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PubMedDate not supplied

[Acute nicardipine and nifedipine poisoning. Multicenter study. Cooperative study by the french poison control centers and the ARIT].

A study, that was realized by the French Association of Poison Control Centers, tried to estimate the toxicity of Dihydropyridine derivatives towards human beings, in comparison with other calcium antagonists, said to be more toxic. Though, the toxicity of the Dihydropyridine derivatives happens to be far less important considering the rarity or absence of their cardiac effects, it must not however be underestimated in the case of a mass ingestion, or if they are taken simultaneously with psychotropic or cardiotropic drugs.

Acute Disease↗
PubMed1991

Pesticide poisoning surveillance through regional poison control centers.

The purpose of this study is to describe pesticide exposure in the population of callers to Minnesota Regional Poison Centers. Case files from 1988 reporting pesticide exposure to humans were identified in cooperation with the Minnesota Center for Health Statistics. Data analysis was conducted by computer using SAS statistical package. Of the 1,428 case files indicating pesticide as the primary substance of exposure to Minnesota residents, a mean age of 5 years (range, one month to 85 years) was identified; 50 percent of all cases were below age 3 years. Males accounted for 1.3 times as many cases as females. Insecticide was identified in the largest percentage of case files (74 percent) followed by herbicide (12 percent), rodenticide (11 percent) and fungicide-nonmedicinal (3 percent). Ingestion was the most common route of exposure; 85 percent of all calls originated from a residence. While insecticides are still the most common types of pesticide call, herbicide has surpassed insecticide in production and sales in the US. In this study, herbicide type exposure calls present a much different picture than other pesticide types. The usefulness of poison control centers for examination of pesticide poisoning is explored. Since reporting occurs coincidental with the exposure and its associated symptoms, each pesticide poisoning report could potentially serve as a true sentinel health event.

Adolescent↗
PubMedDate not supplied

Quality improvement process in the adherence to gastric decontamination guidelines for poison exposures as recommended by a poison control center.

PURPOSE: Adherence to new guidelines for the use of ipecac syrup, gastric lavage, cathartics, and activated charcoal by a poison control center was studied with a quality improvement framework. METHODS: The rates of gastric decontamination were monitored through an electronic case record system. In February 2002, a revised guideline that narrowed the use of gastric decontamination was implemented with a performance improvement process. The rates of recommendation and utilization during 12 months following implementation of the new guidelines were compared with those during 12 previous months. RESULTS: Recommendations for the use of ipecac syrup declined from 1.50% to 0.02% (OR; 95% CI = 0.02; 0.01, 0.03), single-dose-activated charcoal declined from 5.39% to 1.38% (0.25; 0.22, 0.28), gastric lavage declined from 4.19% to 0.22% (0.05; 0.04, 0.06), and a cathartic declined from 1.48% to 0.13% (0.08; 0.06, 0.12). Declines in utilization were also significant (P < .001) for all forms of gastric decontamination. The proportions of patients managed at the scene of the poisoning were unchanged (1.04; 0.99, 1.09) before (67.64%) and after (68.50%) the new guidelines as were those for referral to a health care facility (20.57% and 21.42%, respectively, 1.05; 1.00, 1.11). CONCLUSION: Recommendations on gastric decontamination can be effectively modified with no detriment to patient outcome.

Decontamination↗
PubMed2003

Rapid communication: sociodemographic differences between counties with high and low utilization of a regional poison control center.

A retrospective review of data from the New Jersey Poison Information and Education System (NJPIES) was conducted to determine whether differences exist in the sociodemographic characteristics between counties with high or low utilization of the regional poison control center (PCC). The goal was to generate hypotheses about the potential reasons for the variances in the utilization rates by different subpopulations, in order to develop culturally sensitive educational and preventive strategies in an effort to enhance the use of PCC services. Data from the NJPIES 2002 computerized medical records were analyzed to estimate the utilization rates (number of calls to NJPIES per 1000 of population) for each county in New Jersey. This information was then combined with county sociodemographic data from the 2000 U.S. Census. Sociodemographic characteristics were compared between the counties with high and low utilization rates and statistically significant differences were found. Counties with low utilization of PCC had significantly higher population density per square mile, smaller proportion of White residents, larger proportion of residents of "other race," and larger proportion of Black, Asian, and Hispanic and Latino residents. Further study is needed to examine the underlying reasons for the underutilization of PCC among such populations and to explore methods for improving their awareness and use of the services provided by PCC.

Adolescent↗
PubMed2000

Lithium poisoning from a poison control center perspective.

The purpose of this study was to evaluate the severity of lithium poisoning from a poison control center-based population and the correlation of the Hansen and Amdisen classification with outcome and lithium levels in that setting. All lithium overdoses brought to the attention of the poison control center were prospectively observed during 1 year. Demographic data, amount ingested, coingestants, symptoms and signs, lithium levels, treatment, and outcome were recorded. There were 12 acute lithium overdoses: 5, 5, and 2 with grade 0, 1, and 2, respectively. No patients required hemodialysis or had sequelae or died. There were 174 acute-on-chronic overdoses: 66, 85, 15, and 8 with grade 0, 1, 2, and 3, respectively. Six patients underwent hemodialysis; none had sequelae but one died. There were 19 chronic poisonings: 9, 9, and 1 with grade 1, 2, and 3, respectively. Three patients underwent hemodialysis; one had sequelae and one died. Patients classified as grade 2 had higher lithium levels than those with grade 1 in patients with only lithium poisoning (3.08 +/- 0.77 vs. 2.09 +/- 0.91 mmol/L P = 0.03). The study concluded that morbidity (0.5%) and mortality (1%) associated with lithium poisoning are rarely observed. The Hansen and Amdisen classification does not appear to be a useful clinical tool to predict either morbidity or mortality and does not correlate well with lithium levels.

Acute Disease↗
PubMed1999

Home observation for asymptomatic coin ingestion: acceptance and outcomes. The New York State Poison Control Center Coin Ingestion Study Group.

OBJECTIVES: To obtain preliminary estimates of the acceptance rate and the frequency of adverse outcomes, and to identify issues related to acceptance, associated with management of asymptomatic pediatric coin ingestion by home observation, in preparation for a large-scale prospective study. METHODS: Scripted telephone follow-up of callers who had reported asymptomatic pediatric coin ingestions to one of five poison control centers six to 36 months previously, which had been managed by home observation. RESULTS: Of the 67 callers enrolled, 41 (67%) reported contacting a physician regarding the coin ingestion, despite home observation instruction by poison control center personnel. Those who did not recall being instructed in home observation were more likely to have contacted a physician than those who did. Nearly all, however, were satisfied with the advice they had been given. One child developed subsequent symptoms; as per the instructions that had been given by poison control center personnel, his parent sought physician evaluation, revealing an esophageal coin, which was removed uneventfully. No other child developed complications. CONCLUSIONS: Although all of the 67 children managed by home observation did well, most of their caretakers had not accepted this management strategy. Acceptance, while unrelated to satisfaction, may be related to comprehension of the instructions caregivers are given. A prospective study of home observation for asymptomatic pediatric coin ingestion would be safe and would allow further examination of factors affecting acceptance.

Adolescent↗
PubMed1993

Surveillance of poisoning and drug overdose through hospital discharge coding, poison control center reporting, and the Drug Abuse Warning Network.

There is no gold standard for determining poisoning incidence. We wished to compare four measures of poisoning incidence: International Classification of Diseases 9th Revision (ICD-9) principal (N-code) and supplemental external cause of injury (E-code) designations, poison control center (PCC) reporting, and detection by the Drug Abuse Warning Network (DAWN). We studied a case series at two urban hospitals. We assigned ICD-9 N-code and E-code classifications, determining whether these matched with medical records. We ascertained PCC and DAWN system reporting. A total of 724 subjects met entry criteria; 533 were studied (74%). We matched poisoning N-codes for 278 patients (52%), E-code by cause in 306 patients (57%), and E-code by intent in 171 patients (32%). A total of 383 patients (72%) received any poisoning N-code or any E-code. We found that PCC and DAWN reporting occurred for 123 of all patients (23%) and 399 of 487 eligible patients (82%), respectively. In multiple logistic regression, factors of age, hospital admission, suicidal intent, principal poisoning or overdose type, and mixed drug overdose were statistically significant predictors of case match or report varying by surveillance measure. Our findings indicate that common surveillance measures of poisoning and drug overdose may systematically undercount morbidity.

Adolescent↗
PubMed1997

Willingness to pay for poison control centers.

We used the willingness-to-pay (WTP) method to value the benefits of poison control centers when direct access was blocked, comparing WTP among: (1) blocked callers (n = 396), (2) callers after access was restored (n = 418), and (3) the general population (n = 119). Mean monthly WTP was $6.70 (blocked callers), $6.11 (non-blocked callers), and $2.55 (general population). Blocked and non-blocked callers had a significantly higher WTP than general population respondents (p < 0.001). We conclude that the WTP method measured benefits that are difficult to quantify; however, WTP surveys need to be carefully conducted to minimize bias. We discuss how this approach could be useful for other health care services.

Cost-Benefit Analysis↗
PubMed1995

Epidemiology of ingestions in a regional poison control center over twenty years.

This analysis was conducted to demonstrate the pattern and changes of potential intoxications reported to a German regional poison control center from 1974 to 1993. During this period 155,654 calls were reported of which 111,313 were analyzed. The remaining 44,341 were either of minor importance of preventive calls; 56% referred to children and 44% to adults. Substance categories most commonly implicated were drugs, with a yearly average of 37.6% of the total, followed by household articles (31.2%), plants (9.7%) and chemicals (5.9%). In pediatric cases household articles were the most frequent source of ingestion followed by drugs, plants and nutritional substances, whereas in adults drugs were followed by household articles, chemicals and pesticides. Only 13.4% of all ingestions were classified as toxic or very toxic. There were no major changes in the incidences of the different substance categories during the 20 years. However, there were some changes in the pharmaceuticals, probably due to the introduction of new drugs or the withdrawal of the OTC-status of selected drugs.

Adolescent↗
PubMed1993

Poisoning in the elderly: characterization of exposures reported to a poison control center.

OBJECTIVE: To determine the incidence of poison center calls involving the elderly, characterize these poisonings, and compare them with poisonings that occur in people younger than 60 years of age. DESIGN: Concurrent, observational survey. SETTING: The Virginia Poison Center in Richmond, Virginia. PARTICIPANTS: All persons 60 years of age and older who were involved in a poison exposure reported to the Virginia Poison Center from October 1, 1991 through March 31, 1992. MEASUREMENTS: Incidence, type, route, location, management site, medical outcome of exposures and reasons for these exposures. RESULTS: Exposures in persons 60 years of age and older accounted for 2.3% of all poison center calls during the 6-month study period. These calls were most likely to involve women who unintentionally ingested extra doses of medications. The majority of these exposures occurred in the home and resulted in either no effect or minor effects. For those exposures that necessitated an emergency room visit, elderly persons were more likely to be admitted to the hospital than younger persons (P < 0.05). CONCLUSIONS: The majority of poisonings that occur in persons 60 years of age and older are unintentional and may be amenable to poison prevention education.

Age Factors↗
PubMed1994

Periodicity of suicide attempts reported to a poison control center.

Suicide attempts make up a significant percentage of intentional overdoses and tend to utilize more poison control center (PCC) resources than any other type of call. In order to determine whether time imparts patterns on these suicide calls, we studied all suicide calls to our PCC over a 2-y period. Particular attention was given to the epidemiology and time of call. Suicide exposures (N = 4031) were extracted from PCC records from January 1988 through December 1989 with particular attention to time of day and age and sex of the patient. Data were computer analyzed using standard ANOVA, cosinor and non-linear regression techniques. Serial frequency and spectral analyses were performed using time series procedures. Significant circadian rhythms were noted for all age ranges with peak time (ie acrophase) for calling the PCC occurring in the early evening. However, individuals over the age of 50 y called earlier than younger aged groups. In addition, the 13 to 19-y age group exhibited a significant annual rhythm by peaking in suicide calls to the PCC on January 28 +/- 12.4 d.

Adolescent↗
PubMed2005

Poison Control Center--based syndromic surveillance for foodborne illness.

OBJECTIVES: This retrospective study evaluated the usefulness of a poison control center (PCC) data collection system in Tucson, Arizona for early detection of foodborne disease outbreaks. METHODS: A search of a PCC database identified callers with gastrointestinal symptoms attributable to suspected foodborne illnesses whose calls were received during January 1-March 31, 2000. For each foodborne illness-related call, PCC coding was compared with a predefined diarrhea/gastroenteritis syndrome. PCC calls also were evaluated by using ZIP code, age, sex, and date of symptom onset to determine if call classifications matched any laboratory-confirmed cases reported to a county health department. RESULTS: An independent review generally agreed with the PCC's classification of calls. When calls and cases were compared, only one potential match was identified. CONCLUSION: Although confirmatory diagnostic information was not available, PCC calls were not duplicative of cases evaluated by the county health department, which suggests that they represent two independent data sets. PCC data might provide a useful addition to surveillance data reported to public health agencies for the early detection of foodborne disease outbreaks. These results will now be used to develop collaborative prospective surveillance systems.

Arizona↗
PubMed1979

Paraquat poisoning: Experience of Poison Control Centers in France.

Seventy acute intoxications with paraquat have been collected in 11 out of the 17 French Poison Control Centers from 1970 to 1977. The main route of intoxication is oral ingestion and accounts for all the lethal cases (24). Accidental ingestion may be severe : 7 deaths out of 25 cases but suicidal intoxications have a more important morality rate : 17 deaths out of 22 cases. The addition of an emetic to the formulation of this herbicide will lower the severity of this acute poisoning and will be demonstrated by the survey of the next cases of paraquat poisoning.

France↗
PubMed1997

Effect of a German Poison Control Center on health care cost reductions in harmless exposure cases.

To evaluate the effect of a German Poison Control Center (PCC) service on health care cost reduction in cases of harmless exposures, a prospective telephone survey of 200 callers were asked which medical aid would have been sought if no PCC service had been available. Calculation of savings was based on the total number of calls and standardized fees for medical treatment. Savings in costs for health insurance in these cases was 20 to 50% of the annual PCC budget. The cost effectiveness of this German PCC for this patient group was lower than for North American PCCs. Cost effectiveness might be improved by making efforts to increase the number of public calls.

Cost-Benefit Analysis↗