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AZ BioSense Community of Practice

The mission of the Arizona BioSense Workgroup is to work collaboratively as partners to build capacity and quality of BioSense syndromic surveillance in Arizona. Our vision is to improve population health and emergency response through the use of timely and effective syndromic surveillance. This space is a platform for our members to continue discussions and share cross-role topics and questions from providing the data to using syndromic data (clinician/IT/public health).
Laura ErhartJoli WeissTaylor Lutich, AZHayleigh McCall, Program Analyst III, Syndromic Surveillance at CSTEMatt RoachIrene, Senior Surveillance EpidemiologistAmanda Swanson, TB Special Projects Epidemiologist at AZDHSKaitlyn ChorbiAlyaa Altabbaa, Program Analyst at CSTEHeather VenkatLaura Fox, Environmental Public Health Tracking EpidemiologistChristina Mrukowicz, EpidemiologistSarah GieszlAmy LaiMichelle Kreutzberg-Martinez +189 others
Posted by Rachel Berg ·

Xylazine

Based on the last Exploratory Analysis meeting, I wanted to start a conversation about Xylazine and highlight some work that has been done by Mercedeh Reamer and Shayne Gallaway on creating a Xylazine syndrome definition. Please feel free to contribute your ideas and perspectives to help us further develop this syndrome definition. 


Xylazine definition looks at Emergency for patient class, uses the CDC All Drug v2 CC and DD category, and then added the wounds for CC and DD, as well as key words (,^xylazine^,or,^tranq^,or,^fentanyl^,),and,(,^abcess^,or,^skin infection^,or,^wound^,or,^ulcer^,or,^necrosis^,or,^necrotizing^,or,^open sore^,or,^oozing^,or,^L98^,or,^L00^,or,^L02^,or,^L03^,or,^L08^,or,^L88^,or,^L89^,or,^L96^,or,^L97^,)

Can also look at CCDD category of Fentanyl OD + keywords for skin ulcers, CCDD Category of Benzodyazaphines Overdose  + Skin Ulcer Keywords or the CCDD category of Opioid Overdose + Skin Ulcer Keywords. 

From the Slack channel I have found some other examples as well. 
General Xylazine Definition: (,^xylazine^,or,^heroin^,or,^fentanyl^,or,^dope^,or,^brown powder^,or,^white powder^,or,^tan powder^,or,^tranq^,),and,(,^injection^,or,^syringe^,or,^abscess^,or,^skin infection^,or,^wound^,or,^ulcer^,)

Others have used an advanced query: 
[CHIEFCOMPLAINTS="*abscess*"] OR [CHIEFCOMPLAINTS="*cellulitis*"] OR [CHIEFCOMPLAINTS="*skin infection*"] OR [CHIEFCOMPLAINTS="*wound*"] OR [CHIEFCOMPLAINTS="*ulcer*"] AND  [CHIEFCOMPLAINTS<>"*gun*"] AND [CHIEFCOMPLAINTS<>"*stab*"]AND ([TRIAGENOTE="*xylazine*"] OR [TRIAGENOTE="* tranq *"] OR [TRIAGENOTE="*fentanyl*"] OR [TRIAGENOTE="*heroin*"])

Finally, using keywords associated with street names: Tranq Dope, Tranq, Sleep-Cut, Philly dope, zombie drug, rompun, sedazine, anased, Chanazine, street cut, anestesia de caballo. 

Apply to ccdd 
(,^tranq^, or, ^zylazine^, or,^sleep-cut^,or,^philly dope^,or, ^zombie drug^, or, ^rompum^,or,^sedazine^,or,^anased^,or,^chanazine^,or,^street cut^,or,^anestesia de caballo^, ) 

Hopefully, we can also discuss this in future Exploratory Analysis Meetings. 

Comments & Events

Rachel Berg, Syndromic Surveillance Program Coordinator at ADHS Rachel Berg, Syndromic Surveillance Program Coordinator
Some more examples. Based on the most recent Exploratory Analysis meeting,
ideas to keep in mind would be to potentially look at all drugs in combination with myocarditis, based on some symptoms that are being reported out of Philadelphia. Also, the CDC stimulates definition in combination with skin ulcers. Also good to keep in mind searching Triage Notes to potentially capture more results. 

In addition here are some examples of syndrome definitions shared from Megha Parikh, MPH,the Massachusetts Syndromic Surveillance Epidemiologist.

The first definition is broad and includes street names and symptoms seen in users. The second was developed in conjunction with Brandeis University which does great drug testing work including xylazine.  The SMEs identified 6 syndromes that would be useful in detecting xylazine use in conjunction with the CDC All Drugs definition.  The first definition was in combination with fentanyl and heroin (since these two are the most commonly used illicit drugs with xylazine).  In the ED data, we noticed exclusive xylazine use is not mentioned, but abscesses and wounds were included in the chief complaint text.
Definition 1:
(,^xylazine^,or,^heroin^,or,^fentanyl^,or,^dope^,or,^brown powder^,or,^white powder^,or,^tan powder^,or,^tranq^,),and,(,^injection^,or,^syringe^,or,^abscess^,or,^skin infection^,or,^wound^,or,^ulcer^,)
 
Definition 2:
  1. CDC All Drugs + abscess free text
(,^abscess^,or,^skin infection^,or,^wound^,or,^ulcer^,or,^cellulitis^,or,^A49.02^,or,^A49.01^,or,^L02.91^,or,^L02.419^,or,^L02^,or,^L98.4^,or,^E13.622^,or,^L97^,or,^E11.622^,or,^L89^,or,^L03^,or,^M72.6^,or,^J01.9^,or,^A4902^,or,^A4901^,or,^L0291^,or,^L02419^,or,^L984^,or,^E13622^,or,^E11622^,or,^M726^,or,^J019^,)
  1. CDC All Drugs + Rhabdomyolysis
(,^M62.82^,or,^T79.6^,or,^M62.2^,or,^R30.0^,or,^R74.8^,or,^N17^,or,^M6282^,or,^T796^,or,^M622^,or,^R300^,or,^R748^,)
 
  1. CDC All Drugs + Compartment Syndrome
(,^M79.A^,or,^T79.A^,or,^R20.2^,or,^R23.1^,or,^R22.30^,or,^R22.40^,or,^M79.6^,or,^M794^,or,^T79A^,or,^R202^,or,^R231^,or,^R2230^,or,^R2240^,or,^M796^,)
 
  1. CDC All Drugs + Respiratory
(,^R09.2^,or,^J96^,or,^R092^,)
 
  1. CDC All Drugs + Systemic
(,^R00.1^,or,^I95^,or,^R65.2^,or,^R001^,or,^R652^,) 
 
  1. CDC All Drugs + exposure related effects
(,^L55^,or,^T33^,or,^T68^,or,^T67^,)
 
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