Using Syndromic Emergency Department Data to Augment Oral Health Surveillance

Abstract

ObjectiveTo utilize an established syndromic reporting system for surveillance of potentially preventable emergency department (ED) oral health visits (OHV) in New York City (NYC). IntroductionNYC Department of Health and Mental Hygiene recently reoriented its oral health care strategy to focus on health promotion and expanded surveillance. One surveillance challenge is the lack of timely OHV data; few dental providers are in our electronic health record project, and statewide utilization data are subject to delays. Prior research has examined OHV using ICD-9-CM from ED records, and has suggested that diagnostic specificity may be limited by ED providers' lack of training in dental diagnoses (1-3). We considered our existing ED syndromic system as a complement to periodic population-based surveys. This system captures approximately 95% of all ED visits citywide; 98% of records have a completed chief complaint text field whereas only 52% contain an ICD-9-CM diagnosis.

Visits to US emergency departments by 20- to 29-year-olds with toothache during 2001-2010

“…Similar to our results, Jasek and coinvestigators reported that ED dental visits in New York during 2009–2011 were highest among 18–29 year-olds. 29 Our research is the first to document that toothache is among the top reasons for younger adults to seek care in EDs. Specifically, toothache was the fifth most common chief complaint in EDs among 20–29 year-olds and the third most common for uninsured younger adults.…”

“…To that end, ED toothache visits represents a potential quality indicator for system-level barriers to dental care access or utilization within a region or population. 29 …”

“…In addition, investigators have noted that chief complaint of toothache is more reliably present in ED records than dental diagnoses, and that assigned dental diagnoses tend to be nonspecific. 2,29 For comparison with ED toothache visit trends, we extracted ED visits for chief complaints of back pain (comprised of “back pain, ache, soreness, discomfort,” code=1905.1 and “low back pain, ache, soreness, discomfort,” code=1910.1). We generated the most frequent chief complaint for ED visits in younger adults in order to rank these relative to toothache in 2009–2010.…”

Emergency Department Admissions for Dental & Oral Health Concerns in Rural Northwestern Pennsylvania

“…While our study found that those aged 19 -58 were the most frequent users of the ED, it was not the only population that needed preventative dental care at the community-level and dental health care education. Toothaches, dental caries and other oral health concerns impact all ages and greatly influence one's health status, illustrating the need for improved integration of dental and medical care [15] [21] [26]. The current situation nationally and locally solidifies the need to view oral health as an importance.…”

“…Currently, the community water supply provided by the Meadville Water Authority is not fluoridated. According the Centers for Disease Control and Prevention, community water fluoridation is the most affordable and effective prevention strategy under approved fluoride levels [26]. It is important to make the change to fluoridated water and promote proper oral health from a primary prevention stance.…”