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PubMed1986

Occupationally related illness reported to a regional poison control center.

The San Francisco Bay Area Regional Poison Control Center studied 189 cases of toxic workplace exposure occurring over a six-month period in the belief that Regional Poison Control Center reporting could be a useful surveillance measure for occupational disease. Dermatitis was a relatively uncommon occurrence, but systemic complaints were frequent, a pattern differing from that seen in standard occupational surveillance programs. As compared to chemically caused illness detected through a statewide physician reporting program in California, increases in proportional frequencies of certain industrial chemical causes were observed. A matching strategy utilizing the physician reporting system identified only 15.9 per cent of poison control center cases that appear to have been otherwise detected through established surveillance. A nationwide system of Regional Poison Control Centers already exists with a computerized data base in place. This study indicates that these centers could be utilized as a supplementary system for acute occupational illness related to chemical exposures.

Adolescent↗
PubMed1997

Costs of poisoning in the United States and savings from poison control centers: a benefit-cost analysis.

Data on incidence, medical spending, and payment sources for poisoning were taken from the 1987 National Medical Expenditure Survey, 1991 US Vital Statistics, the 1992 National Hospital Discharge Survey, and 1992 poison control center surveillance data. Benefits, measured as percentage reductions in medical spending attributable to use of poison control centers, were calculated from analyses of published and unpublished studies of jurisdictions in which services became unavailable. Medical spending (payments) for poisoning treatment totaled $3 billion in 1992. Spending averaged $925 per case. Poison control center services were available for 86% of poisonings As used, they reduced the number of patients who were medically treated but not hospitalized for poisoning by an estimated 350,000 (24%) and the number of hospitalizations by 40,000 (12%) in 1992. The average public call to a poison control center for aid prevented $175 in other medical spending. Poison control centers offer a large return on investment. Despite their proven benefits, many poison control centers are unstably funded and financially strapped, in part because the federal government pays far less than its fair share of center costs.

Cost-Benefit Analysis↗
PubMed2001

A nationwide survey of poison control centers comparing 1999 to 1998 triage and management of asymptomatic children who ingested tricyclic antidepressant.

Triage of asymptomatic, unintentional pediatric (< 6y) tricyclic antidepressant (TCA) exposures has been based upon single cases or small studies involving large dose, symptomatic ingestions. This study evaluated patterns of triage for asymptomatic pediatric TCA exposures as practiced nationally by regional centers and compared them to 1998 patterns. It also evaluated the role of activated charcoal in the management of these exposures. Surveys were sent to the 30 certified regional Poison Control Centers that responded to our 1998 survey. Twenty-two centers responded (73%). Fourteen (63%) referred to a health care facility based upon mg/kg, compared to 6 (20%) in 1998. Of the 14, 6 referred at doses >5 mg/kg compared to 2 (6.6%) in 1998. If referred to an emergency department, 18 (82%) recommended activated charcoal compared to 1 (3.3%) in 1998. The lowest toxic dose reported in the literature is 6.7 mg/kg. This is consistent with poison control data during the past 6y where no child became toxic at doses < 5 mg/kg. This survey demonstrated significant changes in triage patterns for asymptomatic pediatric TCA exposures.

Antidepressive Agents, Tricyclic↗
PubMed1999

A national survey of regional poison control centers' management of occupational exposure calls.

Regional poison control centers (PCCs) were surveyed nationally to assess their policies and practices in handling work-related exposures. A 24-item survey was mailed to the executive directors of 44 American Association of Poison Control Centers' certified PCCs nationwide. The survey also requested permission to call the PCC to conduct a blinded role-playing exercise of a case of work-related trichloroethane exposure. Responses on the management questionnaire were compared with the actual responses provided by information specialists in the role-playing exercise. Seventy-five percent of PCCs completed the survey; 43% completed the telephone role-playing exercise. Survey respondents generally overestimated what they thought was routinely done to assess work-related calls, compared with what actually occurred at the time of the work-related call in the role-playing exercise. For example, 32% indicated that their PCC asked about the activities of nearby workers, but none of the PCC staff actually did so. Eighty-nine percent of the PCC executive directors surveyed thought that their staff routinely advised callers to notify their employer about work-related exposure concerns, but this occurred in only 11% of the calls. We concluded that PCCs' responses to work-related calls are inadequate. Given the public health impact of work-related calls, PCCs should develop, implement, and monitor written protocols to better address the public health issues of workplace poisonings.

Adolescent↗
PubMed1990

Occupational illness and poison control centers. Referral patterns and service needs.

In a study of occupational illness reported to a regional poison control center and to gauge the center's outreach and services, we did follow-up interviews of 301 case contacts over a 6-month period. We ascertained referral routes, reasons for contacting the poison control center, and awareness of the center's function. For 122 cases a nonphysician was the initial poison control center contact. Of the nonphysician contacts, 41 had already consulted a health care provider and been referred to the poison control center for assistance. Of the 70 persons with exposure, only 21 had been aware before their exposures that poison control center services might include occupational chemical illness consultation. Physicians and nonphysicians expressed similar reasons for contacting the poison control center, with 118 of 301 identifying the need for an exposure hazard risk assessment. These data suggest that although those contacting a poison control center because of occupational illness include a variety of cases, they have many similar service needs.

Humans↗
PubMed1996

Disaster preparedness of poison control centers in the United States.

OBJECTIVE: To assess the state of disaster readiness of poison control centers, a survey questionnaire was sent to all 96 institutional poison control center members of the American Association of Poison Control Centers in the US, both certified and noncertified programs. DESIGN: The data reported are the results and responses from 76 of 96 (79.2%) poison control centers. RESULTS: Fifty-four percent of responding centers have written disaster plans, with 25% having drills to practice the plans. Of the centers that do not have a written plan, the majority have policies and procedures in place to address physical plant damage, increased phone traffic, loss of phone systems and malfunction of computers. Eighty-six percent of respondents have a back up generator, and 82% have an uninterruptable power supply in place. Fifty-four percent have a back up phone system and 33% have cellular phone capacity. Forty-six percent of responding centers have arrangements with other agencies in the event of a disaster. Only half of the managing directors of the responding centers believe their center can meet the public's needs in the event of a disaster.

Disaster Planning↗
PubMed1998

The costs and outcomes of restricting public access to poison control centers. Results from a natural experiment.

OBJECTIVES: The authors examined the costs and outcomes resulting from a natural experiment during which direct public access to poison control centers was restricted and then restored. METHODS: Both societal and health care purchaser perspectives were used. Probability data were obtained from a natural experiment during which public callers from a large county in California were electronically blocked from directly accessing the poison control center. Callers were referred to 911, which had direct access to the poison control center, if they thought they had a poisoning emergency. We conducted telephone interviews of: (a) persons who attempted to call the poison control center for a child's poisoning exposure but who did not have direct access (n = 270) and (b) persons who called the poison control center after direct access was restored (n = 279). Cost data were obtained from primary data collection and from other sources. The outcome measure was the appropriateness of the treatment location (at home or at a health care facility). Caller-reported outcomes were also examined. RESULTS: The average additional cost per blocked call was $10.89 from a societal perspective, or $33.14 from a health care purchaser perspective. Fourteen percent of callers with restricted access were treated at an inappropriate location, compared with only 2% of callers with direct poison control center access. Also, 14% did not obtain any professional advice after they attempted to call the poison control center, although 66% of these cases involved potentially toxic substances. Results were robust across a range of sensitivity analyses. CONCLUSION: Restricting direct public access to poison control centers created additional costs to society, the health care sector, and callers.

California↗
PubMed1991

Poison control centers: can their value be measured?

Most regions of the United States are served by poison control centers that provide 24-hour toxicologic guidance resulting in the home management of most poison exposures. It has been suggested that without public access to a poison control hotline the majority of poison-exposed patients would seek medical care in emergency departments or other outpatient visits. This study compares the patterns of community response to poison exposure in Louisiana before and after the discontinuance of the state poison control service, and also compares these patterns to the situation in Alabama, which maintained poison center services throughout the study period. After discontinuance of the poison control service in Louisiana, poison exposure cases had up to four times the rate of "self-referral" to health care facilities and less than half the rate of home management when compared to Alabama cases. Before the closing of the Louisiana center, Alabama and Louisiana triage patterns for poison exposures were nearly identical. The maximum annual cost attributable to unnecessary outpatient service utilization in Louisiana was estimated to be $1.4 million, an amount more than three times the annual poison control center state appropriation.

Alabama↗
PubMed1978

National Clearinghouse for Poison Control Centers.

The Clearinghouse was originally conceived to coordinate information flow among the then few Poison Control Centers. Services were to be provided through the state health departments where complete control over the individual state's poison centers was to reside. No authority to establish or regulate centers, or to set standards for staffing and operation of centers, or to designate regional centers was granted. However, growth in the numbers of centers, more sophistocation in the state of the art, more demands for product and human experience data, calls for research support, regionalization, standards setting, competency testing, and others has led to an increasing call for more and more Clearinghouse involvement in the entire poison control program. Though staffing and funding remains fairly constant, the Clearinghouse hopes to be as involved and to provide as great a service as possible to those involved in clinical toxicology and poison control.

Computers↗
PubMed2006

Adult atomoxetine ingestions reported to Texas Poison Control Centers, 2003-2005.

BACKGROUND: Limited information exists on outcomes from adult ingestions of atomoxetine reported to poison control centers. OBJECTIVE: To identify factors that might affect the outcome of adult atomoxetine ingestions reported to poison control centers. METHODS: Using adult ingestions of atomoxetine alone reported to Texas poison control centers during 2003-2005, the proportion of cases involving serious outcomes was determined for selected variables and evaluated for statistical significance by calculating the rate ratio (RR) and 95% confidence interval (CI). RESULTS: Of 64 cases identified, 9 (14%) involved serious outcomes. No serious outcomes were reported with a maximum dose of 100 mg or less. Serious outcomes were significantly more likely to occur with a maximum dose of more than 2 capsules (RR 8.25; 95% CI 1.48 to 83.58), where the circumstances of the exposures involved self-harm or malicious intent (RR 6.02; 95% CI 1.30 to 30.35) or when the patient was already at or en route to a healthcare facility when the poison control center was contacted (RR 18.75; 95% CI 2.10 to 886.83) or was referred to a healthcare facility by the poison control center (RR 22.50; 95% CI 1.81 to 1181.19). CONCLUSIONS: The severity of the outcomes associated with adult atomoxetine ingestions depended on the dose taken and the circumstances of the ingestion. The management of patients with serious outcomes was more likely to involve healthcare facilities. Such information is useful in creating triage guidelines for the management of adult atomoxetine ingestions.

Adult↗