Using routine emergency department data for syndromic surveillance of acute respiratory illness, Germany, week 10 2017 until week 10 2021
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Abstract
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.
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SciScore for 10.1101/2021.08.19.21262303: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics Consent: Data protection and ethics: In AKTIN and ESEG, individual patient consent is not provided for the context of the emergency situation and the technical and organizational measures provided.
IRB: The AKTIN-register received medical ethical approval from the Ethics Committee of the Otto von Guericke University Magdeburg, Medical Faculty (160/15) (20).Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from Limitat…SciScore for 10.1101/2021.08.19.21262303: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics Consent: Data protection and ethics: In AKTIN and ESEG, individual patient consent is not provided for the context of the emergency situation and the technical and organizational measures provided.
IRB: The AKTIN-register received medical ethical approval from the Ethics Committee of the Otto von Guericke University Magdeburg, Medical Faculty (160/15) (20).Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:The findings of this study should be interpreted taking the following limitations into account. First, the selected data are a convenience sample and are not representative for emergency departments in Germany as a whole. Differences on the level of individual departments, as well as differences between emergency departments, played a limited role in the analysis and interpretation. This study aimed to explore the possibility and feasibility to use these routine data for public health surveillance. In addition, structural changes at the department, including active interreference with patient flows with respiratory complaints, could have affected reported attendances and case counts. To fully understand trends in the data, being it due to a change in infection dynamics, healthcare seeking behaviour, the COVID-19 pandemic and NPIs, or structural changes at the emergency department, more information is needed. This type of investigation is, however, beyond the scope of this work. The strength of the current approach of passive surveillance using routine documentation has its own advantages being fast (timely reporting) without creating an additional burden on the healthcare workers. Furthermore, case definitions were based on routine documentation, designed for triage and clinical documentation in the emergency department, not designed for surveillance purposes. The syndromic case definitions heavily rely on clinical presentation, and laboratory diagnosis is often not available...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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