• Roger Morbey, Helen Hughes, Gillian Smith, Kirsty Challen, Thomas C Hughes, and Alex J Elliot.
• Real-time Syndromic Surveillance, Public Health England, Birmingham, UK.
• Emerg Med J. 2019 Aug 1; 36 (8): 459-464.

IntroductionFor the London Olympic and Paralympic Games in 2012, a sentinel ED syndromic surveillance system was established to enhance public health surveillance by obtaining data from a selected network of EDs, focusing on London. In 2017, a new national standard Emergency Care Dataset was introduced, which enabled Public Health England (PHE) to initiate the expansion of their sentinel system to national coverage. Prior to this initiative, we estimated the added value, and potential additional resource use, of an expansion of the sentinel surveillance system.MethodsThe detection capabilities of the sentinel and national systems were compared using the aberration detection methods currently used by PHE. Different scenarios were used to measure the impact on health at a local, subnational and national level, including improvements to sensitivity and timeliness, along with changes in specificity.ResultsThe biggest added value was found to be for detecting local impacts, with an increase in sensitivity of over 80%. There were also improvements found at a national level with outbreaks being detected earlier and smaller impacts being detectable. However, the increased number of local sites will also increase the number of false alarms likely to be generated.ConclusionWe have quantified the added value of national ED syndromic surveillance systems, showing how they will enable detection of more localised events. Furthermore, national systems add value in enabling timelier public health interventions. Finally, we have highlighted areas where extra resource may be required to manage improvements in detection coverage.© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.

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