Using an emergency department syndromic surveillance system to investigate the impact of extreme cold weather events

H. E. Hughes*, Roger Morbey, T. C. Hughes, T. E. Locker, T. Shannon, C. Carmichael, Virginia Murray, Susan Ibbotson, Mike Catchpole, B. McCloskey, Gillian Smith, Alex Elliot

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

21 Citations (Scopus)


This report describes the development of novel syndromic cold weather public health surveillance indicators for use in monitoring the impact of extreme cold weather on attendances at EDs, using data from the 2010-11 and 2011-12 winters.A number of new surveillance indicators were created specifically for the identification and monitoring of cold weather related ED attendances, using the diagnosis codes provided for each attendance in the Emergency Department Syndromic Surveillance System (EDSSS), the first national syndromic surveillance system of its kind in the UK. Using daily weather data for the local area, a time series analysis to test the sensitivity of each indicator to cold weather was undertaken.Diagnosis codes relating to a health outcome with a potential direct link to cold weather were identified and assigned to a number of 'cold weather surveillance indicators'. The time series analyses indicated strong correlations between low temperatures and cold indicators in nearly every case. The strongest fit with temperature was cold related fractures in females, and that of snowfall was cold related fractures in both sexes.Though currently limited to a small number of sentinel EDs, the EDSSS has the ability to give near real-time detail on the magnitude of the impact of weather events. EDSSS cold weather surveillance fits well with the aims of the Cold Weather Plan for England, providing information on those particularly vulnerable to cold related health outcomes severe enough to require emergency care. This timely information aids those responding to and managing the effects on human health, both within the EDs themselves and in the community as a whole.

Original languageEnglish
Pages (from-to)628-635
Number of pages8
JournalPublic Health
Issue number7
Publication statusPublished - Jul 2014

Bibliographical note

Copyright 2014 Elsevier B.V., All rights reserved.


  • Cold weather
  • Emergency department
  • Injury
  • Syndromic surveillance


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