“Cause of RASHes in the Emergency Department” – CRASHED Project

Subtitle: Examining the Prevalence, Clinical Characteristics, and Treatment of Mpox in U.S. Emergency Departments Participating in EMERGEncy ID NET

We propose to conduct Mpox surveillance in the emergency department (ED) setting, which is unique in being broader-based and more likely to reach medically disadvantaged and socially vulnerable groups than surveillance for Mpox among recognized high-risk individuals presenting to sexually transmitted infections (STI), HIV, and LGBTQ+ clinics. This project may suggest that Mpox has been largely eradicated, or possibly resurged and/or that risk factors have evolved, which would impact ongoing public health efforts to control the spread of this infection.

This will be a two-phase project with the first phase being a 1-month pilot project conducted at 3 Los Angeles EDs to develop, test, and refine data collection methods followed by a second phase that will be a 6-month large scale national surveillance project conducted at EMERGEncy ID NET sites. 

Patients age >3 months presenting with a pustular, vesicular, crusted, or ulcerated skin rash will be enrolled and consented in the ED. During the ED visit, the site coordinator will record responses from the participant and their treating clinician about the participant’s illness, and the participant will be asked to allow collection of specimens obtained by swabbing the rash(s) (i.e., 2 swabs). The site coordinator will also obtain two digital pictures of the rash sites that are swabbed. Participants ages ≥16 years of age will also be asked to complete a self-administered questionnaire about their sexual orientation, gender identity, and recent sexual behavior. After the ED visit, the site coordinator will review and abstract data from their medical record about their visit and outcomes. The site coordinator will contact the participant at 45 days to ask them about the outcome of their illness and healthcare utilization. For participants who test positive for Mpox during the project period, the site coordinator will conduct another medical record review at 45 days to capture additional healthcare utilization. Participants who test positive for Mpox and still have symptoms at 45 days will be called again at 90 days to ask about any additional healthcare utilization and the site team will conduct another medical record review at 90 days.