![[PDF]](/pb-assets/Icons/adobe-pdf-icon-1498649896243.png){kind=icon}
Abstract
Objectives:
In Colorado, legalization of recreational marijuana in 2014 increased public access to marijuana and might also have led to an increase in emergency department (ED) visits. We examined the validity of using syndromic surveillance data to detect marijuana-associated ED visits by comparing the performance of surveillance queries with physician-reviewed medical records.
Methods:
We developed queries of combinations of marijuana-specific International Classification of Diseases, Tenth Revision (ICD-10) diagnostic codes or keywords. We applied these queries to ED visit data submitted through the Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE) syndromic surveillance system at 3 hospitals during 2016-2017. One physician reviewed the medical records of ED visits identified by ≥1 query and calculated the positive predictive value (PPV) of each query. We defined cases of acute adverse effects of marijuana (AAEM) as determined by the ED provider’s clinical impression during the visit.
Results:
Of 44 942 total ED visits, ESSENCE queries detected 453 (1%) as potential AAEM cases; a review of 422 (93%) medical records identified 188 (45%) true AAEM cases. Queries using ICD-10 diagnostic codes or keywords in the triage note identified all true AAEM cases; PPV varied by hospital from 36% to 64%. Of the 188 true AAEM cases, 109 (58%) were among men and 178 (95%) reported intentional use of marijuana. Compared with noncases of AAEM, cases were significantly more likely to be among non-Colorado residents than among Colorado residents and were significantly more likely to report edible marijuana use rather than smoked marijuana use (P < .001).
References
| 1. |
Colorado Constitution Article XVIII, Section 16: personal use and regulation of marijuana . https://www.colorado.gov/pacific/sites/default/files/Section%2016%20-%20%20Retail.pdf. Accessed December 19, 2018. Google Scholar |
| 2. |
Ghosh, TS, Vigil, DI, Maffey, A. Lessons learned after three years of legalized, recreational marijuana: the Colorado experience. Prev Med. 2017;104:4–6. doi:10.1016/j.ypmed.2017.02.021 Google Scholar | Medline |
| 3. |
Ghosh, T, Van Dyke, M, Maffey, A, Whitley, E, Gillim-Ross, L, Wolk, L. The public health framework of legalized marijuana in Colorado. Am J Public Health. 2016;106(1):21–27. doi:10.2105/AJPH.2015.302875 Google Scholar | Medline |
| 4. |
Hall, KE, Monte, AA, Chang, T. Mental health-related emergency department visits associated with cannabis in Colorado. Acad Emerg Med. 2018;25(5):526–537. doi:10.1111/acem.13393 Google Scholar | Medline |
| 5. |
Cao, D, Srisuma, S, Bronstein, AC, Hoyte, CO. Characterization of edible marijuana product exposures reported to United States poison centers. Clin Toxicol (Phila). 2016;54(9):840–846. doi:10.1080/15563650.2016.1209761 Google Scholar | Medline |
| 6. |
Wang, GS, Roosevelt, G, Le Lait, MC. Association of unintentional pediatric exposures with decriminalization of marijuana in the United States. Ann Emerg Med. 2014;63(6):684–689. doi:10.1016/j.annemergmed.2014.01.017 Google Scholar | Medline |
| 7. |
Wang, GS, Hall, K, Vigil, D, Banerji, S, Monte, A, VanDyke, M. Marijuana and acute health care contacts in Colorado. Prev Med. 2017;104:24–30. doi:10.1016/j.ypmed.2017.03.022 Google Scholar | Medline |
| 8. |
Todkill, D, Loveridge, P, Elliot, AJ. Utility of ambulance data for real-time syndromic surveillance: a pilot in the West Midlands region, United Kingdom. Prehosp Disaster Med. 2017;32(6):667–672. doi:10.1017/S1049023X17006690 Google Scholar | Medline |
| 9. |
Goldman-Mellor, S, Jia, Y, Kwan, K, Rutledge, J. Syndromic surveillance of mental and substance use disorders: a validation study using emergency department chief complaints. Psychiatr Serv. 2018;69(1):55–60. doi:10.1176/appi.ps.201700028 Google Scholar | Medline |
| 10. |
Yoon, PW, Ising, AI, Gunn, JE. Using syndromic surveillance for all-hazards public health surveillance: successes, challenges, and the future. Public Health Rep. 2017;132(suppl 1):3S–6S. doi:10.1177/0033354917708995 Google Scholar | Abstract |
| 11. |
Lombardo, J, Burkom, H, Elbert, E. A systems overview of the Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE II). J Urban Health. 2003;80(2 suppl 1):i32–i42. doi:10.1007/PL00022313 Google Scholar |
| 12. |
DeYoung, K, Chen, Y, Beum, R, Askenazi, M, Zimmerman, C, Davidson, AJ. Validation of a syndromic case definition for detecting emergency department visits potentially related to marijuana. Public Health Rep. 2017;132(4):471–479. doi:10.1177/0033354917708987 Google Scholar | SAGE Journals | ISI |
| 13. |
Nolan, ML, Kunins, HV, Lall, R, Paone, D. Developing syndromic surveillance to monitor and respond to adverse health events related to psychoactive substance use: methods and applications. Public Health Rep. 2017;132(1 suppl 1):65S–72S. doi:10.1177/0033354917718074 Google Scholar | Abstract |
| 14. |
Coates, RJ, Pérez, A, Baer, A. National and regional representativeness of hospital emergency department visit data in the National Syndromic Surveillance Program, United States, 2014. Disaster Med Public Health Prep. 2016;10(4):562–569. doi:10.1017/dmp.2015.181 Google Scholar | Medline |
| 15. |
Witkop, C, Duffy, M, Cohen, L, Fishbein, D, Selent, M. Assessment of ESSENCE performance for influenza-like illness surveillance after an influenza outbreak—U.S. Air Force Academy, Colorado, 2009. MMWR Morb Mortal Wkly Rep. 2011;60(13):406–409. Google Scholar | Medline |
| 16. |
World Health Organization . International Statistical Classification of Diseases and Related Health Problems. 10th revision. https://www.who.int/classifications/icd/ICD10Volume2_en_2010.pdf. Published 2011. Accessed December 18, 2018. Google Scholar |
| 17. |
Centers for Disease Control and Prevention . Epi Info. https://www.cdc.gov/epiinfo/index.html. Published 2011. Accessed December 18, 2018. Google Scholar |
| 18. |
SAS Institute Inc . SAS/STAT Version 9.4 for Linux. Cary, NC: SAS Institute Inc; 2014. Google Scholar |
| 19. |
Lloyd, SS, Rissing, JP. Physician and coding errors in patient records. JAMA. 1985;254(10):1330–1336. Google Scholar | Medline | ISI |
| 20. |
O’Malley, KJ, Cook, KF, Price, MD, Wildes, KR, Hurdle, JF, Ashton, CM. Measuring diagnoses: ICD code accuracy. Health Serv Res. 2005;40(5 pt 2):1620–1639. doi:10.1111/j.1475-6773.2005.00444.x Google Scholar | Medline | ISI |
| 21. |
Light, MK, Orens, A, Lewandowski, B, Pickton, T. Market Size and Demand for Marijuana in Colorado. Boulder, CO: Colorado Department of Revenue; 2014. Google Scholar |
| 22. |
Kim, HS, Hall, KE, Genco, EK, Van Dyke, M, Barker, E, Monte, AA. Marijuana tourism and emergency department visits in Colorado. N Engl J Med. 2016;374(8):797–798. doi:10.1056/NEJMc1515009 Google Scholar | Medline |
| 23. |
Barrus, DG, Capogrossi, KL, Cates, SC. Tasty THC: promises and challenges of cannabis edibles. Methods Rep RTI Press. 2016;2016(15):1279–1284. doi:10.2146/ajhp140523 Google Scholar |
| 24. |
Kim, HS, Monte, AA. Colorado cannabis legalization and its effect on emergency care. Ann Emerg Med. 2016;68(1):71–75. doi:10.1016/j.annemergmed.2016.01.004 Google Scholar | Medline |
