Zdravko P. Vassilev

The impact of a poison control center on the length of hospital stay for patients with poisoning

While previous research suggests that poison control centers (PCCs) significantly reduce the number of emergency room visits and resultant health care costs for poisonings, little is known regarding the potential impact of the PCC on the length of hospital stay. The aim of this study was to examine whether assistance from a PCC is associated with a shorter length of hospital stay for patients admitted with poisonings. The cases reported to our PCC were matched over a period of 1 yr with the hospital admissions E-coded as poisonings in the Uniform Billing (UB) data maintained by the state health department. The length of hospital stay was then compared between the cases for which a PCC provided assistance (matches) and the cases for which a PCC was not contacted. During the study period, there were 32,245 hospitalizations for poisoning in the UB data and 52,498 poisonings reported to the PCC. The matching process yielded 1719 nonfatal cases. The length of hospital stay for patients who received assistance from a PCC ranged from 0 to 126 d (median = 2.0) and was significantly different compared to a range of 0 to 220 days (median = 5.0) for cases that were never called in to a PCC. The results of this study suggest that patients admitted to hospitals with poisonings who receive PCC assistance have measurable reductions in average hospital stay. Such a decrease may translate into substantial savings in health care costs and resources.

Evaluation of adverse drug reactions reported to a poison control center between 2000 and 2007

PURPOSE The likelihood of hospitalization caused by adverse drug reactions (ADRs) from commonly implicated therapeutic groups is discussed. METHODS A retrospective analysis of the computerized records of exposure cases involving pharmaceutical substances reported to the New Jersey Poison Information and Education System (NJPIES) was conducted from 2000 through 2007. The cases in the National Poisoning Data System that were categorized as an ADR were included in the study set. Only reports involving a single drug were selected for inclusion in the analyses. Characteristics of the ADRs, such as the sex and age of the patient, the therapeutic group involved, and the medical outcome of the exposure, were examined. Reports of ADRs with the most frequently implicated therapeutic groups were analyzed based on whether the patients were managed onsite, referred to a health care facility, or managed at a health care facility. The Adverse Drug Reaction Hospitalization (ADRH) index was calculated for all therapeutic groups, but the focus of the analyses was on the groups that were implicated in 5% or more of all ADRs. RESULTS A total of 454,520 cases of human poisoning exposure were reported to NJPIES from 2000 through 2007. Of these cases, 162,105 were exposures implicating a single drug, of which 5,461 (3.4%) were classified as an ADR. Of the 5,461 cases, 385 patients were admitted into a health care facility. Antidepressants had the highest ADRH index (20.4%) among the therapeutic groups implicated, and antimicrobials had the lowest (2.2%). CONCLUSION The analyses revealed a substantial variation in the likelihood of hospitalization associated with ADRs within different therapeutic groups. Among the groups that were most frequently implicated in ADRs, antidepressants showed the highest probability for an ADR-related hospitalization, followed by dietary supplements, herbals, and homeopathics and then by sedatives, hypnotics, and antipsychotics.

Case of elevated blood lead in a south Asian family that has used sindoor for food coloring

After a routine blood testing, a local pediatrician discovered that a 13-month-old boy had an elevated blood lead level (BLL) of 57 µg/dL. Since the baby was mostly breast-fed, the pediatrician did a blood test on the mother, and the result showed a BLL of 85 µg/dL. As the mother denied any history of pica behavior, the pediatrician suspected a source of lead to which the entire family might have been exposed and tested the fathers BLL. The results showed a BLL of 95 µg/dL, and the pediatrician informed the poison center. The subsequent epidemiological investigation revealed that the parents had used a product called Sindoor for food coloring. Laboratory analyses showed that the product contains more than 57.8% of acid-extractable lead by weight. Given the extremely high content of Pb in this product, Sindoor poses a serious risk of lead poisoning if it is used for food coloring.

Assessment of Barriers to Utilization of Poison Centers by Hispanic/Latino Populations

Previous research suggests that Spanish-speaking parents and residents of areas with large Hispanic and Latino populations are likely to underutilize the assistance that is available through poison control centers (PCCs). In order to examine any real and perceived barriers to utilization of the New Jersey Poison Information and Education System (NJPIES), the only poison control center in the state, an intercept survey was conducted with self-identified Hispanics/Latinos at Women, Infant, and Children (WIC) centers and in nearby grocery stores, bus stops, and public laundromats. Only 38% of the study sample (n = 206) had heard of NJPIES. Common ways to have heard of NJPIES included school or church bulletins, family members, and friends. Twenty-three percent knew the NJPIESs toll-free phone number; 23% knew it was available 24 h per day; and 22% knew that Spanish-speaking personnel were available for assistance. Potential barriers to utilization included not knowing the phone number of the poison center, not speaking English, and not knowing if the poison center could offer any help. Respondent-recommended strategies for increasing awareness of NJPIES among Hispanics/Latinos included advertising on TV, and distributing information through school and church bulletins.

Poison control center surge capacity during an unusual increase in call volume--results from a natural experiment

INTRODUCTION Poison Control Centers (PCCs) play an integral role in the preparation for and management of poison emergencies. Large-scale public health disasters, caused by both natural and human factors, may result in a drastic increase in the number of inquiries received and handled by PCCs in short periods of time. In order to plan and prepare for such public health emergencies, it is important for PCCs to assess their ability to handle the surge in call volume and to examine how the unusually large number of calls could affect the level of services. On 26 January 2006, the New York City Poison Center experienced a sudden loss of telephone service. The disruption in telephone service led to the need to reroute calls from that geographical catchment area to the New Jersey Poison Information and Education System (NJPIES) for several hours. METHODS Data from the NJPIES was abstracted from the telephone switchs internal reporting system and the NJPIESs electronic record system and processed with a standard spreadsheet application. RESULTS Compared to the same time and day in the previous week, the total number of calls received by the NJPIES during the four hours after the disruption increased by 148%. A substantial rise in the number of calls was observed in almost every 15-minute increment during this four-hour (h) time period (with some of these increments increasing as much as 525%). Meanwhile, the percentage of calls answered by the NJPIES decreased, and the percentage of calls abandoned during a 15-minute increment reached as high as 62%. Furthermore, the average time for handling calls was longer than usual in most of these 15-minute increments. CONCLUSIONS Limitations of the telephone technology, which impacted the ability of the NJPIES to respond to the surge of calls, were observed. While the NJPIES was able to handle the unusual increase of incoming calls using available poison specialists and staff, the experience gained from this natural experiment demonstrates the need for PCCs to have a pre-planned surge capacity protocol that can be implemented rapidly during a public health emergency. A number of challenges that PCCs must meet in order to have adequate surge capacity during such events were identified.

Seasonal Changes in Poisoning Exposures Reported to a Regional Poison Center from Coastal Resort Areas

This study examined the role of seasonality in the reporting of poisoning exposures from geographically distinct regions, specifically from coastal resort and vacation areas. The monthly distribution of calls received by a regional poison control center from counties with popular beach and vacation resorts was compared with the monthly distribution of the overall calls to the center. A chi-square goodness-of-fit test was used to determine if there was a significant difference between the monthly distribution of calls received from the resort counties and the overall calls received by the poison center. Further, exposure and information calls from the resort counties were separately examined to determine if they were equally distributed between months. The monthly distribution of calls received from coastal resort counties was significantly different from the monthly distribution of overall calls received by the center. Significantly more calls were received from the resort counties during the months of July and August at the height of the vacation season. While there was no seasonal variation in the number of information calls from these counties, the poisoning exposure calls were not equally distributed between months, as there were more such calls during the months of July and August. Seasonality appears to play a role in the number of calls received by a regional poison center from coastal areas with popular beach resorts. Poisoning exposure calls seem to increase particularly during the months of July and August. A greater effort may have to be put into activities related to poison control and prevention into such areas during the vacation season.

Trends in Major Types of Poisoning Exposures in Children Reported to a Regional Poison Control Center, 1994-2001

According to the 2001 annual report of the American Association of Poison Control Centers (AAPCC) Toxic Exposure Surveillance System (TESS), a total of 1,326,090 poisoning exposure cases involving children 0 to12 years of age were reported to regional poison control centers (PCCs) in the United States during 2001.1 These cases accounted for 58.5% of all cases of human poisoning exposures reported to poison centers in 2001. The documented cases are likely to be lower than the actual number of poisoning exposures in children because of possible underreporting to PCCs.2-5 Still, the TESS data compiled by poison control centers are perhaps the most comprehensive source of information on poisoning exposures occurring among children in the United States during each year. Since 1994, the annual TESS reports compiled by AAPCC have shown a relative increase in the total number of poisonings in children 0 to 12 years of age. Because of inherent year-to-year changes in the regional poison control centers’ participation and reporting, the yearly frequencies of reported exposures aggregated by the AAPCC on a national level may not be accurate proxies for understanding the trends in the occurrence of poisonings over time. In this respect, the TESS data collected by a regional poison control center are a dependable source of continuous information allowing evaluation of the time trends in age-specific poisoning exposures that occur on the local level. In this study, we examined the changes in the major types of poisoning exposures in children reported to the New Jersey Poison Information and Education System (NJPIES) during 1994 through 2001. NJPIES is an AAPCC accredited regional poison center that began service in February 1983, replacing 35 local “poison control centers” at hospitals across the state. Since then, it has been the only resource for onsite treatment of poisoning exposures through telephone management and consultation in New Jersey. NJPIES maintains computerized records for each call that is received by the center. The poison specialists who handle the calls at NJPIES are physicians, registered nurses, or pharmacists who manage over 50,000 poison exposure cases annually. NJPIES