Last data update: Jun 03, 2024. (Total: 46935 publications since 2009)
Records 1-6 (of 6 Records) |
Query Trace: Proescholdbell SK [original query] |
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A Mixed-Methods Comparison of a National and State Opioid Overdose Surveillance Definition
Brathwaite DM , Wolff CS , Ising AI , Proescholdbell SK , Waller AE . Public Health Rep 12/28/2021 136 31s-39s OBJECTIVES: We assessed the differences between the first version of the Centers for Disease Control and Prevention (CDC) opioid surveillance definition for suspected nonfatal opioid overdoses (hereinafter, CDC definition) and the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) surveillance definition to determine whether the North Carolina definition should include additional International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes and/or chief complaint keywords. METHODS: Two independent reviewers retrospectively reviewed data on North Carolina emergency department (ED) visits generated by components of the CDC definition not included in the NC DETECT definition from January 1 through July 31, 2018. Clinical reviewers identified false positives as any ED visit in which available evidence supported an alternative explanation for patient presentation deemed more likely than an opioid overdose. After individual assessment, reviewers reconciled disagreements. RESULTS: We identified 2296 ED visits under the CDC definition that were not identified under the NC DETECT definition during the study period. False-positive rates ranged from 2.6% to 41.4% for codes and keywords uniquely identifying ≥10 ED visits. Based on uniquely identifying ≥10 ED visits and a false-positive rate ≤10.0%, 4 of 16 ICD-10-CM codes evaluated were identified for NC DETECT definition inclusion. Only 2 of 25 keywords evaluated, "OD" and "overdose," met inclusion criteria to be considered a meaningful addition to the NC DETECT definition. PRACTICE IMPLICATIONS: Quantitative and qualitative trends in coding and keyword use identified in this analysis may prove helpful for future evaluations of surveillance definitions. |
Running the numbers: Understanding the prevalence of eye and ear injuries in North Carolina
Geary SM , Cox ME , Proescholdbell SK . N C Med J 2017 78 (2) 134-137 Eye and ear injuries range in severity from minor | bruises, scrapes, or scratches to severe trauma | that may cause long-term hearing or vision loss | [1, 2]. The extent of the injury is a direct result of | the force or object that causes it [2]. Corneal abrasion, caused by scratches from small objects, is the | most common injury impacting the eye [1]. Injuries | to the ear can vary from trauma induced injuries | resulting from a fall or blow to the head to injuries | acquired through exposure to noise that often lead | to chronic hearing loss [2]. A large proportion of | injuries sustained to the eye or ear are preventable, | particularly through the use of protective wear | such as eyewear or earplugs |
Improved ascertainment of pregnancy-associated suicides and homicides in North Carolina
Austin AE , Vladutiu CJ , Jones-Vessey KA , Norwood TS , Proescholdbell SK , Menard MK . Am J Prev Med 2016 51 S234-s240 INTRODUCTION: Injuries, including those resulting from violence, are a leading cause of death during pregnancy and the postpartum period. North Carolina, along with other states, has implemented surveillance systems to improve reporting of maternal deaths, but their ability to capture violent deaths is unknown. The purpose of this study was to quantify the improvement in ascertainment of pregnancy-associated suicides and homicides by linking data from the North Carolina Violent Death Reporting System (NC-VDRS) to traditional maternal mortality surveillance files. METHODS: Enhanced case ascertainment was used to identify suicides and homicides that occurred during or up to 1 year after pregnancy from 2005 to 2011 in North Carolina. NC-VDRS data were linked to traditional maternal mortality surveillance files (i.e., death certificates with any mention of pregnancy or matched to a live birth or fetal death record and hospital discharge records for women who died in the hospital with a pregnancy-related diagnosis). Mortality ratios were calculated by case ascertainment method. Analyses were conducted in 2015. RESULTS: A total of 29 suicides and 55 homicides were identified among pregnant and postpartum women through enhanced case ascertainment as compared with 20 and 34, respectively, from traditional case ascertainment. Linkage to NC-VDRS captured 55.6% more pregnancy-associated violent deaths than traditional surveillance alone, resulting in higher mortality ratios for suicide (2.3 vs 3.3 deaths per 100,000 live births) and homicide (3.9 vs 6.2 deaths per 100,000 live births). CONCLUSIONS: Linking traditional maternal mortality files to NC-VDRS provided a notable improvement in ascertainment of pregnancy-associated violent deaths. |
Observed transition from opioid analgesic deaths toward heroin
Dasgupta N , Creppage K , Austin A , Ringwalt C , Sanford C , Proescholdbell SK . Drug Alcohol Depend 2014 145c 238-241 BACKGROUND: In the United States, overdose mortality from controlled substances has increased over the last two decades, largely involving prescription opioid analgesics. Recently, there has been speculation on a transition away from prescription opioid use toward heroin, however the impact on overdose deaths has not been evaluated. METHODS: Time series study of North Carolina residents, 2007 through 2013. Monthly ratio of prescription opioid-to-heroin overdose deaths. Non-parametric local regression models used to ascertain temporal shifts from overdoses involving prescription opioids to heroin. RESULTS: There were 4332 overdose deaths involving prescription opioids, and 455 involving heroin, including 44 where both were involved (total n=4743). A gradual 6-year shift toward increasing heroin deaths was observed. In January, 2007, for one heroin death there were 16 opioid analgesic deaths; in December, 2013 there were 3 prescription opioid deaths for each heroin death. The transition to heroin appears to have started prior to the introduction of tamper-resistant opioid analgesics. The age of death among heroin decedents shifted toward younger adults. Most heroin and opioid analgesic deaths occurred in metropolitan areas, with little change between 2007 and 2013. CONCLUSIONS: The observed increases in heroin overdose deaths can no longer be considered speculation. Deaths among younger adults were noted to have increased in particular, suggesting new directions for targeting interventions. More research beyond vital statistics is needed to understand the root causes of the shift from prescription opioids to heroin. |
Increases in heroin overdose deaths - 28 states, 2010 to 2012
Rudd RA , Paulozzi LJ , Bauer MJ , Burleson RW , Carlson RE , Dao D , Davis JW , Dudek J , Eichler BA , Fernandes JC , Fondario A , Gabella B , Hume B , Huntamer T , Kariisa M , Largo TW , Miles J , Newmyer A , Nitcheva D , Perez BE , Proescholdbell SK , Sabel JC , Skiba J , Slavova S , Stone K , Tharp JM , Wendling T , Wright D , Zehner AM . MMWR Morb Mortal Wkly Rep 2014 63 (39) 849-854 Nationally, death rates from prescription opioid pain reliever (OPR) overdoses quadrupled during 1999-2010, whereas rates from heroin overdoses increased by <50%. Individual states and cities have reported substantial increases in deaths from heroin overdose since 2010. CDC analyzed recent mortality data from 28 states to determine the scope of the heroin overdose death increase and to determine whether increases were associated with changes in OPR overdose death rates since 2010. This report summarizes the results of that analysis, which found that, from 2010 to 2012, the death rate from heroin overdose for the 28 states increased from 1.0 to 2.1 per 100,000, whereas the death rate from OPR overdose declined from 6.0 per 100,000 in 2010 to 5.6 per 100,000 in 2012. Heroin overdose death rates increased significantly for both sexes, all age groups, all census regions, and all racial/ethnic groups other than American Indians/Alaska Natives. OPR overdose mortality declined significantly among males, persons aged <45 years, persons in the South, and non-Hispanic whites. Five states had increases in the OPR death rate, seven states had decreases, and 16 states had no change. Of the 18 states with statistically reliable heroin overdose death rates (i.e., rates based on at least 20 deaths), 15 states reported increases. Decreases in OPR death rates were not associated with increases in heroin death rates. The findings indicate a need for intensified prevention efforts aimed at reducing overdose deaths from all types of opioids while recognizing the demographic differences between the heroin and OPR-using populations. Efforts to prevent expansion of the number of OPR users who might use heroin when it is available should continue. |
Prescription histories and dose strengths associated with overdose deaths
Hirsch A , Proescholdbell SK , Bronson W , Dasgupta N . Pain Med 2014 15 (7) 1187-1195 OBJECTIVE: Misuse, abuse, and diversion of prescription drugs are large and growing public health problems that have resulted in an overdose epidemic. We investigated whether short-acting or extended-release opioids were more frequently prescribed to those who died of an overdose and whether there was a linear relationship between dose strength and associated overdose deaths. METHODS: The study population was North Carolina residents in 2010. We conducted a retrospective, population-based, descriptive study of medication histories of overdose decedents using data from vital statistics, medical examiner records, and a prescription drug monitoring program. RESULTS: Unintentional or undetermined drug overdoses were responsible for 892 deaths. Out of 191 deaths involving methadone, only two were patients in opioid treatment programs. Immediate-release oxycodone was involved in the greatest number of opioid-related deaths. Out of 221 oxycodone deaths, 134 (61%) of the decedents filled a prescription for oxycodone in the 60 days prior to death. The most common strength dispensed within 60 days to a decedent who died of an oxycodone overdose was 10mg for immediate-release (72 prescriptions). Immediate-release oxycodone products (rho=1.00, P<0.01) and extended-release fentanyl products (rho=1.00, P<0.01) showed strong increasing linear trends between dose strength and proportion of prescriptions dispensed to decedents. CONCLUSIONS: A significant proportion of overdose decedents had been prescribed the same type of drugs that contributed to their death, especially for decedents who died from overdoses involving oxycodone, hydrocodone, and alprazolam. Higher dose strengths for certain opioids had higher associated mortality, and certain immediate-release opioids may be considered for public health prevention efforts. |
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