The Toxicology Investigators Consortium Case Registry—the 2014 Experience

Abstract

The Toxicology Investigators Consortium (ToxIC) Case Registry was established in 2010 by the American College of Medical Toxicology. The Registry includes all medical toxicology consultations performed at participating sites. The Registry was queried for all cases entered between January 1 and December 31, 2014. Specific data reviewed for analysis included demographics (age, gender, ethnicity), source of consultation, reasons for consultation, agents involved in toxicological exposures, signs, symptoms, clinical findings, fatalities, and treatment. In 2014, 9172 cases were entered in the Registry across 47 active member sites. Females accounted for 51.1 % of cases. The majority (65.1 %) of cases were adults between the ages of 19 and 65. Caucasians made up the largest identified ethnic group (48.9 %). Most Registry cases originated from the inpatient setting (93.5 %), with a large majority of these consultations coming from the emergency department or inpatient admission services. Intentional and unintentional pharmaceutical exposures continued to be the most frequent reasons for consultation, accounting for 61.7 % of cases. Among cases of intentional pharmaceutical exposure, 62.4 % were associated with a self-harm attempt. Non-pharmaceutical exposures accounted for 14.1 % of Registry cases. Similar to the past years, non-opioid analgesics, sedative-hypnotics, and opioids were the most commonly encountered agents. Clinical signs or symptoms were noted in 81.9 % of cases. There were 89 recorded fatalities (0.97 %). Medical treatment (e.g., antidotes, antivenom, chelators, supportive care) was rendered in 62.3 % of cases. Patient demographics and exposure characteristics in 2014 Registry cases remain similar to prior years. The majority of consultations arose in the acute care setting (emergency department or inpatient) and involved exposures to pharmaceutical products. Among exposures, non-opioid analgesics, sedative/hypnotics, and opioids were the most frequently encountered. A majority of cases required some form of treatment, but fatalities were rare.

The Toxicology Investigators Consortium Case Registry—the 2015 Experience

“…BUnknown/uncertain^was reported for race in 24.0 % of cases, and for Hispanic ethnicity in 25.9 % of cases. These percentages were lower than those recorded in 2014 (32.8 % for race and 29.5 % for ethnicity) [4]. In 2015, the most commonly reported races were Caucasian (55.6 %) and Black/African (13.1 %), while 9.6 % of cases reported Hispanic ethnicity.…”

“…Similar to 2014, there were slightly more female (51.2 %) than male (48.8 %) cases [4]. Fifty-two cases involved pregnant women, representing 0.6 % of the total 2015 cases.…”

“…such as 50 or fewer cases overall, or the majority of a class having less than 5 entries per individual agent), a detailed table is not presented but information may be described in the text section or available in the Supplementary material. Tables 1 and 2 [4,8]. The number of cases contributed by individual sites ranged from 2 to 1163.…”

“…These include all nonmedications taken purposefully for any reason, such as abusing heroin, or ingesting a caustic for self-harm. The unintentional pharmaceutical category captures exposures such as pediatric exploratory behavior and other accidental medication ingestions and was the third most common reason for [4]. Snake envenomation cases also remained stable in 2015 at 2.8 % of total cases.…”

“…In 2015, six manuscripts using ToxIC data were published in the peer-reviewed literature (Finkelstein et al [2]; Froberg et al [3]; Rhyee et al [4]; Smith and Farmer [5]; Watkins et al [6]; Zelner et al [7]), and 25 published abstracts based on ToxIC data were presented at three national and international meetings.…”