Collecting the Data Questions and Answers

What is a DAWN case?

A DAWN case is any ED visit or death related to recent drug use. The criteria for inclusion in DAWN are intentionally broad and simple, with few exceptions.

What drugs are included in DAWN?

• Illegal drugs of abuse
• Prescription and over-the-counter medications
• Dietary supplements
• Non-pharmaceutical inhalants
• Alcohol in combination with other drugs (adults and children)
• Alcohol alone (age < 21)

What types of cases are included in DAWN?

Because the DAWN cases are defined broadly, DAWN captures many different types of drug-related cases.

What types of ED visits are not included in DAWN?

• If the patient left the ED without being treated.
• If the patient consumed a non-pharmaceutical substance but did not inhale it.
• If the patient has a history of drug use but no current use.
• If alcohol is the only substance involved and the patient is age 21 or over.
• If the only documentation of a drug is in toxicology test results.
• If the drugs listed are not related to the visit (e.g., current medications).
• If there is no evidence of recent drug use.
• If the patient is being treated for under-medication, i.e., taking too little of a drug.

What types of drug-related deaths are not included in DAWN?

There are only a few exceptions to the DAWN case criteria. A death is not included in DAWN:

• If the death is not reviewed or investigated by a medical examiner or coroner.
• If the decedent consumed a non-pharmaceutical substance but did not inhale it.
• If the decedent has a history of drug use but no current use.
• If alcohol is the only substance involved and the decedent is age 21 or over.
• If the only documentation of a drug is in toxicology test results.
• If the drugs listed are not related to the death (e.g., current medications).
• If there is no evidence of recent drug use.
• If the drug did not cause or contribute to the death.
• If the death was due to under-medication, i.e., taking too little of a drug.
• If the decedent was a homicide victim, even if on drugs at the time of death.

How are DAWN cases found?

DAWN cases are found by a retrospective review of all ED medical records or ME/C case files. Patients or families are never interviewed. The review of source records is performed by a trained DAWN Reporter in each member facility. For each DAWN case found, the DAWN Reporter abstracts DAWN data items from the source record.

The DAWN Reporter submits the DAWN data items electronically through secure, Internet-based systems, which help to maintain the timeliness of the information.

Why is it necessary to review all ED medical records or ME/C case files?

Multiple field studies have shown that alternate methods miss substantial numbers of DAWN cases.

Does DAWN review records of patients who do not come through the ED?

No, DAWN only collects data on ED visits, and only the ED charts are reviewed.

Is it true that DAWN only collects data on illegal drugs?

• Illegal drugs of abuse
• Prescription and over-the-counter medications
• Dietary supplements
• Non-pharmaceutical inhalants
• Alcohol in combination with other drugs (adults and children)
• Alcohol alone (age < 21)

How are drug abuse cases denoted in the New DAWN?

New DAWN recognizes it is often difficult to distinguish among cases of drug use, misuse, or abuse in medical records. Also, drug misuse or abuse is often not explicitly or consistently recorded. Therefore, DAWN uses an indirect method to identify drug abuse.

Each case reported to DAWN is assigned to one of eight case types according to the following hierarchy:

Case Type	Drugs Included
1. Suicide attempt	Any drug--illicit, Rx, OTC, alcohol
2. Seeking detox	Any drug--illicit, Rx, OTC, alcohol
3. Alcohol only (age < 21)	Alcohol
4. Adverse reaction	Rx, OTC, alcohol (no illicits)
5. Overmedication	Rx, OTC, alcohol (no illicits)
6. Malicious poisoning	Any drug--illicit, Rx, OTC, alcohol
7. Accidental ingestion	Any drug--illicit, Rx, OTC, alcohol
8. Other	Any drug--illicit, Rx, OTC, alcohol

Cases not falling into any of the first seven case types are classified as "Other." Most drug abuse cases are classified as "Other."

For analysis, DAWN uses methods to identify different categories of non-medical use, misuse, or abuse. One approach may include combining cases of:

• Other
• Overmedication

A more expansive category of drug misuse/abuse might also include:

• Malicious poisoning
• Seeking detox
• Suicide attempt

A third approach focuses on the illicit drugs, regardless of case type.

Is it true that the drugs reported to DAWN are all based on patients’ self reports?

No, drugs reported to DAWN come from the ED medical record or ME/C case file. There are many possible sources for this information: laboratory (toxicology) testing, the clinical assessment and diagnoses, as well as reports by patients, their friends, or their families.

For clarity, we no longer use the term “drug mention,” because it was frequently (erroneously) interpreted to mean that the patient “mentioned” the drug.

Are all the drugs reported to DAWN based on laboratory test results?

No, not all drugs reported to DAWN were confirmed by toxicology. Testing protocols vary across hospitals, clinicians, and patients. However, since 2003 DAWN has been collecting whether the drug being reported from the medical record was confirmed by toxicology.

Does DAWN collect current medications unrelated to the visit or death?

No, DAWN Reporters are trained to report only those drugs related to the ED visit or death. If a current medication is unrelated to the visit, it is not reportable.