We analyzed data from the New York City syndromic surveillance system classified as a “diarrheal” syndrome based on ED patient chief complaint (30). The New York City syndromic surveillance system was established in 2001 to monitor ED visits citywide with the goal of early detection of outbreaks or bioterrorism events. Routinely collected patient chief complaint and demographic information from hospital EDs were transmitted electronically to the DOHMH and analyzed each day for statistically significant temporal increases or spatial clusters. From January 2002 through June 2016, more than 52 million ED visits were recorded in the DOHMH syndromic surveillance system, of which 1.4% were classified into a diarrheal syndrome based on patient chief complaint. Only diarrheal syndrome ED visit data were analyzed in this study; other syndromes based on chief complaint terms and classified as febrile or vomiting syndromes that could potentially indicate rotavirus infection were not included.

Coverage of the ED syndromic surveillance system increased from an estimated 65% of all ED visits citywide in 2002 to more than 95% after 2008. Chief complaint reporting by hospitals in the ED system was not standardized across facilities or through time, and considerable variation existed in the syndrome coding and completeness of reporting. Diarrheal syndrome ED visits have been monitored daily, year-round since 2001 for temporal changes in disease trends and spatial clustering of cases in New York City by the DOHMH. To characterize age-specific trends in this study, weekly counts of diarrheal syndrome and total ED visits were calculated as weekly syndrome proportions as the sum of age-specific diarrheal visits divided by the total number of visits each week by age group (<2, 2 to 4, 5 to 12, and ≥13 years).

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