{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T13:53:20Z","timestamp":1781790800030,"version":"3.54.5"},"reference-count":40,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"The U.S. Centers for Disease Control and Prevention","award":["NU50CK000517-05-02"],"award-info":[{"award-number":["NU50CK000517-05-02"]}]},{"name":"The U.S. Centers for Disease Control and Prevention","award":["NU51CK000368-02-00"],"award-info":[{"award-number":["NU51CK000368-02-00"]}]},{"name":"The U.S. Centers for Disease Control and Prevention","award":["NU90TU000059-02"],"award-info":[{"award-number":["NU90TU000059-02"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Public Health Research"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Illness trends are typically monitored by reportable disease and syndromic surveillance systems, but unanticipated health issues might not be captured. Using diagnosis codes, the New York City Health Department developed a novel data mining process to detect unusual increases in emergency department (ED) visits for any reason.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We applied the tree-temporal scan statistic in TreeScan software to ICD-10-CM diagnosis codes for ED visits. We searched for unusual citywide increases in ED visits or hospital admissions, over any recent time period, and at any part of and level on the ICD-10-CM tree. We conducted proof-of-concept analyses for March 2020 when COVID-19 emerged, then investigated signals detected in daily, automated analyses during April\u2013August 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>If TreeScan analyses had been in place, then increasing hospital admissions for viral pneumonia (J12) would have triggered a signal on March 13, 2020, two days before widespread COVID-19 community transmission was announced. An extreme heat event in June 2025 triggered a signal for admissions for acute kidney failure (N17), prompting outreach to dialysis networks. A sustained signal for hand, foot, and mouth disease (B08.4) prompted outreach to child care programs. Other signals supported situational awareness, including a seasonal increase for swimmer\u2019s ear (H60.33) and burns (T30.0) related to consumer fireworks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>TreeScan quickly detected credible increases in various diagnoses without pre-specification, from minor to severe, rare to common, acute to sustained, and foreseen to unforeseen. TreeScan can strengthen surveillance for health issues related to new pathogens, non-notifiable conditions, environmental exposures, and mass gatherings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/22799036261457753","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T16:23:18Z","timestamp":1781626998000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Asyndromic surveillance of New York City emergency department diagnoses with the tree-temporal scan statistic"],"prefix":"10.1177","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3509-2377","authenticated-orcid":false,"given":"Sharon K.","family":"Greene","sequence":"first","affiliation":[{"name":"New York City Department of Health and Mental Hygiene"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison","family":"Levin-Rector","sequence":"additional","affiliation":[{"name":"New York City Department of Health and Mental Hygiene"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Kulldorff","sequence":"additional","affiliation":[{"name":"Independent Biostatistician"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4079-4610","authenticated-orcid":false,"given":"Ramona","family":"Lall","sequence":"additional","affiliation":[{"name":"New York City Department of Health and Mental Hygiene"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,16]]},"reference":[{"key":"e_1_3_7_2_2","unstructured":"New York City Health Code. Article \u00a711.03 Diseases and conditions of public health interest that are reportable. https:\/\/www.nyc.gov\/assets\/doh\/downloads\/pdf\/about\/healthcode\/health-code-article11.pdf Accessed 25 August 2025."},{"key":"e_1_3_7_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/0033354917711183"},{"key":"e_1_3_7_4_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6946a2"},{"key":"e_1_3_7_5_2","unstructured":"CDC. New ICD-10-CM code for the 2019 Novel Coronavirus (COVID-19). Published 18 March 2020. https:\/\/www.cdc.gov\/nchs\/data\/icd\/Announcement-New-ICD-code-for-coronavirus-3-18-2020.pdf (2020) Accessed 25 August 2025."},{"key":"e_1_3_7_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/00333549231186574"},{"key":"e_1_3_7_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.28654"},{"key":"e_1_3_7_8_2","unstructured":"Council of State and Territorial Epidemiologists. Heat-related illness syndrome query: a guidance document for implementing heat-related illness syndromic surveillance in public health practice. Version 1.0. https:\/\/cdn.ymaws.com\/www.cste.org\/resource\/resmgr\/pdfs\/pdfs2\/CSTE_Heat_Syndrome_Case_Defi.pdf (2016) Accessed 25 August 2025."},{"key":"e_1_3_7_9_2","doi-asserted-by":"publisher","DOI":"10.5210\/ojphi.v7i3.6354"},{"key":"e_1_3_7_10_2","doi-asserted-by":"publisher","DOI":"10.5210\/ojphi.v7i1.5675"},{"key":"e_1_3_7_11_2","doi-asserted-by":"publisher","DOI":"10.5210\/ojphi.v6i1.5069"},{"key":"e_1_3_7_12_2","doi-asserted-by":"publisher","DOI":"10.5210\/ojphi.v9i1.7718"},{"key":"e_1_3_7_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.artmed.2004.04.001"},{"key":"e_1_3_7_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103158"},{"key":"e_1_3_7_15_2","doi-asserted-by":"publisher","DOI":"10.1126\/sciadv.abm4920"},{"key":"e_1_3_7_16_2","unstructured":"National Center for Health Statistics CDC. International Classification of Diseases Tenth Revision Clinical Modification (ICD-10-CM). https:\/\/www.cdc.gov\/nchs\/icd\/icd-10-cm (2024) Accessed 25 August 2025."},{"key":"e_1_3_7_17_2","unstructured":"Sheppard M. Rnssp R Markdown template: ICD-10 discharge diagnosis code usage and features. National Syndromic Surveillance Program Centers for Disease Control and Prevention. https:\/\/cdcgov.github.io\/Rnssp-rmd-templates\/templates\/icd10codeuse\/ Accessed 25 August 2025."},{"key":"e_1_3_7_18_2","doi-asserted-by":"publisher","DOI":"10.1111\/1541-0420.00039"},{"key":"e_1_3_7_19_2","doi-asserted-by":"publisher","DOI":"10.1002\/pds.3423"},{"key":"e_1_3_7_20_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwy023"},{"key":"e_1_3_7_21_2","doi-asserted-by":"publisher","DOI":"10.1002\/pds.4397"},{"key":"e_1_3_7_22_2","unstructured":"CDC. Value sets associated with PHIN Messaging Guide for Syndromic Surveillance. Version 15. Published 30 September 2015. https:\/\/phinvads.cdc.gov\/vads\/ViewView.action?name=Syndromic%20Surveillance Accessed 25 August 2025."},{"key":"e_1_3_7_23_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001885"},{"key":"e_1_3_7_24_2","unstructured":"Centers for Medicare & Medicaid Services. 2025 ICD-10-CM: 2025 Code Tables Tabular and Index (ZIP). Accessed 11 September 2024. https:\/\/www.cms.gov\/medicare\/coding-billing\/icd-10-codes"},{"key":"e_1_3_7_25_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7423a1"},{"key":"e_1_3_7_26_2","volume-title":"TreeScanTM software version 2.3 (January 2025) and TreeScanTM user guide for version 2.1","author":"Kulldorff M and Information Management Services, Inc","year":"2022","unstructured":"Kulldorff M and Information Management Services, Inc. TreeScanTM software version 2.3 (January 2025) and TreeScanTM user guide for version 2.1. 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Environment & Health Data Portal: Real-time heat-related illness. https:\/\/a816-dohbesp.nyc.gov\/IndicatorPublic\/data-features\/heat-syndrome\/ Accessed 25 August 2025."},{"key":"e_1_3_7_34_2","article-title":"Hand, foot and mouth disease is spreading again this summer","author":"Bajaj S","year":"2025","unstructured":"Bajaj S. Hand, foot and mouth disease is spreading again this summer. The New York Times 2025. https:\/\/www.nytimes.com\/2025\/07\/29\/well\/hand-foot-and-mouth-disease-symptoms-treatment.html (Accessed 25 August 2025).","journal-title":"The New York Times"},{"key":"e_1_3_7_35_2","volume-title":"This July 4, Spark Joy \u2014 Not Amateur Fireworks","author":"NYC Health Department","unstructured":"NYC Health Department. This July 4, Spark Joy \u2014 Not Amateur Fireworks. 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