BACKGROUND:Emergency departments (EDs) serve an important role in the care of patients who are imprisoned (incarcerated) in the federal and state prison systems, and the University of North Carolina Healthcare (UNCH) System helps provide care to these patients. Our aim was to identify and characterize this marginalized patient population by payer source, compare it with the general ED population, and, ultimately, seek ways to improve ED and follow-up care. METHODS:This was a hypothesis-generating study utilizing two separate ED sites: a tertiary referral academic ED and a smaller, academically affiliated community hospital. Retrospective data were sourced from the Epic Electronic Health Record via the Carolina Data Warehouse for Health, part of the North Carolina Translational and Clinical Sciences Institute. All ED encounters involving incarcerated individuals were obtained from January 1, 2018, through December 31, 2024. Inmate encounters were identified via a distinct payer source, the NC Department of Public Safety. Descriptive statistics, including means and percentages, were generated using Python (Python Software Foundation, Beaverton, Oregon) and pandas (The pandas development team, NumFOCUS, Austin, Texas). RESULTS:A total of 555 encounters involving 478 unique patients were identified. The majority of patients presenting from NC prison facilities were male (92.4% of encounters), compared with 43.7% of ED patients overall. The average age was similar (46.4 versus 49.7 years), but a smaller proportion of patients from prison were younger (18-24 years old) or older (over 65 years old). A higher percentage of patients presenting from prison were identified as Black or African American (44.9% versus 29.6%). The most common chief complaints were abdominal pain, chest pain, and "abnormal lab," compared with abdominal pain, chest pain, and shortness of breath in the general ED population. CONCLUSION:Challenges exist in retrospectively identifying incarcerated patients in the ED for research. Using a distinct payer source, we identified and characterized a cohort of incarcerated patients and compared them with other ED patients. Future work will investigate how to improve ED and follow-up care for this unique patient population.

STUDY OBJECTIVE:Frequent past-year emergency department (ED) use is a risk factor for suicide but also presents an intervention opportunity. This study aimed to quantify ED visit timing among suicide decedents by past-year ED use and characterize differences between suicide decedents and other ED patient populations. METHODS:ED records were obtained from the North Carolina Disease Event Tracking and Epidemiological Collection Tool (NC DETECT), and death records were obtained from the NC Violent Death Reporting System (NC-VDRS). ED visits corresponding to the decedent's suicide were probabilistically linked to their corresponding death record. Decedents were classified as frequent (≥4) and infrequent (<4) users based on nonfatal ED visits occurring within one year of their death. Timing from decedents' final nonfatal visit to death was assessed. Decedents' demographics and visit characteristics were compared with all ED patients and mental health patients, stratified by past-year use. RESULTS:From 2019 to 2020, 670 of 2,883 NC-VDRS suicide decedents linked to an ED visit associated with their suicide. One third (n=213) of linked decedents had past-year ED use. Among these individuals, 21.6% (n=46) were frequent users. Within 30 days of their final nonfatal visit, only 28% of frequent users survived, compared with 65% of infrequent users (difference: -36.4% [-51.3% to -21.5%]). Suicide decedents with frequent use were distinct from infrequent users and from both reference groups regarding demographic and visit-level characteristics. CONCLUSION:Suicide decedents who visited the ED once or who were frequent users were demographically distinct from the overall population of ED patients. Timing from final nonfatal ED visit to death by suicide varied with past-year use.

Objective About one million United States emergency department (ED) visits annually are due to acute decompensated heart failure (ADHF) symptoms. Characterizing the presentation of ED symptoms among ADHF patients may improve clinical care; however, sex and age differences in ED chief complaints have not been thoroughly investigated. In this paper, we describe differences in chief complaints and comorbid conditions for ED patients with ADHF diagnoses, stratified by sex and age. Methods We conducted a retrospective analysis of adults presenting to North Carolina EDs using the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT), a statewide syndromic surveillance system, between 2010 and 2016, screening for patients with a diagnosis of ADHF. We evaluated frequencies of chief complaint categories for ED visits and comorbid conditions, stratified by sex and age, and computed standardized differences. Results The most common chief complaints were dyspnea (19.1%), chest pain (13.5%), and other respiratory complaints (13.4%). In the 18-44 years age group, women were more likely than men to report nausea/vomiting (6.7% vs. 4.1%) and headache (4.2% vs. 2.0%). In those 45-64 and >= 65 years, complaints were similar by sex. When stratified by age group alone, the 18-44 and 45-64 years age groups had more complaints of chest pain, whereas balance issues, weakConclusion Differences in atypical ADHF symptoms were seen in in ED patients based on sex and age. Understanding the variation in ADHF symptoms among ED patients can facilitate the identification of ED patients with ADHF and improve management of ADHF-related symptoms.

CONTEXT:Timely and representative data for sexual violence surveillance in the United States are lacking. OBJECTIVE:To address this gap, we aimed to improve the identification of sexual violence in syndromic surveillance emergency department (ED) visit data through evaluation of the latest Centers for Disease Control and Prevention (CDC) sexual violence surveillance definition (CDC V3) using North Carolina (NC) syndromic surveillance data and development of an enhanced definition (V4). DESIGN:We created a gold standard dataset of visits representing incident sexual violence, history of sexual violence, or no sexual violence through manual review, developed an enhanced V4 definition based on this review, and then compared the performance of the CDC V3 and V4 definitions against the gold standard. SETTING:North Carolina. PARTICIPANTS:Emergency department visits in NC, 1/1/2016-6/3/2024. MAIN OUTCOME MEASURES:We compared the precision measures (Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value, and F1) of the CDC V3 and new V4 definitions for sexual violence. We applied both definitions to NC ED visit data for 2019-2023 to compare demographics and crude rates. RESULTS:The CDC V3 sexual violence definition proved highly specific. The V4 definition identified a 6% increase in incident sexual violence ED visits compared to the CDC V3 definition, with additional chief complaint search terms and the selective incorporation of triage notes. Trends in patient sex, age group, race, and ethnicity were similar across both definitions. The F1 score showed improvement for the V4 definition compared to the CDC V3 definition, suggesting that it better optimizes the need to comprehensively identify ED visits for sexual violence while minimizing false positives. CONCLUSIONS:Syndromic surveillance ED visit data provide timely, population-based data on this complex topic. Building upon the CDC V3 definition and incorporating triage notes where available allowed us to develop a more sensitive and accurate surveillance definition for incident sexual violence.

BACKGROUND:In 2015, the CDC removed unspecified head injuries from its TBI surveillance case definition, complicating the investigation of long-term morbidity trends. We examined the long-term impact of this change on quantifying statewide TBI incidence. METHODS:North Carolina emergency department (ED) visit records were obtained from 2012 to 2024 and classified based on the presence (S09.90+) or absence (S09.90-) of the ICD-10-CM code for "head injury, unspecified". Segmented Poisson regression was used to compare slope- and level-changes in monthly TBI visit counts. RESULTS:From January 2012 through September 2015, TBI visits increased at a rate of 14.9 visits per month. TBI visits dropped at the onset of COVID-19, and then rebounded after the relaxation of the state's stay-at-home-order; however, this trend was diminished under the S09.90- definition, with a difference of 75.9 (57.2-94.6) visits per month between the two definitions. CONCLUSIONS:The presence of unspecified head injuries in the TBI surveillance case definition substantially altered statewide trends and their inclusion may better reflect injury burden.

Long-term impacts of the COVID-19 pandemic on racial and ethnic disparities in motor vehicle crash (MVC) injuries and death are poorly understood. This study aimed to characterize trends and investigate the heterogeneity of MVC-related disparities in North Carolina across several data sources. Crash reports, emergency department visit records, and death certificates from 2018 to 2021 were used to calculate monthly population-rates of MVC-related public health outcomes. We estimated trendlines using joinpoint regression and compared outcomes across racial and ethnic classifications. MVC and MVC-related injury rates declined in conjunction with NC's stay-at-home order, while rates of severe outcomes remained unimpacted. By December 2021 rates of MVC-related outcomes met or exceeded pre-pandemic levels, with the highest rates observed among non-Hispanic Black individuals. Racial and ethnic disparities in MVC-related outcomes remained prevalent throughout the COVID-19 pandemic. These results highlight the importance of a holistic approach to traffic injury surveillance when assessing the impact of MVCs.

Abstract Background Firearm violence is a significant public health issue. However, it is unclear if there is an association between the Social Vulnerability Index (SVI) and the intent of both fatal and nonfatal firearm injuries, and if these associations are modified by community race and ethnic composition. This study examines the association between community-level social vulnerability and firearm injury incidence in North Carolina (NC) using 2021–2022 emergency medical services (EMS) data. Additionally, it investigates how these associations vary by the intent of injury (assault, self-inflicted, and unintentional), and whether they are modified by community racial/ethnic composition. Methods This cross-sectional study utilized NC EMS data, capturing firearm incidents from January 1, 2021, to December 31, 2022. The SVI from the Centers for Disease Control and Prevention (CDC) was used to assess community-level vulnerability. The SVI’s racial/ethnic minority status component was removed for stratification analysis. Firearm injury rates were calculated per 100,000 population, and negative binomial regression models were used to estimate Incidence Rate Ratios (IRRs) for different SVI levels and intents of firearm injuries. Results During the study period, we identified 7,250 EMS encounters at non-healthcare locations related to firearm injuries, encompassing 2,648 NC census tracts. Assault was the leading cause of firearm injuries (n = 3,799), followed by self-inflicted (n = 1,498), and unintentional injuries (n = 722). High-SVI communities had significantly higher rates of firearm injuries compared to low-SVI communities, particularly for assault-related injuries. When the minority status component was excluded from SVI, racial/ethnic minority status emerged as a significant modifier, with higher rates of firearm injuries being observed in communities with larger racial/ethnic minority populations. Conclusion Community-level social vulnerability is significantly associated with firearm injury incidence, with the effect being more pronounced in racial/ethnic minority communities. These findings underscore the need for targeted public health interventions that address underlying social determinants of health (e.g., access to education) to reduce firearm violence. Future research should further explore the intersection of social vulnerability and racial/ethnic composition to develop effective prevention strategies.

BACKGROUND:The timeliness, accuracy, and completeness of data for firearm injury surveillance is crucial for public health surveillance efforts and informing injury prevention measures. While emergency department (ED) visit data can provide near real-time information on firearms injuries, there are concerns surrounding the accuracy of intent coding in these data. We examined whether emergency medical service (EMS) data provide more accurate firearm injury intent coding in comparison to ED data.METHODS:We applied a firearm injury definition to EMS encounter data in NC's statewide syndromic surveillance system (NC DETECT), from January 1, 2021, through December 31, 2022. We manually reviewed each record to determine intent, and the corresponding manual classifications were compared to the injury cause codes entered in the EMS data and to ED visit records where EMS-ED record linkage was possible. We then calculated the sensitivity, specificity, positive and negative predictive values for each intent classification in SAS 9.4 using the manually reviewed intent classifications as the gold standard.RESULTS:We identified 9557 EMS encounters from January 1, 2021, through December 31, 2022 meeting our firearm injury definition. After removing false positives and duplicates, 8584 records were available for manual injury classification. Overall, our analysis demonstrated that manual and EMS injury cause code classifications were comparable. However, for the 3401 EMS encounters that could be linked to an ED visit record, sensitivity of the ED ICD-10-CM codes was low for assault and intentional self-harm encounters at 18.2% (CI 16.5-19.9%) and 22.2% (CI 16-28.5%), respectively. This demonstrates a marked difference in the reliability of the intent coding in the two data sources.CONCLUSIONS:This study illustrates both the value of examining EMS encounters for firearm injury intent, and the challenges of accurate intent coding in the ED setting. EMS coding has the potential for more accurate intent coding than ED coding within the context of existing hospital-based coding guidance. This may have implications for future firearm injury research, especially for nonfatal firearm injuries.

ObjectiveDrowning is a leading cause of injury-related death in the pediatric and adolescent population. This epidemiologic study describes the trends in emergency department (ED) visits for pediatric drowning injury in North Carolina and the impact of the coronavirus disease 2019 (COVID-19) pandemic on incidence rate.MethodsData were obtained using the North Carolina Disease Event Tracking and Epidemiologic Collection Tool, a public health surveillance system, to identify ED visits for drowning injury from 2016 to 2022. We performed a chart review on a subset of patients to further characterize injury.ResultsA total of 1285 ED encounters were identified. In North Carolina, the incidence rate of pediatric drowning has been decreasing, abruptly in 2019 and again in 2020. The postpandemic rate continued in the same downward trend, suggesting that the COVID-19 pandemic did not affect the overall statewide incidence rate of pediatric drowning (P = 0.14). The age distribution of children treated in the ED for drowning injury in North Carolina changed following the pandemic.ConclusionsThis study is limited by the fortunate rarity of pediatric drowning events. Injuries may be underreported because these are only ED presentations. This study relied on provider documentation in electronic health records. The definition of postpandemic is not well defined, and sequelae of the COVID-19 pandemic may not yet be fully appreciated. The incidence of North Carolina ED encounters for drowning injury in the pediatric population has decreased, and the COVID-19 pandemic had a noticeable, although not statistically significant, effect.

ObjectiveLinking data between violent death decedents and other sources can provide valuable insight, highlighting opportunities for prevention of violent injury. This study investigated the feasibility of linking North Carolina Violent Death Reporting System (NC-VDRS) records with North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) emergency department (ED) visit data to identify prior-month ED visits among this population.MethodsNC-VDRS death records from 2019 through 2020 were linked to NC DETECT ED visit data from December 2018 through 2020 using a probabilistic linkage approach. Linkage variables included date of birth, age, sex, zip code and county of residence, date of event (death/ED visit) and mechanism of injury. Potential linkable ED visits were filtered to those occurring in the month prior to death and manually reviewed for validity. Linked records were compared with the NC-VDRS study population to assess linkage performance and generalisability.ResultsAmong the 4768 violent deaths identified, we linked 1340 NC-VDRS records to at least one ED visit in the month prior to death. A higher proportion of decedents dying in medical facilities (ED/outpatient, hospital inpatient, hospice or nursing/long-term care facility) linked to a prior-month visit (80%) relative to those dying in other locations (12%). When stratified by place of death, linked decedents demographically resembled the overall NC-VDRS study population.ConclusionsThough resource intensive, an NC-VDRS-to-NC DETECT linkage was successful in identifying prior-month ED visits among violent death decedents. This linkage should be leveraged to further analyse ED utilisation prior to violent death, expanding the knowledge base surrounding prevention opportunities for violent injuries.

The COVID-19 pandemic has had far-reaching impacts on the health and well-being of North Carolinians, including injury and violence. Firearm purchases surged and, as the pandemic evolved, North Carolinians experienced increases in firearm-related deaths and injuries. This paper describes firearm injuries and deaths in the state from 2017 to 2021.

Context:Local health departments (LHDs) need timely county-level and subcounty-level data to monitor health-related trends, identify health disparities, and inform areas of highest need for interventions as part of their ongoing assessment responsibilities; yet, many health departments rely on secondary data that are not timely and cannot provide subcounty insights.Objective:We developed and evaluated a mental health dashboard in Tableau for an LHD audience featuring statewide syndromic surveillance emergency department (ED) data in North Carolina from the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT).Design:We developed a dashboard that provides counts, crude rates, and ED visit percentages at statewide and county levels, as well as breakdowns by zip code, sex, age group, race, ethnicity, and insurance coverage for 5 mental health conditions. We evaluated the dashboards through semistructured interviews and a Web-based survey that included the standardized usability questions from the System Usability Scale.Participants:Convenience sample of LHD public health epidemiologists, health educators, evaluators, and public health informaticians.Results:Six semistructured interview participants successfully navigated the dashboard but identified usability issues when asked to compare county-level trends displayed in different outputs (eg, tables vs graphs). Thirty respondents answered all questions on the System Usability Scale for the dashboard, which received an above average score of 86.Conclusions:The dashboards scored well on the System Usability Scale, but more research is needed to identify best practices in disseminating multiyear syndromic surveillance ED visit data on mental health conditions to LHDs.

By Anna Waller, Katherine J. Harmon & 2 more. A better understanding of firearm decedents with multiple ED visits in the year prior to death and the circumstances of their ED visits can contribute to more effective targeted interventions.

Mental and behavioral health conditions among school-aged children, including substance use disorders and overall emotional well-being, are a public health concern in the United States. Timely data on seasonal patterns in child and adolescent conditions can guide optimal timing of prevention and intervention strategies. CDC examined emergency department (ED) visit data from the National Syndromic Surveillance Program for 25 distinct conditions during January 2018-June 2023 among U.S. children and adolescents aged 5-17 years, stratified by age group. Each year, during 2018-2023, among persons aged 10-14 and 15-17 years, the number and proportion of weekly ED visits for eight conditions increased in the fall school semester and remained elevated throughout the spring semester; ED visits were up to twice as high during school semesters compared with the summer period. Among children aged 5-9 years, the number and proportion of visits increased for five mental and behavioral health conditions. Seasonal increases in ED visits for some conditions among school-aged children warrant enhanced awareness about mental distress symptoms and the challenges and stressors in the school environment. Systemic changes that prioritize protective factors (e.g., physical activity; nutrition; sleep; social, community, or faith-based support; and inclusive school and community environments) and incorporate preparedness for increases in conditions during back-to-school planning might improve child and adolescent mental health.

Introduction: Pregnancy-associated complaints are a common reason for emergency department visits for women of reproductive age. Emergency department utilization during pregnancy is associated with worse birth outcomes for both mothers and infants. We used statewide North Carolina emergency department surveillance data between 2016 and 2021 to describe the sociodemographic factors associated with the use of emergency department for pregnancy-associated problems and subsequent hospital admission. Methods: North Carolina Disease Event Tracking and Epidemiologic Collection Tool is a syndromic surveillance system that includes all emergency department encounters at civilian acutecare facilities in North Carolina. We analyzed all emergency department visits between January 1, 2016 and December 31, 2021 for female patients aged 15-44 years residing in North Carolina with at least 1 ICD-10-CM code (analysis occurred in July 2021-October 2022). Each emergency department visit was categorized as pregnancy-associated if assigned ICD-10-CM code(s) indicated pregnancy. We stratified visits by age, race, ethnicity, county of residence, and insurance and compared them with estimated pregnant population proportions using 1-sample t-tests. We used multivariable logistic regression to determine whether pregnancy-associated visits were more likely to be associated with hospital admission and then to determine sociodemographic predictors of admission among pregnancy-associated emergency department visits. Results: More than 6.4 million emergency department visits were included (N=6,471,197); 10.1% (n=655,476) were pregnancy-associated, significantly higher than the proportion of women estimated to be pregnant at any given time in North Carolina (4.6%, p<0.0001) and increased over time (8.6% in 2016 vs 11.1% in 2021, p<0.0001). Pregnancy-associated visits were lower than expected for ages 25-44 years and higher than expected for those aged 15-24 years, for those of Black race, and for patients residing in rural or suburban areas. The proportion admitted was higher for pregnancy-associated emergency department visits than for nonpregnancy associated (15.6% vs 7.0%, AOR=3.06 [95% CI=3.03, 3.09]). Pregnancy-associated emergency department visits for patients of Black race had 0.58 times (95% CI=0.57, 0.59) the odds of admission compared with White patients. Conclusions: Emergency department utilization during pregnancy is common. The proportion of pregnancy-associated emergency department visits among reproductive-age women is increasing, as are inpatient admissions from the emergency department for pregnancy-associated diagnoses. Use of public health surveillance databases such as the North Carolina Disease Event Tracking and Epidemiologic Collection Tool may help identify opportunities for improving disparities in maternal health care, especially related to access to care. AJPM Focus 2023;2(4):100142. (c) 2023 The Authors. Published by Elsevier Inc. on behalf of The American Journal of Preventive Medicine Board of Governors. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Whether patients present to the emergency department (ED) with physical ailments and comorbid psychiatric needs or primary psychiatric complaints, understanding differences in clinically relevant age and sex patterns over time is crucial to optimal psychiatric care in the ED setting. We used population-level surveillance data provided by the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) from January 1, 2008, through December 31, 2014. Mental health-related (MHR) ED visits were identified by International Classification of Diseases, Clinical Modification 9th revision (ICD-9-CM) codes analyzed in the Agency for Healthcare Research and Quality (AHRQ) clinical classification software groupings of related diagnostic categories. Trends were assessed based on total and average annual visit counts. We identified approximately 4 million MHR ED visits. The average number of visits per year was highest among 50-year-olds, while patients over the age of 90 had the highest proportion of their ED visits associated with an MHR code. Mood disorders were more prevalent among females, while substance use disorders were more prevalent among males. Within MHR categories, age-related peaks did not differ by sex except for suicide and self-inflicted injury. Whether it be a teenage boy presenting with suicidal ideation, a middle-aged man presenting with alcohol abuse, or an elderly female presenting with dementia, ED MHR visits’ needs vary across the lifespan. Understanding these trends is important to holistic patient care.

Context Injury prevention requires data to inform policy and practice through surveillance, research and evaluation. NC DETECT, a syndromic surveillance system originally developed for bioterrorism and infectious disease identification and response, provides timely, population-based data for injury prevention efforts. Purpose We use this system to monitor and respond to both long-standing prevalent injury issues and emerging threats, including COVID-19’s impact on injury. Process Established in 2002 and legislatively mandated in 2005, NC DETECT uses statewide near-real-time emergency department (ED) and EMS data for North Carolina, USA (population >10.5 million). Data are available to users through a Web-based portal that includes options to generate custom data reports and personalize data dashboards. Targeted injury reports are sent to public health practitioners and prevention partners. New surveillance case-definitions and reports are added within hours of a request. Analysis Statewide, all 24/7, acute care, civilian, hospital-affiliated EDs (currently N=130) submit data 3-times daily, while all EMS encounters are submitted daily. Over 4.5 million ED visits and over 1.5 million EMS encounters are added to NC DETECT each year. Outcomes NC DETECT informs prevention efforts related to road safety, falls, overdose, violence, suicide, firearms, disaster response and climate resiliency. Weekly reports track trends for heat-related illness during summer months, monthly reports help counties monitor opioid overdoses and evaluate community-based interventions, and NC DETECT health outcomes data, integrated with motor vehicle crash report data, inform road safety policies and priorities. Learning Outcomes Injury control professionals can use syndromic surveillance data to further prevention and practice efforts.

Background The global COVID-19 pandemic impacted population-level emergency department (ED) utilization patterns for treatment of acute injuries. We examined the frequency and proportion of North Carolina, USA (NC) ED visits for injury during the first two years of the COVID-19 pandemic. Methods Data for the years 2019–2021 were obtained from NC DETECT, NC’s statewide syndromic surveillance system. Frequencies and proportions of injury-related ED visits overall and for selected injury mechanisms were compared, along with counts and proportions of COVID-Like-Illness (CLI) ED visits. Results As compared to 2019 (N=924,663), the total number of injury-related ED visits declined in 2020 (N=748,427) and 2021 (N=766,794). As a proportion of total ED visits, injury-related ED visits decreased only slightly from 2019–2021 (18.7% to 17.8%). Most injury mechanisms saw a decrease in the number of ED visits in 2020 with a partial rebound in numbers in 2021. Drug overdoses, however, increased each year, with a total 14.9% increase from 2019 to 2021; the proportion of overdose visits to all ED visits only increased in 2020. Firearm injury spiked alarmingly in 2020 then fell somewhat in 2021. Early in the pandemic, injury-related ED visits decreased sharply as CLI ED visits increased. While CLI visits remained high, injury-related visits rebounded but generally did not return to pre-pandemic levels. Conclusion Both ED avoidance and decreased exposures may have contributed to declines, while increases in select injury mechanisms may reflect unanticipated impacts of COVID-19 mitigation strategies. Learning Outcomes Injury outcomes exacerbated by the pandemic require timely public health responses.

OBJECTIVES:Emergency departments (EDs) have been increasingly utilized over time for psychiatric care. While multiple studies have assessed these trends in nationally representative data, few have evaluated these trends in state-level data. This investigation seeks to understand the mental health-related ED burden in North Carolina (NC) by describing trends in ED visits associated with a mental health diagnosis (MHD) over time.METHODS:Using data from NC DETECT, this investigation describes trends in NC ED visits from January 1, 2008 through December 31, 2014 by presence of a MHD code. A visit was classified by the first listed MHD ICD-9-CM code in the surveillance record and MHD codes were grouped into related categories for analysis. Visits were summarized by MHD status and by MHD category.RESULTS:Over 32 million ED visits were recorded from 2008 to 2014, of which 3,030,746 (9.4%) were MHD-related visits. The average age at presentation for MHD-related visits was 50 years (SD 23.5) and 63.9% of visits were from female patients. The proportion of ED visits with a MHD increased from 8.3 to 10.2% from 2008 to 2014. Annually and overall, the largest diagnostic category was stress/anxiety/depression. Hospital admissions resulting from MHD-related visits declined from 32.2 to 18.5% from 2008 to 2014 but remained consistently higher than the rate of admissions among non-MHD visits.CONCLUSION:Similar to national trends, the proportion of ED visits associated with a MHD in NC has increased over time. This indicates a need for continued surveillance, both stateside and nationally, in order to inform future efforts to mitigate the growing ED burden.