epidemiology of poisoning in kentucky henry spiller, m.s., a.b.a.t. kentucky regional poison center
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National Picture
58 poison centers in the US.51 of these centers are Certified Regional
Centers.2.2 million human exposures reported to
poison centers in 2003.One poisoning every 14 seconds.
Local Picture - Kentucky
One poison center serving all 120 counties.45,317 human poisoning cases in 2003
reported to the center.Poisoning in Kentucky every 12 minutes.Poison center open 24/7.Receive calls from lay public and health
professionals.
Type of calls to the Poison Center
Human Exposures 45,317
Animal Exposures 1,970
Information calls 24,669
Total 71,956
Age patterns - Children
National statistics 1,142,796 (52.7%) < 6
years 151,221 (7%)
6-12 years 160,505 (7.4%) 13-
18 years total children 67.2%
Kentucky Statistics 222937 (50.6%)
< 6 years 3,007 (6.6%)
6-12 years 3,081 (6.8%)
13-18 yearsTotal children 64%
Age pattern - AdultsAge group Nation Kentucky 20 – 29 171,975 (7.9) 3,289 (7.3)
30 –39 174,371 (8.0) 2,676 (5.9) 40 – 49 127,995 (5.9) 2,161 (4.8) 50 – 59 72,261 (3.3) 1,292 (2.9) 60 –69 39,056 (1.8) 639 (1.4) 70 - 79 30,245 (1.4) 517 (1.1) 80 –89 16,144 (0.7) 322 (0.7) >90 2,936 (0.1) 55 (0.1)
Incidence of Poisoning by age group
Population of KY25.1 % of population
is < 18 years of age
12.5% >65 years of age
Poisoning cases64% of poisonings
occur in patient < 18 years of age.
2.7% of poisonings occur in patients > 65 years of age
Fatal outcomes by age group (National)
Age group % cases % fatalities 0 to 5yr 52.7 2.2 6 to 12yrs 7.0 0.7 13-19yrs 7.4 7.2 20 to 39 13.2 35.5 40 to 59 9.2 36.7 60 to 79 3.2 10.7 >80 0.8 4.8
Fatal outcomes by age group (Kentucky)
Age group % cases % fatalities 0 to 5yr 50 4.4
6 to 12yrs 6.4 0.0
13-19yrs 6.8 8.8 20 to 39 15.5 42.2 40 to 59 7.7 24.3 60 to 79 2.5 13.3 >80 0.8 2.2
Gender
National StatisticsMale - 1,049,953
(48.4%)Female 1,108,938
(51.1)Male <6yr (56.1%)Female <6yr (45.9%)
Kentucky StatisticsMale 22,763 (49%)Female 23,521 (51%)
Male <6yr (52.7%) Female <6yr (47.2%)
Fatalities by age and gender (National)
Age group % male % female0 to 5yr (n=20) 40 606 to 12yrs (n=6) 33.3 66.613-19yrs (n=66) 63.6 36.420 to 39 (n=327) 54.4 45.640 to 59 (n=337) 51.3 48.760 to 79 (n=98) 54.1 45.9>80 (n=44) 43.2 56.8Total all ages 53.2 46.8
Calls by Month
01000200030004000500060007000
J F M A M J J A S O N D
Month
Information Calls
Human Exosures
General
Enviromental
Occupational
Therapeutic error
Misuse
Bite Sting
Food Poisoning
Breakout of unintentional exposures
37203
2939 2709 44801634 236 221
Ing
esti
on
Inh
alat
ion
Occ
ula
r
Der
mal
Bit
e/S
tin
g
Par
ente
ral
Oth
er
Route of exposure
Human Exposures reported to two
poison centers 1996 through 2002
42000
43000
44000
45000
46000
47000
48000
49000
50000
Ken
tuck
y
52000
54000
56000
58000
60000
62000
64000
66000
Ind
ian
a
Kentucky 49227 47247 45447 44865 45552 46111 46885
Indiana 63912 62619 62218 58215 59054 58155 57263
1996 1997 1998 1999 2000 2001 2002
Total calls to the poison center for assistance
54000
56000
58000
60000
62000
64000
66000
68000
70000
72000
Ken
tuck
y
66000
68000
70000
72000
74000
76000
78000
80000
82000
Ind
ian
a
Kentucky 64336 61466 61018 61473 63721 67710 71156
Indiana 78890 77758 81049 76936 79112 79559 77097
1996 1997 1998 1999 2000 2001 2002
Impact of a Public Education program
The addition of a Public Educator was associated with a positive impact on human exposures and penetrance reported to a regional poison center.
It appears from the data that a measurable impact of the educator was on marketing the center to promote awareness and utilization of the service as compared with change in behaviors to reduce incidence of poisoning
Management site
76 % of patients are managed outside of healthcare facilities
Saves an estimated $10 to $12 million per year from reduced unnecessary ER visits
Allows appropriate triage at the site of exposure.
Staffing of Poison Center
Registered Nurses with a mean of 10 years of experience (range 1 to 19 years)
Average 4,000 human exposures per year per Nurse (range 3,200 to 5,000)
Each nurse has personally managed a mean of 40,000 cases
The only Board Certified Toxicologists in the state (n=3)
Management site
24 % of patient managed in a Health care facility.
Of these, 2/3 were already in the ED on first contact with the Poison center
1/3 were referred to the ED
Substances involved in Poisonings
42 % of all exposures were pharmaceuticals58 % of all exposures were non-
pharmaceuticals
92 % of fatalities were pharmaceuticals8 % of fatalities were non-pharmaceuticals
Top ten substance groups
Personal Care Products (perfumes, cosmetics dental care products, etc.)
Cough/Cold Products and AntihistaminesCleaning substancesPain Relievers (Tylenol, Aspirin, Ibuprofen,
etc.)Foreign Bodies
Top ten substance groups
Plants and MushroomsTopical Ointments and CreamsInsecticides and Rat PoisonsAntimicrobials (Antibiotics, etc.)Hydrocarbons (gasoline, kerosene, etc.)
Other examples of what is tracked in database.Clinical effects
Cardiovascular, Dermal, Gastrointestinal, Hemetological and Hepatic, Neurological, Respiratory, Ocular, Other (e.g. acidosis, hypoglycemia, fever, etc)
Therapies 68 specific therapies
Severity of outcomes
0.09 % of exposures were fatalities.1 % of exposures had life threatening
events.6 % of exposures had severe symptoms
requiring invasive measures
Challenges in data collection
Passive reporting system If they don’t think to call the poison center the
case does not get in the database
Reluctance to give information secondary to privacy issues
Nature of contact (i.e.phone) assessment is second-hand Access to pertinent data is by effort of others
Challenges in data collection
Time a lot of data to get from busy people, must
balance data collection with patient management needs.
Awareness of the staff of the value of specific data items
Examples of Discrepancies
9 oxycodone deaths in the Poison Center database for 2000-2001
Check of 6 counties death reports found 26 deaths related to oxycodone
Why? - person found dead, died in ER before OD recognized
Value of the database
Only Statewide database of poisoning cases with input from both lay public and health professionals
real time reportingcan reference real time to historical valuesIn Kentucky high usage by population
(greater than national average)
Value of the database - continued
Used by CDC and Homeland Security to monitor for abnormal event that might signal an event
Searching the Database
Relational database - easy to searchSubstances categorized into groupings
assigned by the American Association of Poison Control Centers. (in use since 1983)
No relation to E-codes
Research
Retrospective e.g. Tobacco spit ingestion, toxicity of citirizine
Prospective e.g Mississippi River Delta Pesticide Project,
Morbidity of copperhead snake bite