Do Poison Center Triage Guidelines Affect Healthcare Facility Referrals?

Abstract

There is great variability in poison center triage values and referral rates for iron and acetaminophen poisoning. Guidelines can account for a meaningful proportion of referral variation. Their influence appears to be substance dependent. These data suggest that efforts to determine and utilize the highest, safe, triage threshold value could substantially decrease healthcare costs for poisonings as long as patient medical outcomes are not compromised.

Acetaminophen Poisoning: an Evidence-Based Consensus Guideline for Out-of-Hospital Management

“…Several observational studies investigated the potential safety and efficacy of various poison center protocols in the management of acute, accidental pediatric (less than 6 or 7 years of age) ingestions of acetaminophen (6,55,68,79,80). Most articles (levels 2b, 3b, and 4) suggest that patients with ingestions of less than 200 mg/kg could be managed at home, provided that the acetaminophen dose is known.…”

“…The healthcare facility referral threshold for acetaminophen ingestion among US poison centers ranges from 120 mg/kg to 201 mg/kg of acetaminophen (6). A guideline that effectively determines the need for referral could optimize patient outcome, reduce costs, and reduce disruption for patients and caregivers.…”

webPOISONCONTROL: can poison control be automated?

“…Toxicologist case review showed uniformly correct dose calculations and appropriate triage recommendations. The app delivered consistent recommendations and uniform algorithm adherencephenomena not observed in traditional poison centers because of variability between centers with differing guidelines, lack of guidelines, and individual deviation from established guidelines where they exist [15,16]. Safety was also demonstrated through automated follow-up, with 82.3% of followed, home-triaged cases having no effect.…”

“…To reduce the tremendous variability in triage practices [15], 17 US national triage guidelines were published from 2003 to 2008, but address only 107 ingredients [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. Most substances are not covered by national guidelines, and most poison centers have only a limited set of additional site-specific guidelines; thus, there is a high degree of triage variability both between and within centers and considerable time spent reassessing toxicity each time an exposure occurs.…”

A comparison of emergency triage scales in triaging poisoned patients

“…[6][7][8] The ability to filter the majority of trivial and minor exposures with out-ofhospital management selects higher acuity patients for ED presentation. 9 PICs also play a key role in ambulance triage at the scene as well as in ambulance control systems that decide on transportation of potentially poisoned patients.…”