Poison Control Centers and TESS. Role of Regional Poison Control Center 24-hour resource for poison...

Poison Control Centers and TESS

Role of Regional Poison Control Center

24-hour resource for poison information, prevention, education and clinical toxicology consultation

Types of calls include: pediatric ingestions, overdoses, abuse, adverse reactions, therapeutic misadventures, environmental, occupational, natural products, plants, envenomations, etc.

US Poison Centers Available 24-7 65 US Poison Centers Universal access through 1-800-222-

1222 Specialized services

Language translation Hearing Impaired

Available to public and health professionals

New Telephone Number

Nationwide toll-free number routes caller to one of 65 poison centers based on area code and exchange

Coverage: 50 States, DC and Puerto Rico

Poison Center Staff

Specialists in Poison Information: pharmacists and nurses with additional training in clinical toxicology

Clinical Toxicologists Medical Toxicologists Educators

Regional Poison Control Centers

Numerous resources on-site Interface with regional treatment

facilities pre -hospital providers clinical laboratories health care facilities

• Outreach education

Regional Poison Control Centers

• Disaster preparedness and response

• Epidemiologic surveillance

Calls to US Poison Centers 2001

2.2 million poison exposures 860,000 information calls 111,000 animal exposures

Exposure Management Public Call

History of exposure Assessment of toxicity Triage – home, ED Home treatment recommendations Healthcare provider

recommendations Prevention education Follow-up

Exposure Management HCF Call

History of exposure Assessment of toxicity Differential diagnosis Clinical toxicology consultation Specific treatment

recommendations Follow-up

Poisoning History Patient Status Substance Amount Time Since Exposure Reason Past Medical History First Aid Provided Age/gender/weight

Follow-up call Public

To ensure that recommendations were understood

Situation resolving Documentation of outcome

HCF Review and update recommendations as

patient status changes Documentation of outcome

TESS Toxic Exposure Surveillance System

is the database of the American Association of Poison Control Centers

Compiled by the AAPCC in cooperation with majority of US Poison Centers

64 poison centers reported in 2001 Requirement for certified regional

poison centers

Toxic Exposure Surveillance System Single largest database on poison

exposures in US 1983 to present Hospitalized and home management

for poison exposures > 31 million poison exposures

reported to date Strong consistent temporal

relationship

History of TESS Deficiencies of US National

Clearinghouse for PCCs PCC Driven FDA fellowship to organize, pilot and

implement a functional system, develop software, instructions, generic classification scheme, uniform reporting forms

Pilot tested in 1983 National implementation in 1984

TESS Data Collection

Computerized data collection program at each poison center

Data collected at time of telephone call

Autoupload of data to AAPCC in real time

Medical records retained on-site

Human Exposures

3000

3500

4000

4500

5000

5500

6000

6500

7000

7500

8000

1/1/2000 7/1/2000 12/30/2000 6/30/2001 12/29/2001 6/29/2002 12/28/2002

Cas

es/D

ay

Weekdays

Weekends

All Info Calls 2000-2002

0

500

1000

1500

2000

2500

3000

3500

4000

4500

8/28/1999 3/15/2000 10/1/2000 4/19/2001 11/5/2001 5/24/2002 12/10/2002 6/28/2003

Date

Cas

es/D

ay

weekday

weekend

Use of TESS Data TESS Annual Report

September issue of Am J Emerg Med www.aapcc.org

Identification of new product risks Post-marketing surveillance Public health surveillance Regulatory actions Education program development Research

TESS Data Collection

Case Information Call type Caller Site Exposure Site Reason Relationship of caller to patient

(optional) Location information (zipcode/exchange)

Caller/Exposure Site Own Residence Other Residence Health Care Facility School Restaurant Public area Workplace Other Unknown

Reason for Exposure Unintentional

General Environmental Occupational Therapeutic error Unintentional

misuse Food poisoning Bite/sting Unknown

Intentional Suicide Misuse Abuse Unknown

Other Malicious Contamination

Adverse Reaction

TESS Data Collection

Patient Data Age Gender Pregnant

TESS Data Collection Exposure Information

Time since exposure (optional) Substance Clinical Effects Route of Exposure Therapy provided Management Site Medical Outcome

Substance Information Coded to brand and formulation if

known Coded by generic or category if

unknown Number of substances Quantity Certainty Dosage form

Clinical Effects Cardiovascular Dermatologic Gastrointestinal Heme/hepatic Neurologic

Ocular Respiratory Renal/

genitourinary Respiratory Miscellaneous

Specific definitions – some require objective findingsCoded as related, unrelated or unknown if related

Therapy Provided

No therapy Observation only Refused Unknown Decontamination Other therapies

Management Site

Onsite – non health care facility Already in/enroute to HCF Referred to HCF Other (nursing home, detox, jail) Unknown

Management Site - HCF

Treated and released from ED Admitted to critical care Admitted to non-critical care Admitted for psychiatric care Lost to follow-up Refused referral (referred only)

Medical Outcome No effect Minor effect Moderate effect Major effect Death

Unknown, non-toxic

Unknown, minimally toxic

Unknown, potentially toxic

Unrelated

Duration of symptoms

TESS Data Collection

Scenarios Pesticide exposures Therapeutic errors

Information not available from TESS

Narrative description Patient identifiers: name, address,

birthdate Socioeconomic data

Use of TESS DataSpecific Examples

Iron formulations Acetonitrile Pesticides

Arsenic containing rodenticides Mouthwash Rx OTC switch (ibuprofen, H2

antagonists, nicotine patch)

Quality Control

Data Collection Manual and Workbook

Center specific chart audits Electronic data checks and edits Data quality factors Fatality verifications

What TESS Can Not Do Poison Exposure vs Poisoning Absence of clinical effects

Prompt treatment or guidance by PCC Limited toxicity of substance Limited amounts/concentrations of substance Exposure suspected but did not occur

Telephone reporting Passive reporting Increased reports ≠increased hazard Calculate incidence of poisoning

Exposure Site

   Site of

Caller (%)

Site of Exposure

(%)

Residence 76.3 89HCF 13.9 0.3Workplace 1.6 2.5School 0.8 1.6

Route

Route % All % Fatal

Ingestion 76.2 76.4

Dermal 7.6 1.1

Inhalation 6.1 8.5

Ocular 5.4 0.1

TESS 2001

Management Site

Refused Referral

2%

On-site74%

HCF22%

Other1%

Unknown1%

TESS 2001

Management SiteHealth Care Facility

ICU admit14%

Lost16%

Psych8%

Non ICU7%

ED Only74%

TESS 2001

Most common substances by Age

< 6 years Cosmetics Cleaners Analgesics Foreign bodies Topicals Plants Cold preps

Adults Analgesics Sedative/hypnotics Cleaners Antidepressants Bites/stings Alcohols Food poisoning

Substances Related to Deaths Analgesics (pain

killers) Antidepressants Sedatives/

hypnotics/antipsychotics

Stimulants and street drugs

Cardiovascular drugs

Alcohols Anticonvulsants Muscle Relaxants Gases and Fumes Chemicals

Impact of Space Shuttle

Figure 1. TX and LA Inform ation Calls 2/3/2002 to 2/8/2003

0

100

200

300

400

500

600

700

2/3/2002 3/25/2002 5/14/2002 7/3/2002 8/22/2002 10/11/2002 11/30/2002 1/19/2003

date

calls

per

day w eekend days

w eekdays

1-Feb-03

Information calls to PCCs

Fig 2. All US PCC calls (excluding TX, LA) 2/3/02 through 2/8/03

0

500

1000

1500

2000

2500

3000

3500

4000

4500

2/3/2002 3/25/2002 5/14/2002 7/3/2002 8/22/2002 10/11/2002 11/30/2002 1/19/2003

date

calls

per

day w eekday info

callsw eekend dayinfo calls1-Feb-03

Carbon monoxideTESS Carbon Monoxide Human Exposures by day 1/93 to 2//03

0

100

200

300

400

500

600

12/31/1992 5/15/1994 9/27/1995 2/8/1997 6/23/1998 11/5/1999 3/19/2001 8/1/2002

date

N

Snake Bites

0

5

10

15

20

25

8/28/1999 3/15/2000 10/1/2000 4/19/2001 11/5/2001 5/24/2002 12/10/2002 6/28/2003

Cas

es/D

ay

Pesticide Exposures (Excl Rodenticides) by Day

0

100

200

300

400

500

600

6/15/1994 10/28/1995 3/11/1997 7/24/1998 12/6/1999 4/19/2001 9/1/2002 1/14/2004

Cas

es p

er d

ay, a

ll ag

es, a

ll ro

utes

Summary Comprehensive poisoning

surveillance database Includes cases managed in and

outside HCF Voluntary Telephone reports Consistent temporal nature Identification of public health hazards

Questions