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Abstract
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Schoenbaum and Colpe identify important limitations to our study1 on trends in emergency department (ED) visits for mental health, overdose, and violence before and during the COVID-19 pandemic. Specifically, they highlight 3 aspects of the data from the National Syndromic Surveillance Program (NSSP) at the US Centers for Disease Control and Prevention (CDC) that affected the interpretation of reported trends, including the expanded coverage of the NSSP over time, that analyses were not limited to EDs with consistent participation, and that rates per population were not reported.
NSSP coverage expanded from 62.4% of ED visits in the US in 2019 to 70.7% in 2020. While this growth can affect interpretability of trends, particularly following substantial declines in the overall number of ED visits, NSSP's expansion has resulted in additional resources that have improved data quality and system functionality, including recent advances in the ability to limit analyses to facilities with consistently high discharge diagnosis code completeness and consistent reporting over time. Recently, NSSP used this methodology to characterize the effect of COVID-19 on ED visits from December 2018 to January 2021 and found results consistent with our study,1 with more individuals seeking emergency care for mental or behavioral health and socioeconomic (eg, threats of job loss) and psychosocial concerns during the pandemic period compared with the prepandemic period.2 Therefore, NSSP's growth actually reflects a system strength, as it facilitates subset analyses that can confirm and bolster confidence in national-level study results.
While calculating rates per population is challenging because of varying NSSP coverage by state, robust population-based estimates can be determined on finer geographic scales by limiting analyses to counties with participating facilities...
Language: en |