The Toxicology Investigators Consortium Case Registry—the 2019 Annual Report

Abstract

The Toxicology Investigators Consortium (ToxIC) Registry was established by the American College of Medical Toxicology (ACMT) in 2010. The Registry collects data from participating sites with the agreement that all bedside medical toxicology consultation will be entered. This tenth annual report summarizes the Registry's 2019 data and activity with its additional 7177 cases. Cases were identified for inclusion in this report by a query of the ToxIC database for any case entered from 1 January to 31 December 2019. Detailed data was collected from these cases and aggregated to provide information which included demographics, reason for medical toxicology evaluation, agent and agent class, clinical signs and symptoms, treatments and antidotes administered, mortality, and whether life support was withdrawn. 50.7% of cases were female, 48.5% were male, and 0.8% were transgender. Non-opioid analgesics was the most commonly reported agent class, followed by opioid and antidepressant classes. Acetaminophen was once again the most common agent reported. There were 91 fatalities, comprising 1.3% of all Registry cases. Major trends in demographics and exposure characteristics remained similar to past years' reports. Sub-analyses were conducted to describe exposures in cases of self-harm, gender differences in substance use disorder, and trends in addiction medicine and pain management consultations.

The Toxicology Investigators Consortium 2020 Annual Report

“…Tables 2 and 3 summarize selective demographics for age and gender and race and ethnicity, respectively. Gender breakdown was similar to recent years [2][3][4][5]. In 2020, 50.6% of cases involved female patients, and 1% involved transgender or gender non-conforming patients (37 female-to-male, 17 male-to-female, 8 gender non-conforming).…”

“…Table 13 describes the opioid class. Similar to recent years, heroin was again the most common agent in the class (32.1%) [2,3]. The relative contribution of fentanyl increased again this year, now representing 25.4% of the opioid class (14.6% in 2019), and again was the second most common agent.…”

“…In 2020 there were a total of 6668 individual cases of toxicologic exposures reported to the ToxIC Registry from 37 sites comprised of 58 separate health care facilities. This is a decrease in total cases compared with 2019 [2]. Individual facilities contributing cases in 2020 are listed in Table 1.…”

“…Consistent with recent years, intentional pharmaceutical exposures were by far the most common reason for medical toxicology encounters (43.8%). Addiction medicine consult was a new reason for encounter in 2018 and has increased in frequency each year (2.7% to 6.6% to 7.1%) [2,3]. Within the intentional pharmaceutical exposures, the majority of cases were again an attempt at self-harm (73.9%), primarily suicide attempts (87.5%).…”

“…Consistent with recent years, the non-opioid analgesic class was the most common (15.5%) class of drugs reported. Again in 2020, the opioid class was the second most common agent class reported (12.7%) [2] followed by the antidepressant (10.4%) and ethanol (8.4%) classes.…”