Poison-related visits in a pediatric emergency department: A retrospective analysis of patients who bypass poison control centers

Johnson, Amberly R.; Tak, Casey; Anderson, Kenneth W.; Dahl, Bradley; Smith, Cassandra; Crouch, Barbara Insley

doi:10.1016/j.ajem.2019.158418

Cited by 3 publications

(5 citation statements)

References 32 publications

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Section: Discussionmentioning

confidence: 72%

“…A total of 46.6 % of self-referrals to the PED proved to be redundant according to the criteria established by the control center. 13 Since regional poison control centers report a higher rate of medical appropriateness, in terms of justified PED referrals, 14 this may explain the difference in the hospitalization rate in our study. Endocrinology includes: Diabetes-8, Thyroid-4, Hormone-2; Other includes: Vitamins-6, Iron/Folic acid-2, Homeopathic-2, Antihistamine-8, Pseudoephedrine-2, antibiotic-9, PPI inhibitor-4, H2 block-2, Dermatology-4, Hematology-1, Nephrology-1, and Urology-1.…”

Section: Discussionmentioning

confidence: 72%

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Unintentional Acute Poisoning Related Emergency Department Visits in Children in a Single-Center: A Nine-Year Prospective Survey

Amram

Daviko

Dalal

et al. 2022

Clin Pediatr (Phila)

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Pediatric morbidity due to unintentional poison exposure is a significant burden on public health. We prospectively characterize patterns of unintentional poison exposure in a single pediatric emergency department, using a detailed computerized questionnaire for all unintentional injuries admitted during 2009 to 2017. Out of 71,765 visits due to unintentional injuries, 252 children were admitted due to unintentional poison exposure. Most (198/252, 79%) were between 1 and 3 years of age. The majority of events (209/252, 82.9%) occurred at the patient’s home and 81% (205/255) were classified as exploratory ingestion. In 41/252 (14%) cases, exposure to more than one substance was reported. Most events 231/293 (79%) involved medications and 21% were due to domestic products. Four medications account for 45% of the events (Paracetamol, Salbutamol, Antihypertensive, and Antidepressants). Opioids were responsible for only 1.7%. By, collaboration between government, public health, educational institutions and commercial companies, can the burden of pediatric unintentional poison exposure be reduced.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 72%

Unintentional Acute Poisoning Related Emergency Department Visits in Children in a Single-Center: A Nine-Year Prospective Survey

Amram

Daviko

Dalal

et al. 2022

Clin Pediatr (Phila)

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“…8 However, the use of PCs still underused, with one study reporting that 46.6% of pediatric patients who presented to the ED would have been redirected to an outpatient site had they initially called a PC. 11 Furthermore, studies have suggested that there may be racial, gender, socioeconomic, and cultural disparities that impact PC usage. 12 Considering the elevated healthcare costs of TE cases that present to the ED, the identification of high-risk groups in the ED is crucial for targeted exposure-prevention education.…”

Section: Discussionmentioning

confidence: 99%

Toxicologic Exposures in California Emergency Departments in 2011 and Its Risk Factors

Loftipour

Saadat

et al. 2021

WestJEM

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Introduction: Toxicologic exposures (TE) are a major preventable public health issue, with most cases due to unintentional causes. Although these cases are well documented and reported via the National Poison Data System, there is little information regarding toxicologic exposure cases in the emergency department (ED). The aim of this study was to identify demographic groups at risk for potential poisoning. Methods: This was a cross-sectional study. We used data from the California State Emergency Department Database (SEDD) 2011 for statistical analysis. Results: The study included 10,124,598 ED visits in California in 2011. The prevalence of TE was 383.4 (379.6-387.3) per 100,000 visits. Toxicologic exposures were most common among patients aged <10 years (555.4, 95% confidence interval [CI]: 544.5-566.5 per 100,000 visits). Overall, TE was more common among males. White patients showed the highest prevalence of TE compared to other racial groups (P <0.001). Subpopulation analysis showed Native American female patients ages 10-19 had a noticeably higher prevalence of TE (1,464.4, 95% CI: 802.9-2444.9 per 100,000). The prevalence of TE was higher in households of higher median income (P <0.001). Prevalence of TE among those with a history of substance use was also elevated. Conclusion: Toxicologic exposure cases in the ED are elevated in particular age and race/ethnicity groups, as well as among those with a diagnosis of substance use disorder. The strength of association between these factors and TE in the general population may be different because we examined ED visits only. Further preventive and education strategies are necessary and should target the demographic groups identified in this epidemiological study.

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“…Research has shown that PCC involvement reduces the frequency of ED visits, ED length of stay, and improves patient outcomes 22 . Further, for unintentional pharmaceutical, chemical or fume exposures, previous research has estimated that approximately 47% of ED visits may be preventable through PCC management 23 …”

Section: Discussionmentioning

confidence: 99%

“…22 Further, for unintentional pharmaceutical, chemical or fume exposures, previous research has estimated that approximately 47% of ED visits may be preventable through PCC management. 23 The poisoning exposures in this study were ascertained specifically via ICD-9-CM diagnosis codes. Although we intended to capture all relevant poisoning exposures within the observation period, many PCC records indicated ED presentation remained unmatched.…”

Section: Limitationsmentioning

confidence: 99%

Unintentional Pediatric Poisoning Exposures in an Emergency Department

Johnson¹,

Tak²,

Mundorff

et al. 2020

Pediatr Emer Care

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Objectives:The purpose of this study is to describe the demographics and clinical characteristics of patients referred to a pediatric emergency department (ED) for unintentional poisoning exposures by a poison control center (PCC) compared with patients/caregivers who self-refer. Methods:The electronic data warehouse at a pediatric hospital was queried from October 1, 2014, to September 30, 2015, for unintentional poisoningrelated ED visits and subsequent inpatient admissions. Eligible patients aged 18 years and younger were identified by International Classification of Diseases, Ninth Revision, Clinical Modification codes for pharmaceuticals, nonpharmaceuticalchemicals, fumes/vapors, foreign bodies, adverse food reactions, food poisoning, and bites/stings. Referral classification (PCC referral vs self-refer) was determined by PCC and hospital medical records.Descriptive statistics were used to characterize the patient demographics and ED visits by referral classification and age group. Simple and multiple logistic regression models examined the individual and combined impact of demographic and clinical characteristics on self-referral.Results: Of the 705 patients identified, 84.4% presented as caregiver/ self-referred compared with PCC-referred. As compared with those who self-referred, a higher percentage of patients who contacted the PCC before ED presentation were white (93.9% [89.4-98.2%] vs 83.8% [80.7-86.7%]) and had commercial insurance (62.7% [51.5-69.5%] vs 53.0% [48.9-57.0%]). Pharmaceutical (71.9%) and chemical (14.0%) exposures were the most common exposure types for PCC-referred patients whereas foreign bodies (54.3%) were the most common for self-referred patients. The largest predictors of self-referral were age, insurance, and exposure type.Conclusions: Among patients presenting at 1 pediatric ED, disparities with PCC utilization exist among age groups, racial identification, and poison exposure type. Educational outreach interventions are needed to ensure optimal use of the PCC services by patients, caregivers, and health care professionals.

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Poison-related visits in a pediatric emergency department: A retrospective analysis of patients who bypass poison control centers

Cited by 3 publications

References 32 publications

Unintentional Acute Poisoning Related Emergency Department Visits in Children in a Single-Center: A Nine-Year Prospective Survey

Unintentional Acute Poisoning Related Emergency Department Visits in Children in a Single-Center: A Nine-Year Prospective Survey

Toxicologic Exposures in California Emergency Departments in 2011 and Its Risk Factors

Unintentional Pediatric Poisoning Exposures in an Emergency Department

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