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Unintentional Pediatric Poisoning Exposures in an Emergency Department: A Comparison of Poison Control Center
Amberly R Johnson, Casey R Tak, Michael Mundorff1
1Department of Systems Improvement, Primary Children's Hospital, Intermountain Healthcare.
Insights
Pediatric emergency department visits for unintentional poisoning show disparities in poison control center (PCC) utilization. Educational outreach is needed to ensure optimal PCC services for all patients and caregivers.
Area of Science:
- Pediatric Emergency Medicine
- Toxicology
- Public Health
Background:
- Unintentional poisoning is a common reason for pediatric emergency department (ED) visits.
- Poison control centers (PCCs) provide crucial guidance for poisoning exposures.
- Understanding referral patterns to the ED is essential for optimizing PCC utilization.
Purpose of the Study:
- To compare the demographics and clinical characteristics of pediatric patients with unintentional poisoning exposures referred by a PCC versus those who self-referred to the ED.
- To identify factors influencing self-referral versus PCC referral for pediatric poisoning cases.
Main Methods:
- Retrospective query of a pediatric hospital's electronic data warehouse (October 2014-September 2015).
- Identification of patients aged 18 years and younger with unintentional poisoning using ICD-9-CM codes.
- Classification of referrals as PCC-referred or self-referred based on medical records.
- Descriptive statistics and logistic regression to analyze demographic and clinical characteristics associated with referral type.
Main Results:
- Of 705 patients, 84.4% were self-referred; PCC-referred patients were more likely to be white and have commercial insurance.
- Pharmaceutical exposures (71.9%) and chemical exposures (14.0%) were most common in PCC-referred cases.
- Foreign body ingestions (54.3%) were most common in self-referred cases.
- Age, insurance status, and exposure type were significant predictors of self-referral.
Conclusions:
- Significant disparities exist in poison control center utilization among pediatric patients presenting to the ED for unintentional poisoning.
- Differences in utilization are observed across age groups, racial identification, and types of poison exposure.
- Targeted educational outreach is necessary for patients, caregivers, and healthcare professionals to improve PCC service utilization.
Objectives:
The purpose of this study is to describe the demographics and clinical characteristics of patients referred to a pediatric emergency department (ED) for unintentional poisoning exposures by a poison control center (PCC) compared with patients/caregivers who self-refer.
Methods:
The electronic data warehouse at a pediatric hospital was queried from October 1, 2014, to September 30, 2015, for unintentional poisoning-related ED visits and subsequent inpatient admissions. Eligible patients aged 18 years and younger were identified by International Classification of Diseases, Ninth Revision, Clinical Modification codes for pharmaceuticals, non-pharmaceuticalchemicals, fumes/vapors, foreign bodies, adverse food reactions, food poisoning, and bites/stings. Referral classification (PCC referral vs self-refer) was determined by PCC and hospital medical records.Descriptive statistics were used to characterize the patient demographics and ED visits by referral classification and age group. Simple and multiple logistic regression models examined the individual and combined impact of demographic and clinical characteristics on self-referral.
Results:
Of the 705 patients identified, 84.4% presented as caregiver/self-referred compared with PCC-referred. As compared with those who self-referred, a higher percentage of patients who contacted the PCC before ED presentation were white (93.9% [89.4-98.2%] vs 83.8% [80.7-86.7%]) and had commercial insurance (62.7% [51.5-69.5%] vs 53.0% [48.9-57.0%]). Pharmaceutical (71.9%) and chemical (14.0%) exposures were the most common exposure types for PCC-referred patients whereas foreign bodies (54.3%) were the most common for self-referred patients. The largest predictors of self-referral were age, insurance, and exposure type.
Conclusions:
Among patients presenting at 1 pediatric ED, disparities with PCC utilization exist among age groups, racial identification, and poison exposure type. Educational outreach interventions are needed to ensure optimal use of the PCC services by patients, caregivers, and health care professionals.
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