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Accidental pediatric ingestion, hospital charges and failure to utilize a poison control center
1Department of Pediatrics, Medical College of Wisconsin, Milwaukee, USA.
Insights
Accidental poison ingestions in young children are often nontoxic. Utilizing poison control centers for initial evaluation significantly saves healthcare costs compared to emergency department visits.
Area of Science:
- Pediatric Emergency Medicine
- Toxicology
- Health Services Research
Background:
- Accidental poison ingestions are common in children under 6, but most do not cause clinical toxicity.
- Nontoxic ingestions can often be managed via telephone, avoiding healthcare facility visits.
- Evaluating the cost-effectiveness of poison control centers versus emergency departments for pediatric ingestions is crucial.
Purpose of the Study:
- To evaluate clinical effects and costs of emergency department care versus poison control center telephone advice for accidental ingestions in children aged 6 and under.
Main Methods:
- A 1-year retrospective review of pediatric emergency department cases involving accidental ingestions in children 6 and under.
- Cases were classified as nontoxic or toxic based on poison control center criteria.
- Demographics, clinical effects, dispositions, and charges were compared between groups.
Main Results:
- Out of 467 cases, 141 met nontoxic criteria.
- Toxicity was not associated with race or gender; younger children (≤2 years) were most frequently involved.
- Poison control center calls are estimated to cost less than $25 per call.
Conclusions:
- Emergency department evaluations for nontoxic pediatric ingestions incur significant healthcare costs.
- Using poison control centers as the first point of contact for accidental pediatric ingestions leads to substantial healthcare savings.
Problem:
Telephone contact with a poison control center may determine that accidental poison ingestion may not pose a risk of developing adverse clinical effect. Over 50% of reported human poisonings occur in children less than 6 years old. Yet most of these accidental childhood ingestions do not produce clinical toxicity. Such nontoxic ingestions can be managed by telephone rather than treated in a health care facility. This study evaluated the clinical effects produced, and the cost of emergency department care, versus obtaining telephone advice from a poison control center, following accidental poison ingestion in children age 6 and under.
Methods:
1 year review of all cases of accidental ingestion in children 6 years and under evaluated in a pediatric emergency department. Utilizing the hospital's poison control center criteria, cases were grouped as nontoxic (no risk of adverse effect) or toxic (significant risk for adverse effect). Groups were compared for demographics, clinical effect, dispositions, charges.
Results:
467 cases were seen; 141 met nontoxic criteria. Toxicity was not related to race or gender. Children age 2 and less accounted for the majority of cases (p = .003) [table: see text] Estimated poison control center costs are less than $25 per telephone call.
Conclusion:
Significant charges are billed to health care payers when an emergency department is utilized as the primary means of evaluating children with nontoxic ingestions. Utilization of a poison control center as the initial means of intervention following an accidental pediatric ingestion results in significant savings in health care expenditures.