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State of the national's poison centers: 1995 American Association of Poison Control Centers Survey of US Poison Centers.

The American Association of Poison Control Centers (AAPCC) 1995 annual survey is summarized. A decline in the total number of poison centers was noted (from 104 in 1991 to 83 in 1995). The 83 US poison centers handled 2,431, 599 human exposure cases. Certified centers (44) served 63.1% of the US population, handled 72.5% of all poison exposures handled by poison centers nationally, and achieved higher utilization rates within their regions (10.9 vs 7.4 human exposure cases handled/1,000 population). Certified centers had superior staff credentials as measured, by passing the certification examinations for specialists in poison information or board certification for medical and managing directors. Funding for poison centers in 1995 to-total $74.6 million, although this funding level was recognized to be inadequate as only 63.1% of the population was served by certified centers and utilization of poison centers was not optimal. The annual cost of covering the entire US with adequate poison control services (meeting AAPCC certification standards and with utilization at a level of 15 human exposures per thousand population) is estimated at $120 million. Funding difficulties were prevalent. Thirty-five centers indicated that closure had been a real threat at least once in the previous 5 years. Analysis of cost per human exposure case by center volume demonstrated that economies of scale were achieved when a center handled at least 20,000 to 30,000 human exposure calls/year. Increasing human exposure volume beyond 30,000/year did not lead to a reduction in the average cost per human exposure case.

Cost-Benefit Analysis↗

Poison control centers and state-specific poisoning mortality rates.

OBJECTIVE: The purpose of this study was to compare poisoning mortality rates of states served by a poison control center certified by the American Association of Poison Control Centers (AAPCC) to those that are not served by a certified center because health policy has been based on certification status. METHODS: Poisoning mortality rates from 1993 to 1997 were obtained from a public use database of death certificates and were stratified by state and circumstance. Each state was classified as being fully served, partially served, or not served by an AAPCC-certified center. States in one category of service for the entire 5 years were selected for analysis. RESULTS: During this 5-year period, 39 states exhibited a consistent category of poison control center services. The mortality rates per 100,000 population during these 5 years were 5.93, 6.12, 6.01, 6.23, and 6.68 respectively (P <0.05) for all 39 states. The mean 5-year mortality rate for states with certified poison control center services (7.08 +/- 2.59; n = 17) was higher (P <0.05) than those with noncertified service (5.17 +/- 1.46; n = 15) but not significantly different from those with partial certified service (6.25 +/- 1.75; n = 7). CONCLUSION: Increased poisoning mortality rates were associated with AAPCC certification status and year. Poisoning mortality rates may not be an appropriate outcome measure of the impact of poison control centers, AAPCC-certification notwithstanding, at this time. Basing poison control center-related policy on state-specific poisoning mortality rates can not be supported by these findings.

Certification↗

Poisoning in older adults: a 5-year experience of US poison control centers.

BACKGROUND: Poisoning in older adults has received relatively little attention. OBJECTIVE: To describe poison exposures in older adults reported to US poison centers and identify substances that pose a unique risk to this population. METHODS: A retrospective review of human exposures for patients aged >or=60 years reported to the American Association of Poison Control Center's Toxic Exposure Surveillance System from 1993 to 1997 was performed. Frequencies and cross-tabulations were used to describe the data. Hazard factor analysis was conducted to identify medications that pose risk in this population. Statistical analysis included chi(2) and Fisher's exact test for hazard factors. RESULTS: A total of 298,713 poison exposure cases were reported to US poison centers involving individuals aged >or=60 years between 1993 and 1997. The proportion of cases in this age group also steadily increased from 2.5% of all cases in 1993 to 3.4% of all cases in 1997. The mean age of the patients was 64.7 years, and 34.1% were males. Hazard factor analysis was conducted on unintentional exposures and adverse reactions to pharmaceutical agents to determine medications that posed increased risk to older adults. The substance categories that had the highest hazard factor were radiopharmaceuticals, asthma therapies, anti-coagulants, anesthetics, and antidepressants. CONCLUSIONS: Therapeutic errors and adverse reactions to medications are common reasons for major effects and fatal outcomes among older adults reported to poison centers. Understanding poisoning issues specific to this population may help direct future outreach education efforts.

Aged↗

[Responsibility of poison control center physicians].

Rennes's Poison Control Centers as a public medical department associated with an emergency care unit for poisoned patients, is also endowed with a role in toxicological information. In this regard, doctors are working as health officers in the respect of professional ethics. Administrative courts will therefore have to consider suits opposed to poison control doctors. The contract linking the doctor to his counterpart is a benevolence contract. The validity of his oral advice was defined by the Cour de Cassation. The potential evaluation of a fault will be modulated by the particular circumstances of data collection and hence its uncertainty. However, Poison Control Centers must be best organized so that their answers to queries are given by a toxicology-qualified staff. The doctor will also have to provide assistance to those people in danger by adequate help. Despite the ambiguity of some calls which he has to face, the doctor in a Poison Control Center does not seem to be involved by the Law on suicide.

Ethics, Medical↗

The potential impact of poison control centers on rural hospitalization rates for poisoning.

OBJECTIVE: This study tested the hypothesis that underutilization of poison control centers is associated with increased rates of hospitalizations attributable to poisonings in rural areas. METHODS: To measure the potential impact of poison control centers on hospitalization rates in rural areas among people who visit emergency departments because of poisoning, we estimated the reduction in hospitalization rates associated with increased rates of calls to centers. We used the 2003 State Inpatient Database and State Emergency Department Database from the Healthcare Cost and Utilization Project to calculate the numbers of emergency department visits and hospitalizations for each county in the 12 states analyzed. We used Toxic Exposure Surveillance System data from the American Association of Poison Control Centers to calculate the number of human exposure calls per capita according to county. RESULTS: In rural counties, a 1% higher poison control center human poison exposure call rate was associated with a 0.19% lower hospitalization rate among people who visited emergency departments because of poisoning. If the observed association is causative, then 43.3 calls would prevent 1 hospital admission, yielding 7321 dollars in net cost savings and a return on investment of 5.9:1 (from the health care system perspective). CONCLUSIONS: Our results establish the existence of the hypothesized association between rural poison control center utilization rates and hospitalization rates among emergency department-treated poisoning patients.

Child↗

Accidental pediatric ingestion, hospital charges and failure to utilize a poison control center.

PROBLEM: Telephone contact with a poison control center may determine that accidental poison ingestion may not pose a risk of developing adverse clinical effect. Over 50% of reported human poisonings occur in children less than 6 years old. Yet most of these accidental childhood ingestions do not produce clinical toxicity. Such nontoxic ingestions can be managed by telephone rather than treated in a health care facility. This study evaluated the clinical effects produced, and the cost of emergency department care, versus obtaining telephone advice from a poison control center, following accidental poison ingestion in children age 6 and under. METHODS: 1 year review of all cases of accidental ingestion in children 6 years and under evaluated in a pediatric emergency department. Utilizing the hospital's poison control center criteria, cases were grouped as nontoxic (no risk of adverse effect) or toxic (significant risk for adverse effect). Groups were compared for demographics, clinical effect, dispositions, charges. RESULTS: 467 cases were seen; 141 met nontoxic criteria. Toxicity was not related to race or gender. Children age 2 and less accounted for the majority of cases (p = .003) [table: see text] Estimated poison control center costs are less than $25 per telephone call. CONCLUSION: Significant charges are billed to health care payers when an emergency department is utilized as the primary means of evaluating children with nontoxic ingestions. Utilization of a poison control center as the initial means of intervention following an accidental pediatric ingestion results in significant savings in health care expenditures.

Adolescent↗

The nation's first poison control center: taking a stand against accidental childhood poisoning in Chicago.

Prior to the 1950's, there existed no formal system for poison prevention or treatment in the US. Estimates place the number of pediatric poisoning fatalities at over 400/y at that time. After World War II, urbanization and modern technological methods brought forth over 250,000 different brand name products on the market. Health care professionals presented with cases of acute poisoning usually had little knowledge of what ingredients were contained in these new products, making it difficult to treat these patients. In the 1930's, pharmacist Louis Gdalman established a poison information service at St Luke's hospital. Because of Gdalman's training in pharmacy and chemistry, physicians throughout Chicago and the US called on him in search of assistance. In the late 1940's, Gdalman began recording information on small cards, and developed a standard data collection from. By the 1950's he had established an extensive library on the management of acute and chronic poisonings. In 1948, a national effort to reduce the number of accidents in children was started by the American Academy of Pediatrics, and a committee was formed in Chicago to address this public safety need. In November, 1953, the poison center at Presbyterian-St Luke's Hospital was formally recognized, and the poison program model spread nationwide. As the number of poison centers grew, coordination was achieved through the National Clearing House for Poison Control Centers, founded in 1957, and the American Association of Poison Control Centers, created in 1958. By 1970, the number of poison centers in the US was reported to be 597. The need for large and better centers led to regional poison control centers. Other outgrowths were the formation of the National Poison Prevention Week Council, the enactment of the Poison Prevention Packaging Act, development of "Mr. Yuk" and other symbols, and formation of the National Animal Poison Control Center. As a result, the number of children dying from accidental poisoning has dropped to under 50/y.

Chicago↗

Underreporting of fatal cases to a regional poison control center.

We assessed fatal drug overdose and poisoning case surveillance by a regional poison control center, comparing it with medical examiner determinations of death by poisoning over the same 2-year period and from the same catchment area. We studied 358 fatal cases of poisoning or drug overdose reported by a medical examiner and 10 fatal cases of poisoning or drug overdose reported by a poison control center, analyzing demographics and other case-associated factors with with possible successful poison control center case surveillance. Of the medical examiner cases, 245 (68%) were prehospital deaths. Of the remaining 113 emergency department or hospital cases, only 5 (4.4%) were also reported to the poison control center. Compared with cases involving illicit drugs, other narcotics, and sedative drugs, those that involved other prescription drugs (relative odds, 30.6; 95% confidence interval, 2.7 to 351) and over-the-counter products and other substances (odds ratio, 18.9; 95% confidence interval, 1.4 to 257) were significantly more likely to be reported to the poison control center. Most fatal cases of poisoning and drug overdose are not detected through poison control center surveillance. For prevention and treatment, health planners and policy makers should recognize the implications of case underreporting.

Adult↗