186136 Unusual Death Surveillance System (UDSS): Real-time monitoring of infectious disease related coroner's case deaths in Los Angeles County

Tuesday, October 28, 2008: 8:50 AM

Ashley M. Peterson, MPH , Los Angeles County Department of Public Health, Acute Communicable Disease Control, Los Angeles, CA
Kim Bryant, RN, BSN , Los Angeles County Department of Public Health, Acute Communicable Disease Control, Los Angeles, CA
Sharon Sakamoto, RN MSN MPH CNS , Los Angeles County Department of Public Health, Acute Communicable Disease Control, Los Angeles, CA
David E. Dassey, MD, MPH , Los Angeles County Department of Public Health, Acute Communicable Disease Control, Los Angeles, CA
Dawn Terashita, MD, MPH , Los Angeles County Department of Public Health, Acute Communicable Disease Control, Los Angeles, CA
     
Introduction: Collaboration between Los Angeles County (LAC) Department of Coroner (DC) and LAC Department of Public Health can provide early detection of bioterrorist attack or emerging infectious disease outbreak deaths. Additionally, UDSS functions as an infectious disease death surveillance tool. Analysis of UDSS offers valuable insights into the benefits of unusual death surveillance.

Methods: A 42-variable dataset containing each day's coroner cases (CC's) is subject to tandem visual and automated computer algorithm review yielding a subset of CC's requiring additional follow-up. The SAS algorithm uses character string recognition programming to search for communicable disease key words within death description fields. A 0.5 FTE public health nurse (PHN) actively and passively interacts with DC staff to ascertain final causes of death (COD) of follow-up cases. Cases with selected infectious disease COD receive further investigation and possible reporting.

Results: From 2003 to 2006, 70,774 CC's were reported to ACDC, from which 424(0.6%) were selected for follow-up (78[18%] via visual inspection and 346[82%] via computer algorithm.) PHN investigations and COD information revealed 196(46%) of follow-up cases listed an infectious disease COD, 70(36%) of which were found on visual inspection alone and not by computer algorithm. Of cases with infectious disease COD, 81(41%) were not previously reported including deaths from cysticercosis, hantavirus, and rabies.

Discussion: In the absence of bioterrorist or emerging infectious disease events, UDSS is useful in detecting reportable infectious disease related deaths. Visual review of CC's is more effective in predicting infectious disease COD but is time consuming.

Learning Objectives:
1. Describe three coroner case definitions important to infectious disease surveillance. 2. Discuss the merrits of visual and computer aided review of coroner case information. 3. Identify the requisite interractions between the Department of Coroner and Department of Public Health to investigate possible reportable communicable disease related deaths.

Keywords: Infectious Diseases, Death

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: For the past year I have been the lead on the Unusual Death Surveillance System obtaining, organizing and analyzing the data.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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