Discrepant advice from poison centres and their medical directors

To characterize the recommendations of the medical directors of North American poison information centres for gastrointestinal decontamination of a hypothetical poisoned patient, and to examine the extent to which those recommendations agree with the advice previously issued by their poison information centres for the same scenario.

The medical directors of 72 poison centres in the United States and Canada were contacted and invited to participate in a survey. Each participant was asked to provide specific advice for gastrointestinal decontamination of a hypothetical patient presenting 1 h after a potentially life-threatening ingestion (32.5 g) of enteric-coated acetylsalicylic acid. The directors were then presented with the recommendation their poison centres had previously issued for the same overdose scenario. The main outcome measures were perceived agreement with their own centre's recommendation and director-centre concordance for each method of gastrointestinal decontamination.

Sixty-seven of 72 (93%) medical directors participated in the survey. They issued 30 different management suggestions for our hypothetical patient, and were in full agreement with their own centres 27% of the time. Concordance was moderate for recommendations on syrup of ipecac (k=0.468, P<0.001), and fair for whole bowel irrigation (k=0.348, P=0.005) and the use of sorbitol with activated charcoal (k=0.305, P=0.005). Concordance was poorest for advice on gastric lavage (k=0.093, P=0.445) and multidose charcoal (k=0.039, P=0.745).

The medical directors of North American poison centres offer widely varying advice on gastrointestinal decontamination for a hypothetical patient who is acutely poisoned with enteric-coated acetylsalicylic acid. Their advice was often different from that previously issued by their respective centres.