{"id":25847566,"date":"2025-08-13T14:23:41","date_gmt":"2025-08-13T14:23:41","guid":{"rendered":"https:\/\/odalertsdev.wpengine.com\/?page_id=25847566"},"modified":"2026-03-13T15:28:23","modified_gmt":"2026-03-13T15:28:23","slug":"develop-case-definitions","status":"publish","type":"page","link":"https:\/\/odalerts.cste.org\/?page_id=25847566","title":{"rendered":"Develop Case Definitions"},"content":{"rendered":"

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This section guides public health practitioners through defining clear and comprehensive case definitions to identify overdose events as part of an anomaly investigation. While many jurisdictions already have case definitions embedded within their surveillance systems, others may need to develop or adapt them to ensure consistent identification and reporting. This section focuses on defining an overdose, not whether an outbreak has occurred.<\/div>\n

[\/et_pb_blurb][et_pb_blurb title=”Emergency Department Case Definition” image_icon_width=”40px” icon_alignment=”left” content_max_width=”100%” _builder_version=”4.14.2″ _module_preset=”default” header_font=”|600|||||||” header_text_align=”left” header_text_color=”#071018″ header_font_size=”22px” header_letter_spacing=”-0.2px” header_line_height=”1.2em” body_font=”Poppins||||||||” body_text_color=”#64748B” body_font_size=”20px” body_line_height=”1.4em” text_orientation=”center” custom_margin=”15px||80px|0px|false|false” custom_padding=”|56px||56px|false|true” header_font_size_tablet=”22px” header_font_size_phone=”18px” header_font_size_last_edited=”on|phone” body_font_size_tablet=”” body_font_size_phone=”12px” body_font_size_last_edited=”on|phone” custom_css_blurb_title=”text-transform: none;” locked=”off” global_colors_info=”{}”]<\/p>\n

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An emergency department case definition for overdose involves\u202fidentifying encounters related to drug toxicity, often using a combination of keywords in the chief complaint or discharge diagnosis fields, including terms like “overdose” or “poisoning” with an unspecified or specified drug, and may also incorporate the administration and response to naloxone in the patient’s record. Utilize\u202fICD-10-CM codes (CDC\u2019s 2018 Annual Surveillance Report of Drug-Related Risks and Outcomes<\/a>) when possible. <\/span><\/p>\n

Most ED visits classified as overdose are not lab-confirmed by toxicology and will differ from syndromic definitions. <\/span><\/p>\n

ICD-10-CM Injury Codes for drug-related poisonings are available in\u202fCDC\u2019s 2018 Annual Surveillance Report<\/a> of Drug-Related Risks and\u202fOutcomes. Hospital discharge ICD-10-CM definitions used will differ from syndromic definitions, which include additional unstandardized text to assist in the identification of an overdose.<\/span><\/p>\n<\/div>\n

[\/et_pb_blurb][et_pb_blurb title=”EMS Nonfatal Opioid Overdose Case Definition” image_icon_width=”40px” icon_alignment=”left” content_max_width=”100%” _builder_version=”4.14.2″ _module_preset=”default” header_font=”|600|||||||” header_text_align=”left” header_text_color=”#071018″ header_font_size=”22px” header_letter_spacing=”-0.2px” header_line_height=”1.2em” body_font=”Poppins||||||||” body_text_color=”#64748B” body_font_size=”20px” body_line_height=”1.4em” text_orientation=”center” custom_margin=”15px||80px|0px|false|false” custom_padding=”|56px||56px|false|true” header_font_size_tablet=”22px” header_font_size_phone=”18px” header_font_size_last_edited=”on|phone” body_font_size_tablet=”” body_font_size_phone=”12px” body_font_size_last_edited=”on|phone” custom_css_blurb_title=”text-transform: none;” locked=”off” global_colors_info=”{}”]<\/p>\n

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An EMS nonfatal overdose case definition\u202foften incorporates elements like the administration of naloxone and documented improvement, or specific mentions of overdose-related symptoms or keywords in the patient narrative. <\/span><\/p>\n

Most jurisdictions already use definitions built on standard EMS fields, and CSTE has worked with national partners to develop a Nonfatal Opioid Overdose Standardized Surveillance Case Definition<\/a>.\u202fThis definition uses six validated EMS fields (Provider\u2019s Primary Impression;\u202fProvider\u2019s Secondary Impression;\u202fPrimary Symptom;\u202fOther Associated Symptoms;\u202fMedication Administered;\u202fResponse to Medication Administered) along with free-text narrative fields to identify a nonfatal opioid overdose. <\/span><\/p>\n

The following table highlights NEMSIS data elements that may be useful for developing your own case definition.\u202fIt is not exhaustive in nature and should not replace any standing jurisdictional guidance.<\/span>
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\n \n\n \n \n \n \n \n \n
\n Data\u00a0Source\u00a0 <\/th>\n \n NEMSIS v3 Variable\u00a0 <\/th>\n \n NEMSIS v3 Variable Definition\u00a0 <\/th>\n \n NEMSIS v3 Variable Options\u00a0 <\/th>\n <\/tr>\n
\n Patient Care Report Narrative\u00a0 <\/td>\n \n eNarrative.01 - Patient Care Report Narrative\u00a0 <\/td>\n \n The narrative of the patient care report (PCR).\u00a0 <\/td>\n \n State, E, 0:1 \nString values 1-10000 characters\u00a0 <\/td>\n <\/tr>\n
\n Medication Administered by EMS\u00a0 <\/td>\n \n eMedications.03 - Medication Given\u00a0 <\/td>\n \n The medication given to the patient.\u00a0 <\/td>\n \n National, State, R, 1:1\u00a0\nString based on\u00a0RxNorm\u00a0(RXCUI) codes\u00a0\nPertinent Negatives (PN):\u00a0\u00a0\n8801001 \u2013 Contraindication Noted\u00a0\u00a0\n8801003 \u2013 Denied By Order\u00a0\u00a0\n8801007 \u2013 Medication Allergy\u00a0\u00a0\n8801009 \u2013 Medication Already Taken\u00a0\u00a0\n8801019 \u2013 Refused\u00a0\u00a0\n8801023 \u2013 Unable to Complete\u00a0 <\/td>\n <\/tr>\n
\n Response to Medication\u00a0 <\/td>\n \n eMedications.01 - Medication Given\u00a0 <\/td>\n \n The patient\u2019s response to the medication.\u00a0 <\/td>\n \n National, State, R, 1:1\u00a0\nCode Description:\u00a0\n9916001 \u2013 Improved\u00a0\n9916003 \u2013 Unchanged\u00a0\n9916005 - Worse\u00a0 <\/td>\n <\/tr>\n
\n Primary Impression (including ICD-10-CM codes)\u00a0 <\/td>\n \n eSituation.11 - Provider\u2019s Primary Impression\u00a0 <\/td>\n \n The EMS personnel\u2019s impression of the patient\u2019s primary problem or most significant condition which led to the management given to the patient (treatments, medications, or procedures).\u00a0 <\/td>\n \n National, State, R, 1:1\u00a0\u00a0\nICD-10-CM codes: (R[0-6][0-9](\\.[0-9]{1,4})?|(R73\\.9)|\n(R99))|([A-QSTZ][0-9][0-9A-Z])((\\.[0-9A-Z]{1,4})?)\u00a0\u00a0\u00a0 <\/td>\n <\/tr>\n
\n Secondary Impression\u00a0 <\/td>\n \n ESituation.12 - Provider\u2019s Secondary Impressions\u00a0 <\/td>\n \n The EMS personnel\u2019s impression of the patient\u2019s secondary problem or most significant condition which led to the management given to the patient (treatments, medications, or procedures).\u00a0 <\/td>\n \n National, State, R, 1:M\u00a0\nString values based on ICD-10-CM codes, 1-255 characters\u00a0 <\/td>\n <\/tr>\n <\/table>\n<\/div>