Emergency department use after pediatric pharmaceutical ingestion: comparison of two national databases

Setlik, Jennifer; Ho, Mona; Bond, G. Randall

doi:10.3109/15563650903397234

Cited by 16 publications

(16 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Moreover, the information from the American Association of Poison Control Centers National Poison Data System (AAOCC-NPDS) does not include medical examinations or final diagnoses. Estimates of pediatric acetaminophen exposure and overdose are similar between NEISS and AAPCC however, both may be underestimates of the rate of accidental pharmaceutical exposure and overdose among children [6]. …”

Section: Introductionmentioning

confidence: 99%

“…This is one of few instances in which ICD-9 codes were explicitly used to identify discharges related to acetaminophen exposure among children. As no “gold standard” measures exist and current surveillance and reporting methods may be flawed, it is important to re-evaluate and assess novel approaches for estimating acetaminophen overdose among the pediatric population [6]. …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Validation of ICD-9-CM codes for identification of acetaminophen-related emergency department visits in a large pediatric hospital

Achaval

Feudtner

Palla

et al. 2013

BMC Health Serv Res

View full text Add to dashboard Cite

BackgroundAcetaminophen overdose is a major concern among the pediatric population. Our objective was to assess the validity of International Classification of Disease (ICD-9-CM) codes for identification of pediatric emergency department (ED) visits resulting from acetaminophen exposure or overdose.MethodsWe conducted a retrospective medical record review of ED visits at Texas Children’s Hospital in Houston, Texas, between January 1, 2005, and December 31, 2010. Visits coded with 1 or more ICD-9 codes for poisoning (965, 977, and their subcodes and supplemental E-codes E850, E858, E935, E947, and E950 and their subcodes) were identified from an administrative database, and further review of the medical records was conducted to identify true cases of acetaminophen exposure or overdose. We then examined the sensitivity, positive predictive value, and percentage of false positives identified by various codes and code combinations to establish which codes most accurately identified acetaminophen exposure or overdose.ResultsOf 1,215 ED visits documented with 1 or more of the selected codes, 316 (26.0%) were a result of acetaminophen exposure or overdose. Sensitivity was highest (87.0%) for the combination of codes 965.4 (poisoning by aromatic analgesics, not elsewhere classified) and E950.0 (suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics), with a positive predictive value of 86.2%. Code 965.4 alone yielded a sensitivity of 85.1%, with a positive predictive value of 92.8%. Code performance varied among age groups and depending on the type of exposure (intentional or unintentional).ConclusionICD-9 codes are useful for ascertaining which ED visits are a result of acetaminophen exposure or overdose within the pediatric population. However, because ICD-9 coding differs by age group and depending on the type of exposure, hypothesis-driven strategies must be utilized for each pediatric age group to avoid misclassification.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Validation of ICD-9-CM codes for identification of acetaminophen-related emergency department visits in a large pediatric hospital

Achaval

Feudtner

Palla

et al. 2013

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…At the same time, capturing infant poisonings may be challenging. Epidemiological estimates from both the AAPCC data and from nationwide ED records via the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIPO) are both believed to significantly underestimate the true magnitude of the problem [7][8][9]. In that respect, the ToxIC and AAPCC registries complement each other, providing an effective, real-time toxicosurveillance coverage in the United States.…”

Section: Discussionmentioning

confidence: 99%

“…In children less than 5 years of age, there is an estimated sevenfold under-reporting of poison-related fatalities to PCCs and an even higher under-estimation of non-fatal cases [5]. Guardians of poisoned infants that attend the ED are not likely to have previously contacted a PCC [6][7][8][9][10]. The ToxIC case registry addresses that gap by documenting all inadvertent exposure presenting to participating sites and requiring bedside consultation.…”

Section: Discussionmentioning

confidence: 99%

Toxico-Surveillance of Infant and Toddler Poisonings in the United States

et al. 2012

View full text Add to dashboard Cite

Infant and toddler poisonings are important to capture and may be challenging to manage. We aim to describe the Toxicology Investigators Consortium (ToxIC) Case Registry as a tool for toxico-surveillance of this problem in the United States. Using the ToxIC Case Registry database of the American College of Medical Toxicology, we identified infant and toddler poisonings over a 15-month period between April 1, 2010 and June 30, 2011 reported to the 31 Registry sites. Of 6,810 poisoning cases reported to the ToxIC registry, 248 (3.6 %) involved children younger than 2 years (51 % males). Fifty-four percent were hospital inpatients, 42 % were in the Emergency Department and 4 % were outpatients. Sixty-three percent were symptomatic. The most common ingested compounds were highly toxic-cardiac drugs (16 %), psychotropics (15 %), recreational drugs, alcohols, and controlled narcotic drugs (13 %), analgesics (9 %), and cleaning compounds (7 %). Fourteen percent of cases involved multiple agents. The ToxIC registry is a potentially useful toxico-surveillance tool to identify and trend clinically significant poisonings in young children, and potentially other populations. These data could be used to target specific preventive interventions.

show abstract

“…However, it is estimated that only 20% to 30% of all poisoning cases are reported to RPCs, and therefore NPDS cases most likely represent the minimum number of actual exposures to a chemical or drug. 29,30 Also, due to the nature of these separate databases, it is impossible to determine if a case is reported in both datasets. Therefore these cases cannot be aggregated to generate an actual number of cases nationwide.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Hydrocarbon-Related Injuries in the United States: 2000–2009

et al. 2013

View full text Add to dashboard Cite

OBJECTIVE: To generate national estimates of hydrocarbon-related exposures occurring in children ≤5 years of age who were treated in US emergency departments or called a regional poison control center. METHODS: This retrospective review compared hydrocarbon-related injuries that occurred from January 1, 2000, through December 31, 2009, that were reported to the National Poison Data System and the National Electronic Injury Surveillance System for children ≤5 years of age. RESULTS: From 2000 through 2009, the National Poison Data System reported 65 756 actual calls to regional poison centers, and the National Electronic Injury Surveillance System reported an estimated 40 158 emergency department visits for hydrocarbon-related injuries. Individuals involved were predominantly male and 1 to 2 years of age. Ingestion was the most common mechanism of injury, and most injuries did not result in hospitalization. The rate of emergency department visits and calls to poison centers decreased significantly (P < .0001) over the 10-year study period. Exposures to hydrocarbons demonstrated seasonal variation, with more occurrences in the summer months. CONCLUSIONS: The comparison of the two data sets illustrates a similar trend in hydrocarbon-related injuries in children. Although cases have declined, most likely due to existing prevention efforts, hydrocarbons are still a large source of preventable exposure and injury in children.

show abstract

Emergency department use after pediatric pharmaceutical ingestion: comparison of two national databases

Cited by 16 publications

References 5 publications

Validation of ICD-9-CM codes for identification of acetaminophen-related emergency department visits in a large pediatric hospital

Validation of ICD-9-CM codes for identification of acetaminophen-related emergency department visits in a large pediatric hospital

Toxico-Surveillance of Infant and Toddler Poisonings in the United States

Pediatric Hydrocarbon-Related Injuries in the United States: 2000–2009

Contact Info

Product

Resources

About