The surveillance systems used do not tally treat-and-release ED visits but do capture the proportion of patients hospitalized with a given disease; we combined this proportion with the ratio of treat-and-release ED visits for each disease (reported in HCUP NEDS) to hospitalizations for that disease (in HCUP NIS) to calculate the estimated proportion of reported cases with an ED visit. Although not all patients who visited the ED would have been reported or received a diagnosis, they were assumed to be more likely to receive a diagnosis than patients without an ED visit. Instead of applying the higher underdiagnosis factor used for illness, we used an underdiagnosis factor with a modal value of 2, consistent with previous estimates, and supported by a recent analysis comparing the incidence of bacterial gastroenteritis captured in surveillance and hospital discharge data (14,22,23).

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