The Toxicology Investigators Consortium Case Registry—the 2015 Experience

Abstract

The American College of Medical Toxicology established the Toxicology Investigators Consortium (ToxIC) Case Registry in 2010. The Registry contains all medical toxicology consultations performed at participating sites. The Registry has continued to grow since its inception, and as of December 31, 2015, contains 43,099 cases. This is the sixth annual report of the ToxIC Registry, summarizing the additional 8115 cases entered in 2015. Cases were identified by a query of the Registry for all cases entered between January 1 and December 31, 2015. Specific data reviewed for analysis included demographics (age, race, gender), source of consultation, reason for consultation, agents and agent classes involved in exposures, signs, symptoms, clinical findings, fatalities, and treatment. By the end of 2015, there were 50 active sites, consisting of 101 separate health-care facilities; 51.2 % of cases involved females. Adults between the ages of 19 and 65 made up the majority (64.2 %) of Registry cases. Caucasian race was the most commonly reported (55.6 %); 9.6 % of cases were identified as Hispanic ethnicity. Inpatient and emergency department referrals were by far the most common referral sources (92.9 %). Intentional pharmaceutical exposures remained the most frequent reason for consultation, making up 52.3 % of cases. Of these intentional pharmaceutical exposures, 69 % represented an attempt at self-harm, and 85.6 % of these were a suicide attempt. Nonopioid analgesics, sedative-hypnotics, and antidepressant agents were the most commonly reported agent classes in 2015. Almost one-third of Registry cases involved a diagnosed toxidrome (32.8 %), with a sedative-hypnotic toxidrome being the most frequently described. Significant vital sign abnormalities were recorded in 25.3 % of cases. There were 98 fatalities reported in the Registry (1.2 %). Adverse drug reactions were reported in 4.3 % of cases. Toxicological treatment was given in 65.3 % of cases, with 33.0 % receiving specific antidotal therapy. Exposure characteristics and trends overall were similar to prior years. While treatment interventions were required in the majority of cases, fatalities were rare.

A Study of Pharmaceutical Drugs Poisoning Cases Admitted to the National Poisoning Center, Kasralainy Teaching Hospital in Cairo

“…Paracetamol and NSAIDs (19.2%) were the most common pharmaceutical poisons ( Figure 3). As similar, the American (18) and a review of a toxicology cases (19) reported that the most common drugs causing to poisoning were analgesics, sedatives, antipsychotics and anti-depressants. Analgesics and anti-depressants are the most common among single agent ingestions causing acute poisoning in Turkey (12).…”

Hypoglycemia and lactic acidosis outperform King’s College criteria for predicting death or transplant in acetaminophen toxic patients

“…Acetaminophen is one of the most widely consumed over the counter analgesic medications and is one of the most common medications toxicologists encounter in overdose [1]. Toxicity can result in severe liver damage and standard therapy includes N-acetylcysteine (NAC).…”

When Your N >1: Drawing Meaningful Conclusions from Registry Studies

“…The first registry featured in this issue is the 6th Annual ToxIC report [5]. The Toxicology Investigators Consortium (ToxIC) registry was established in 2010 in an effort to fill in the missing details in NPDS by providing bedside level data on a large scale [7].…”

“…Unlike NPDS where data are volunteered by callers with no specialized toxicology training or a formal mechanism for verifying the details, the ToxIC registry provides more credible and reliable data to analyze poisoning trends and generate new research questions. It is reassuring to see that clinically important national trends, such as the increase in severe exposure visits from sedatives last year, is a consistent finding in both NPDS and ToxIC [4,5]. To be fair, it is important to recognize the data in ToxIC has a sampling bias, because only centers with an onsite toxicologist (or toxicology fellowship program) consulted for a case can enter data into the registry, thereby skewing the cases to an arguably sicker population.…”

“…As noted by the authors, BWhile there may be variation in agent frequencies from year to year, and new trends may emerge, overall the most common exposures, toxidromes, clinical abnormalities, and antidotes as recorded in the Registry, represent the routine practice of the specialty of Medical Toxicology. The Registry forms a representation of our specialty and the expertise that a Medical Toxicologist brings to the bedside.^ [5] ToxIC's 6th annual report is even better than ever and we look forward to future reports from the consortium.…”