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Assessing unnecessary emergency department visits for poison exposures in pediatric patients less than six years old
Liam P McLoughlin1,2, Howard A Greller1,3, Mehruba A Parris1,3
1New Jersey Poison Control Center, Newark, NJ, USA.
Insights
Many pediatric emergency department visits for poison exposure are unnecessary. Improving parental education on poison control centers and safety measures can reduce these non-urgent visits.
Area of Science:
- Pediatric Emergency Medicine
- Toxicology
- Public Health
Background:
- Pediatric emergency department (ED) visits for poison exposures are common.
- A significant proportion of these visits may not be medically necessary.
- Contacting poison control centers (PCCs) prior to ED presentation can help triage cases.
Purpose of the Study:
- To investigate the medical necessity of pediatric ED presentations for poison cases.
- To determine the rate of non-contact with PCCs before ED visits.
- To identify factors influencing the decision for ED evaluation of pediatric poison cases.
Main Methods:
- Retrospective analysis of 348 pediatric poison control center cases.
- Toxicologists evaluated case summaries using a 4-point Likert scale.
- Binomial regression and qualitative thematic analysis were performed on reviewer data.
Main Results:
- Approximately 65% of cases were deemed not to require ED evaluation.
- Clinical symptoms significantly influenced toxicologists' concern levels.
- Reviewers desired more information on exposure circumstances and specific symptoms.
Conclusions:
- Many pediatric ED visits for poison exposure are not medically indicated.
- Clinical presentation is a key factor in determining ED necessity.
- Future efforts should focus on enhancing public awareness and utilization of PCCs.
Introduction:
We will investigate the medical necessity of pediatric emergency department presentations, specifically for emergency department poison cases where a poison control center was not contacted prior to presenting.
Methods:
A retrospective analysis of 348 poison control center cases involving patients aged < six, originating from a healthcare facility were evaluated. Toxicologists were presented with case summaries and were asked: "would you send this patient to the emergency department?" Evaluators answered on a 4-point Likert scale from "definitely would not send" to "definitely would send." Reviewers had the opportunity to write in additional information that would be beneficial to deciding their disposition. To simulate the need to make a yes or no decision on whether to send, Likert scores were manipulated into a binomial score of 0/1. Binomial regression analysis and qualitative thematic analysis were completed.
Results:
Toxicologists found that 38% of patients definitely did not require emergency department evaluation, and 27% were unlikely to require it. The presence of clinical symptoms were significantly associated with increased concern by toxicologists. Qualitative analysis from reviewer free text case comments, demonstrated that understanding the situation surrounding the exposure (certainty, past medical history, etc. n = 26) and presence of specific symptoms in each case (fever, vomiting, etc. n = 25) were desired to better determine the need for an emergency department.
Discussions:
About 65% of cases were evaluated as not requiring emergency department evaluation. The presence of clinical symptoms is a key factor related to clinician level of concern. Further work should include finding ways to prevent these emergency department presentations.
Conclusions:
Many emergency department evaluations for poison exposure amongst children less than six years old are not medically required. Further work should focus on improving parental knowledge of poison centers and poison safety, while continuing to promote poison centers as accessible resources to the public.
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