NSW Emergency Department Records for Epidemiology (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health.
Asthma like illness includes patients who appear to have asthma symptoms when they present in the emergency department, however some of these patients may have been misdiagnosed and be found to have respiratory infections or Chronic obstructive pulmonary disease (COPD).
Asthma like illness emergency department (ED) presentations are selected using the following definition:
• Unplanned ED presentations;
• By person of all ages;
• To 84 public hospitals that reported continuously and collected reasonably complete diagnosis information since 2009-10;
• Where the provisional diagnosis was assigned an asthma problem ICD-9, ICD-10 or SNOMED-CT code (as summarised in the Codes tab).
Presentations to the 84 NSW EDs included in this report accounted for approximately 87% of all NSW ED (planned and unplanned) activity in 2018-19. The data used to produce this report is subject to change from day to day due to data updates at the source ED.
Data refer to all unplanned presentations to the included EDs regardless of the district or state of residence of the patient. Unplanned presentations include those that were not pre-arranged, with the majority classified as emergency presentations.
Both the number of presentations and reported rates are under-estimated because not all emergency departments in NSW are included in the analysis. However, the trend over time includes a consistent cohort of hospitals and consistent population denominators and therefore allows for valid trend comparisons over the time.
Analyses by Local Health District, Primary Health Network, Local Government Area and remoteness from service centres are not included as the representation of EDs included in the analysis varies by geographic area.
Rates were age-adjusted using the Australian population as at 30 June 2001. Age adjustment was used for analyses of all ages, but age-specific rates were not age-adjusted. Data refer to all presentations to the included EDs regardless of the district or state of residence of the patient.
The NSW Emergency Department Records for Epidemiology (EDRE) is derived from computer databases used for managing patients in Emergency Departments (ED). It is an enhanced version of the NSW Emergency Department Data Collection (EDDC) and is accessed via SAPHaRI.
The EDDC commenced in 1994, but was organised into a formal data collection from July 1996. Only public hospital EDs participate in the EDDC. The number of participating EDs has increased over time from around 52 EDs in 1996-97 to around 177 EDs in 2018-19. The larger EDs participate in the EDDC so a substantial proportion of the NSW population is covered, but this proportion varies over time. Presentations to the 84 NSW hospital EDs included for reporting from EDRE accounted for approximately 87% of all NSW public ED activity in 2018-19.
Analyses based on ED diagnoses are useful for monitoring trends, but accuracy can vary due to the variation in computer programs used and data entry practices in each hospital. Unlike the admitted patient data collection, the EDDC does not have diagnoses formally coded by clinical coders. In EDs, the diagnoses are recorded by staff working in each emergency department. Depending on the computer program used in the hospital at a point in time, the diagnosis is recorded according to one of three classification systems – the International Classification of Disease Revision 9 (ICD-9), Revision 10 (ICD-10) or the Systematized Nomenclature of Medicine - Clinical Terminology (SNOMED-CT). ED diagnoses do not include intent or external cause codes.
Presentations are reported based on where a person presents to ED and not where a person resides, unlike the population denominator. Unplanned presentations include presentations that were not pre-arranged, with the majority classified as emergency presentations. Presentations may be reported by triage category and admission status. For more complete definitions, please refer to the Codes tab.
Depending on the information system used in the emergency department at a point in time, the diagnosis of acute alcohol problem is recorded according to one of three classification systems: the International Classification of Diseases, 9th revision (ICD-9), the International Classification of Diseases and Related Health Problems, 10th revision (ICD-10) or the Systematised Nomenclature of Medicine — Clinical Terms (SNOMED-CT).
|Description||ICD-9 & ICD-9-CM||ICD-10 & ICD-10-AM||SNOMED-CT|
|Asthma||493||J45,J46||1945002, 11944003, 12428000, 16862005, 18197001, 19849005, 30352005, 31387002, 41997000, 55570000, 57546000, 57607007, 59327009, 63088003, 67415000, 80374003, 91340006, 92807009, 93432008, 134380003, 134381004, 134383001, 134384007, 135854001, 135855000, 135857008, 135858003, 135859006, 135861002, 135862009, 135863004, 161527007, 162660004, 170631002, 170632009, 170633004, 170634005, 170635006, 170636007, 170638008, 170658009, 195967001, 195968006, 195970002, 195971003, 195972005, 195973000, 195975007, 195976008, 195977004, 195979001, 195980003, 195981004, 195983001, 225057002, 233678006, 233679003, 233680000, 233681001, 233682008, 233683003, 233684009, 233685005, 233686006, 233690008, 241942008, 266361008, 266363006, 266364000, 266365004, 274105009, 278517007, 281239006, 304527002, 312453004, 312454005, 370202007, 370204008, 370205009, 370208006, 370218001, 370219009, 370220003, 370221004, 373899003, 389145006, 389146007, 390798007, 390921001, 394967008, 395022009, 397579009, 400987003, 401193004, 404804003, 404805002, 405720007, 405944004, 407674008, 409663006, 416601004, 418395004, 442025000|
Codes: Presentations to emergency departments in NSW
|Emergency Department coding category||Code and description|
Unplanned ED presentations
Emergency department presentation type:
01 Emergency presentations
03 Unplanned return visit for a continuing condition
09 Person in transit
10 Dead on arrival
13 Current admitted patient
Mode of separation:
1 Admitted to ward or inpatient unit, not a critical care ward
3 Admitted: died in ED
10 Admitted: to a critical care ward
11 Admitted: via operating suite
12 Admitted: transferred to another hospital
1 Immediately life-threatening condition: need to have treatment immediately or within two minutes
2 Imminently life-threatening condition: need to have treatment within 10 minutes
3 Potentially life-threatening condition: need to have treatment within 30 minutes
4 Imminently serious condition: need to have treatment within one hour
5 Less urgent condition: need to have treatment within two hours
• 11.5% of adults aged 16 years and over (8.4% of men and 14.4% of women) had asthma, as estimated from the 2019 NSW Adult Population Health Survey (self reported using a Computer Assisted Telephone Interview or CATI).
• Asthma was responsible for 165 deaths in 2017 and around 11,290 hospitalisations in 2018-19.
• In 2018-2019, 20.6% of children aged 2-15 years (24.1% of boys and 16.8% of girls) ever had asthma, as estimated from the NSW Population Health Survey.
• 14.2% of adult Aboriginal persons aged 16 years and over had asthma, as estimated from the 2018 NSW Adult Population Health Survey (self reported using a Computer Assisted Telephone Interview or CATI).
Self-reported data on asthma have been collected for adults in NSW since 1997 through the NSW Population Health Survey and parent-reported data on asthma have been collected for children in NSW since 2001 through the NSW Population Health Survey.
Prevalence estimates, although differing slightly between surveys because of different sampling frames, participation rates and modes of collection (telephone versus face-to-face personal interview) have not changed over time.
Centre for Epidemiology and Evidence, NSW Ministry of Health. NSW Population Health Survey. Available at: http://www.health.nsw.gov.au/epidemiology/Pages/nsw-population-health-survey.aspx
Australian Bureau of Statistics, National Health Survey: First Results (4364.0.55.001); NSW Table, 2017-2018. Available at: http://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0.55.001
Respiratory diseases include acute diseases such as influenza and pneumonia, and chronic respiratory diseases (specifically asthma, chronic obstructive pulmonary disease, asbestosis, and respiratory tuberculosis), where preventive measures and better management of conditions can reduce the burden of disease and reduce associated healthcare costs.
Chronic respiratory diseases were responsible for 7.5% of the total burden of disease and injury in Australia in 2015, with chronic obstructive pulmonary disease and asthma accounting for 51.4% and 33.8% of this burden, respectively (AIHW 2019).
Influenza and pneumonia are acute respiratory diseases that can be very severe and, in persons at high risk, can lead to death. Influenza and pneumonia cause around 2.5% of all deaths and around 0.9% of hospital separations and are an important cause of hospitalisations in the very young, and of death and hospitalisations among older age groups.
Asthma is a significant public health problem in Australia and it is estimated that Australian prevalence rates are among the highest in the world. Fortunately, recent studies in children show no further increase in prevalence. In Australia in 2015, asthma was estimated to account for 2.5% of the disease burden (AIHW 2019).
Chronic bronchitis and emphysema are the two main conditions comprising chronic obstructive pulmonary disease (COPD). In Australia in 2015, COPD was estimated to account for 3.9% of the disease burden (AIHW 2019).
Tuberculosis (TB) is caused by the bacterial organism Mycobacterium tuberculosis. Despite the increasing burden from respiratory tuberculosis globally, it is not a major public health problem in NSW. In fact the mortality and morbidity from all types of tuberculosis in NSW is one of the lowest in the world.
Lung cancer is usually excluded from analyses of respiratory diseases as it is classified with cancers in the International Classification of Diseases (the coding system used for health data in NSW). It has been included with respiratory diseases here to provide a more appropriate measure of the burden of respiratory disease from a clinical and health services planning perspective.
Cigarette smoking is the main risk factor for both COPD and lung cancer and the current incidence rates of these conditions reflect smoking rates 20 years and more in the past. Lung cancer is one of the leading causes of death in Australia.
Australian Institute of Health and Welfare 2019. Australian Burden of Disease Study: Impact and causes of illness and death in Australia 2015. Australian Burden of Disease Study series no. 19. BOD 22. Canberra: AIHW. Available at: https://www.aihw.gov.au/reports/burden-of-disease/burden-disease-study-illness-death-2015/contents/table-of-contents
Written asthma management plans are recommended as part of the national guidelines for the management of asthma: Australian Asthma Handbook (NACA 2015). They enable people with asthma to recognise a deterioration in their condition and initiate appropriate treatment, thereby reducing the severity of acute episodes.
The Australian Asthma Handbook promotes preventive care activities, proper inhaler technique and adherence and stepped medical management where the use of medicines can be increased or decreased depending on circumstances and the therapy combinations.
Australia is fortunate in having one of the lowest rates of TB in the world. This has been primarily achieved as a result of a continued commitment to provide specialised health services dedicated to the prevention and control of TB in each of the states and territories. The National TB Advisory Committee’s Strategic Plan for the Control of Tuberculosis, 2011-2015 sets out the goals and objectives of TB control in Australia.
Despite Australia’s success in reducing TB, there is no room for complacency. Global connectivity through air travel and migration means that TB will remain a public health concern in Australia until worldwide control of TB is achieved. The NSW TB Program is the provider of specialised services for the prevention and control of TB in NSW and plays a vital role in maintaining Australia’s success in reducing the burden of TB.
Influenza and pneumonia
Influenza and pneumococcal disease are covered by the National Immunisation Programs in NSW.
Influenza has been a notifiable disease by all laboratories under the Public Health Act in NSW since 2001. Surveillance is enhanced in winter months when the NSW Ministry of Health collects and reports weekly on influenza-like illness presentations to Emergency Departments, through the Public Health Rapid, Emergency, Disease and Syndromic Surveillance System (PHREDSS), and laboratory-confirmed diagnoses of influenza virus infections.
Emergency Departments in NSW are prepared for influenza epidemics with peak visit plans and similar measures in winter months.
National Asthma Council Australia. Australian Asthma Handbook. NACA, 2015. Available at: https://www.nationalasthma.org.au/health-professionals/australian-asthma-handbook
Australian Centre for Airways disease Monitoring (ACAM) at http://www.asthmamonitoring.org
National Asthma Council Australia at http://www.nationalasthma.org.au
Australian Bureau of Statistics at http://www.abs.gov.au
Australian Institute of Health and Welfare at http://www.aihw.gov.au
healthdirect at http://www.healthdirect.gov.au