EMERGEncy ID NET: An Emergency Department–Based Emerging Infections Sentinel Network☆,☆☆,★,★★,♢
Section snippets
INTRODUCTION
In the last decade, 3 reports by expert committees convened by the Institute of Medicine emphasized the ongoing threat of emerging infectious diseases to domestic health.1, 2, 3 In 1994 the Centers for Disease Control and Prevention (CDC) issued the report, “Addressing Emerging Infectious Disease Threats: A Preventive Strategy for the US,” that identified the priority of confronting the current limitations of the public health system and proposed a strategic plan to address emerging infections
CONCEPTUAL BASIS
Recognition of the role that EDs could play in the study of infectious diseases prompted Olive View–UCLA investigators to study various syndromes including bacterial meningitis, dog and cat bite infections, pyelonephritis, HIV infection, and tuberculosis infection control. Some of these projects required multicenter study or led to CDC collaboration. These experiences provided the conceptual underpinning for discussions between emergency medicine and CDC representatives that led to development
DEVELOPMENT AND STRUCTURE OF EMERGENCY ID NET
EMERGE ncy ID NET has 3 components: (1) study sites, where patient data are collected, (2) the Olive View–UCLA Medical Center, where the principal investigators administer the network and concatenate data, and (3) the CDC, where collaborative representatives participate in study design, direction, and analyses, and where specialized laboratory testing is done.
In 1995–1996, the network sites were recruited from university-affiliated medical centers that had previously participated in multicenter
DATA COLLECTION
Every study patient initially undergoes a clinical evaluation as per usual practice. The examining physician, typically a resident in training, then determines whether the patient meets the case definition for a syndrome under study. Data capture for qualifying patients occurs at the bedside during the ED visit. To enhance patient enrollment, some study site investigators use incentive programs to enhance physician participation (eg, lotteries for book stipends and tee-shirts).
Data to be
DATA MANAGEMENT AND TRANSFER
IBM-compatible microcomputers are used as workstations at each site. A database application displays data questionnaires and directly stores and manages study data. The program reads screen images from a data table, displays the images, and collects responses into the template via keyboard or mouse. The program is capable of presenting screen images and storing data for multiple concurrent studies. Captured data are initially stored in a relational database on the microcomputer hard disk drive
QUALITY ASSURANCE
Case finding sensitivity is determined through audits at each site. ED patient logs are reviewed during audit periods of 1 month per year. Standardized screening criteria for log entry diagnoses that would possibly include case definitions are established. For example, for bloody diarrhea, all cases with the ED diagnosis of diarrhea, gastroenteritis, and dysentery are reviewed. All charts meeting these screening criteria diagnoses for unenrolled patients are reviewed to identify missed cases
EMERGING INFECTIOUS DISEASES CURRENTLY UNDER STUDY
The process by which emerging infectious diseases and corresponding clinical syndromes are selected for study is as follows. CDC Divisions/Programs/offices are informed about the existence and nature of EMERGE ncy ID NET and are asked to identify emerging infectious diseases that might be studied through this network, particularly those encompassed in acutely presenting syndromes that prompt ED presentation. A prioritized list is developed, based on public health importance, and reviewed with
EMERGENCY MEDICINE EDUCATION
In 1997, in order to foster communication between public health agencies and emergency physicians about emerging infections, EMERGE ncy ID NET established a special section in the Annals of Emergency Medicine entitled “Update on Emerging Infections from the Centers for Disease Control and Prevention.” This bimonthly feature summarizes and provides commentary about important Mortality and Morbidity Weekly Reports (MMWR) articles on emerging infections with relevance to ED practitioners.
FUTURE DIRECTIONS
EMERGE ncy ID NET is designed to be flexible and allow easy incorporation of new sites and new project areas. The network may be expanded according to geographic and demographic considerations. Because of population biases associated with academic emergency centers, consideration will be given to incorporating other types of ED sites, such as community hospital–based EDs. We also have received inquiries from other countries regarding our ability to either expand into an international network,
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2016, American Journal of Emergency MedicineCitation Excerpt :Emergency departments (EDs) are an important venue to study trends in infectious disease (ID) epidemiology and management [1,2].
Practice patterns and management strategies for purulent skin and soft-tissue infections in an urban academic ED
2012, American Journal of Emergency MedicineCitation Excerpt :For the last decade, the incidence of infections from community-acquired methicillin-resistant Staphylococcus aureus (MRSA) (CA-MRSA) has dramatically increased, and CA-MRSA is now considered as the most common identifiable cause of skin and soft-tissue infections (SSTIs) in the United States [1,2]. Emergency departments (EDs) are the primary treatment site for SSTIs [3-5]. Greater than 80% of ED patients with CA-MRSA SSTI are treated as outpatients, and thus the overall health burden of MRSA-related SSTI is significant [1,6].
Invasive Infection With Hypermucoviscous Klebsiella pneumoniae: Multiple Cases Presenting to a Single Emergency Department in the United States
2009, Annals of Emergency MedicineCitation Excerpt :Both patients were Asian and presented in diabetic ketoacidosis. EDs can play an important role in infectious disease surveillance to detect emergence of new pathogens, as well as shifts in antibiotic resistance and bacterial virulence.12-14 Our 4 case patients all presented to a single public hospital in Oakland, CA, that serves a diverse population, including a large number of recent immigrants from Asia and elsewhere.
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For the EMERGEncy ID NET Study Group
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From the Olive View–UCLA Medical Center, Sylmar, CA, UCLA School of Medicine,* and the UCLA Emergency Medicine Center, UCLA School of Medicine, Los Angeles, CA,‡ and the National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA.§
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Members of the EMERGEncy ID NET Study Group are listed in the Appendix.
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Address for reprints: David A Talan, MD, Department of Emergency Medicine, Olive View–UCLA Medical Center, 14445 Olive View Drive—North Annex, Sylmar, CA 91342, E-mail [email protected]
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