissions for falls on snow and ice as temperature falls. The rate of admissions in 2009/10 was highest among the elderly and particularly men aged 80 and over. The total inpatient cost of falls on snow and ice in the 2009/10 winter was 42 million GBP.
Emergency hospital admissions for falls on snow and ice vary greatly across winters, and according to temperature, age and gender. The cost of these admissions in England in 2009/10 was considerable. With responsibility for health improvement moving to local councils, they will have to balance the cost of public health measures like gritting with the healthcare costs associated with falls. The economic burden of falls on snow and ice is substantial; keeping surfaces clear of snow and ice is a public health priority.
While the effects of weather and, in particular, ambient temperature on overall mortality are well documented, the strength of the evidence base for the effects on acute myocardial infarction (MI) are less clear.
To systematically review studies specifically focusing on the effects of temperature on MI.
Medline, Embase, and GeoBase publication databases, as well as reference lists, and the websites of a number of relevant public organisations.
Studies of original data in which ambient temperature was an exposure of interest and MI a specific outcome were selected.
The reported effects of ambient temperature on the risk of MI, including effect sizes and confidence intervals, where possible, were recorded. Methodological details were also extracted, including study population, location and setting, ascertainment of MI events, adjustment for potential confounders and consideration of lagged effects.
19 studies were identified, of which 14 considered the short-term effects of temperature on a daily timescale, the remainder looking at longer-term effects. Overall, 8 of the 12 studies which included relevant data from the winter season reported a statistically significant short-term increased risk of MI at lower temperatures, while increases in risk at higher temperatures were reported in 7 of the 13 studies with relevant data. A number of differences were identified between studies in the population included demographics, location, local climate, study design and statistical methodology.
A number of studies, including some that were large and relatively well controlled, suggested that both hot and cold weather had detrimental effects on the short-term risk of MI. However, further research with consistent methodology is needed to clarify the magnitude of these effects and to show which populations and individuals are vulnerable.
Much debate remains regarding why certain countries experience dramatically higher winter mortality. Potential causative factors other than cold exposure have rarely been analysed. Comparatively less research exists on excess winter deaths in southern Europe. Multiple time series data on a variety of risk factors are analysed against seasonal-mortality patterns in 14 European countries to identify key relations Subjects and setting: Excess winter deaths (all causes), 1988-97, EU-14.
Coefficients of seasonal variation in mortality are calculated for EU-14 using monthly mortality data. Comparable, longitudinal datasets on risk factors pertaining to climate, macroeconomy, health care, lifestyle, socioeconomics, and housing were also obtained. Poisson regression identifies seasonality relations over time.
Portugal suffers from the highest rates of excess winter mortality (28%, CI=25% to 31%) followed jointly by Spain (21%, CI=19% to 23%), and Ireland (21%, CI=18% to 24%). Cross country variations in mean winter environmental temperature (regression coefficient (beta)=0.27), mean winter relative humidity (beta=0.54), parity adjusted per capita national income (beta=1.08), per capita health expenditure (beta=-1.19), rates of income poverty (beta=-0.47), inequality (beta=0.97), deprivation (beta=0.11), and fuel poverty (beta=0.44), and several indicators of residential thermal standards are found to be significantly related to variations in relative excess winter mortality at the 5% level. The strong, positive relation with environmental temperature and strong negative relation with thermal efficiency indicate that housing standards in southern and western Europe play strong parts in such seasonality.
High seasonal mortality in southern and western Europe could be reduced through improved protection from the cold indoors, increased public spending on health care, and improved socioeconomic circumstances resulting in more equitable income distribution.
Despite the high burden from exposure to both hot and cold weather each year in England and Wales, there has been relatively little investigation on who is most at risk, resulting in uncertainties in informing government interventions.
To determine the subgroups of the population that are most vulnerable to heat-related and cold-related mortality.
Ecological time-series study of daily mortality in all regions of England and Wales between 1993 and 2003, with postcode linkage of individual deaths to a UK database of all care and nursing homes, and 2001 UK census small-area indicators.
A risk of mortality was observed for both heat and cold exposure in all regions, with the strongest heat effects in London and strongest cold effects in the Eastern region. For all regions, a mean relative risk of 1.03 (95% confidence interval (CI) 1.02 to 1.03) was estimated per degree increase above the heat threshold, defined as the 95th centile of the temperature distribution in each region, and 1.06 (95% CI 1.05 to 1.06) per degree decrease below the cold threshold (set at the 5th centile). Elderly people, particularly those in nursing and care homes, were most vulnerable. The greatest risk of heat mortality was observed for respiratory and external causes, and in women, which remained after control for age. Vulnerability to either heat or cold was not modified by deprivation, except in rural populations where cold effects were slightly stronger in more deprived areas.
Interventions to reduce vulnerability to both hot and cold weather should target all elderly people. Specific interventions should also be developed for people in nursing and care homes as heat illness is easily preventable.
This study illustrates the potential of using emergency department attendance data, routinely accessed as part of a national syndromic surveillance system, to monitor the impact of thunderstorm-related asthma.
The Emergency Department Syndromic Surveillance System (EDSSS) routinely monitors anonymised attendance data on a daily basis across a sentinel network of 35 emergency departments. Attendance data for asthma, wheeze and difficulty breathing are analysed on a daily basis.
A statistically significant spike in asthma attendances in two EDSSS emergency departments in London was detected on 23 July 2013, coinciding with a series of large violent thunderstorms across southern England. There was also an increase in the reported severity of these attendances.
This preliminary report illustrates the potential of the EDSSS to monitor the impact of thunderstorms on emergency department asthma attendances. Further work will focus on how this system can be used to quantify the impact on emergency departments, thus potentially improving resource planning and also adding to the thunderstorm asthma evidence-base.
Objective
To explore the relationship between the number of patients presenting to the Emergency Department and the weather. To determine if the number of non-urgent cases presenting to the ED is affected by the weather.
Methods
Retrospective review of all presentations to the ED of a tertiary referral hospital in the south-west of Sydney, Australia over a 1 year period. Total daily numbers of patient presentations and their triage acuity were correlated with temperature, rainfall, day of the week and the absence or presence of a Public holiday.
Results
During the study period 46,903 patients presented to the ED with an average of 128.5 patients a day. Rainfall occurred on 135 days. There was a positive correlation between day of the week (P < 0.001) and the presence of a public holiday (P < 0.001) on ED attendances. Increasing maximum daily temperature was also associated with a rise in ED presentations (P = 0.04). Daily rainfall did not significantly influence ED attendance numbers (P = 0.07). The presence of a Public holiday was the only significant variable affecting the numbers of non-urgent presentations (P = 0.003).
Conclusions
Meteorological factors such as rainfall and temperature impact minimally on ED attendances. Day of the week and Public holidays are more important variables impacting on total ED workload and resource planning should be guided by this.
Mortality due to cardiovascular diseases shows a seasonal trend that can be associated with cold weather. Portugal is the European country with the highest excess winter mortality, but nevertheless, the relationship between cold weather and health is yet to be assessed. The main aim of this study is to identify the contribution of cold weather to cardiovascular diseases within Portugal. Poisson regression analysis based on generalized additive models was applied to estimate the influence of a human-biometeorological index (PET) on daily hospitalizations for myocardial infarction. The main results revealed a negative effect of cold weather on acute myocardial infarctions in Portugal. For every degree fall in PET during winter, there was an increase of up to 2.2% (95% CI = 0.9%; 3.3%) in daily hospital admissions. This paper shows the need for public policies that will help minimize or, indeed, prevent exposure to cold.
Background The London 2012 Olympic and Paralympic Games is a mass gathering event that will present a major public health challenge. The Health Protection Agency, in collaboration with the College of Emergency Medicine, has established the Emergency Department Sentinel Syndromic Surveillance System (EDSSS) to support the public health surveillance requirements of the Games.
Methods This feasibility study assesses the usefulness of EDSSS in monitoring indicators of disease in the community. Daily counts of anonymised attendance data from six emergency departments across England were analysed by patient demographics (age, gender, partial postcode), triage coding and diagnosis codes. Generic and specific syndromic indicators were developed using aggregations of diagnosis codes recorded during each attendance.
Results Over 339 000 attendances were recorded (26 July 2010 to 25 July 2011). The highest attendances recorded on weekdays between 10:00 and 11:00 and on weekends between 12:00 and 13:00. The mean daily attendance per emergency department was 257 (range 38–435). Syndromic indicators were developed including: respiratory, gastrointestinal, cardiac, acute respiratory infection, gastroenteritis and myocardial ischaemia. Respiratory and acute respiratory infection indicators peaked during December 2010, concomitant with national influenza activity, as monitored through other influenza surveillance systems.
Conclusions The EDSSS has been established to provide an enhanced surveillance system for the London 2012 Olympics. Further validation of the data will be required; however, the results from this initial descriptive study demonstrate the potential for identifying unusual and/or severe outbreaks of infectious disease, or other incidents with public health impact, within the community.
To determine whether unfavorable weather conditions affect the number and acuity of visits to a pediatric emergency department (ED), a retrospective analysis was conducted of children's hospital ED visits and weather conditions utilizing an ED log book and local climatological data during the year 1993. Visits, intensive care unit (ICU) admissions, non-ICU admissions, time periods with favorable weather (TPF), and time periods with unfavorable weather (TPUF) were measured. Each day of the year was divided into two time periods. The time periods were labeled TPF or TPUF based on certain weather conditions. There were 632 (86%) TPF and 98 (14%) TPUF. The number of visits, non-ICU admissions, and ICU admissions during TPF were 13,008 (88%), 1,031 (87%) and 121 (86%), respectively. The number of visits, non-ICU admissions, and ICU admissions during TPUF were 1,720 (12%), 148 (13%), and 19 (14%), respectively. No significant differences in visits and admissions during TPF and TPUF were identified. Also, there was no difference identified when the distribution of visits and admissions was examined during TPUF due to different weather factors, eg, low temperature, precipitation, etc. The results show that unfavorable weather due to the types of weather factors discussed does not affect the number or the nature of visits to a pediatric ED.
To quantify gender differences for non-fatal unintentional fall related injuries among US adults age 65 years and older treated in hospital emergency departments (EDs).
The authors analyzed data from a nationally representative sample of ED visits for January 2001 through December 2001, available through the National Electronic Injury Surveillance System All Injury Program (NEISS-AIP). For each initial ED visit, coders record one principal diagnosis (usually the most severe) and one primary part of the body affected.
Based on 22,560 cases, an estimated 1.64 million older adults were treated in EDs for unintentional fall injuries. Of these, approximately 1.16 million, or 70.5%, were women. Fractures, contusions/abrasions, and lacerations accounted for more than three quarters of all injuries. Rates for injury diagnoses were generally higher among women, most notably for fractures which were 2.2 times higher than for men. For all parts of the body, women's injury rates exceeded those of men. Rate ratios were greatest for injuries of the leg/foot (2.3), arm/hand (2.0), and lower trunk (2.0). The hospitalization rate for women was 1.8 times that for men.
Among older adults, non-fatal fall related injuries disproportionately affected women. Much is known about effective fall prevention strategies. We need to refine, promote, and implement these interventions. Additional research is needed to tailor interventions for different populations and to determine gender differences in the underlying causes and/or circumstances of falls. This information is vital for developing and implementing targeted fall prevention strategies.
To investigate the effects of high ambient temperatures, including the summer 2003 heat-episode, on NHS Direct usage and its suitability as a surveillance tool in heat health warning systems.
Analyses of data on calls to NHS Direct in English Regions in the period Dec 2001-May 2004. Outcomes were daily rates of all symptomatic calls, and daily proportion of calls for selected causes (fever, vomiting, difficulty breathing, heat/sun-stroke)
Total calls were moderately increased as environmental temperature increased; this effect was greatest in calls for young children and for fever. Total calls were moderately elevated during two summer heat episodes in 2003: calls specifically for heat/sun stroke increased acutely in response to these episodes. No association was apparent between environmental temperature and proportion of calls for vomiting and difficulty breathing.
Calls to NHS Direct are sensitive to daily temperatures and extreme weather. NHS Direct is timely and has great potential in health surveillance. Calls for heat- and sun-stroke are now routinely monitored as part of the UK Heat-wave plan
Evaluation report e cold weather plan for England 2011e12. London: Health Protection Agency [updated 30.01.2013; cited 2013
- A Ghosh
- C Carmichael
- Murray
Ghosh A, Carmichael C, Murray V. Evaluation report e cold weather plan for England 2011e12. London: Health Protection Agency [updated 30.01.2013; cited 2013 January 2013]. Available from: http://www.hpa.org.uk/webc/HPAwebFile/ HPAweb_C/1317136356328; 2012.
Cold weather plan for England 2012 Available from:, https
- Department
- Health
Department of Health. Cold weather plan for England 2012. London [updated 30.01.2013; cited 2013 30 January]. Available from:, https://www.wp.dh.gov.uk/publications/files/2012/10/9211-TSO-NHS-Cold-Weather-Plan_Accessible-main-doc.pdf; 2012.
Heatwave plan 2012. London: Department of Health [updated 30
- Department
- Health
Department of Health. Heatwave plan 2012. London: Department of Health [updated 30.01.2013; cited 2013 30
Cold weather plan for England: making the case Available from: https://www.gov.uk/government
- Public Health
- England
Public Health England. Cold weather plan for England: making the case. Available from: https://www.gov.uk/government/ uploads/system/uploads/attachment_data/file/252854/Cold_ Weather_Plan_2013_Making_the_Case_final_v2.pdf; 2013.
Assessment of syndromic surveillance in Europe
- Triple S Project
Triple S Project. Assessment of syndromic surveillance in Europe. Lancet 2012;378:1833e4.
Risk of cardiovascular morbidity and mortality in relation to temperature In: ISDS annual conference proceedings 2012; San Diego, USA; 2012. 24. Bachenheimer EA. The relationship between weather and hospital emergency department volume
- Mathes R K Ito
- Matte
Mathes R, Ito K, Matte T. Risk of cardiovascular morbidity and mortality in relation to temperature. In: ISDS annual conference proceedings 2012; San Diego, USA; 2012. 24. Bachenheimer EA. The relationship between weather and hospital emergency department volume. J Healthc Manag 2007;52:127e36.