epidemiology of poisoning in kentucky henry spiller, m.s., a.b.a.t. kentucky regional poison center

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Epidemiology of Poisoning in Kentucky Henry Spiller, M.S., A.B.A.T. Kentucky Regional Poison Center

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Epidemiology of Poisoning in Kentucky

Henry Spiller, M.S., A.B.A.T.

Kentucky Regional Poison Center

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

Age group Number Percentage

Children (<19 years)

28,997 64%

Adults 16,320 36%

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

Mean calls per day

0

50

100

150

200

250

J F M A M J J A S O N D

InformationCalls

HumanExposures

01000

200030004000

50006000

mid 3 6 9

12N 15 18 21

Cases by hour of day

Unintentional

Intentional

Adverse ReactionOther

Reason for exposure

General

Enviromental

Occupational

Therapeutic error

Misuse

Bite Sting

Food Poisoning

Breakout of unintentional exposures

40,109

21291504161 690 7271100

Ow

n

Oth

er

Wo

rkp

lce

HC

F

Sch

oo

l

Pu

blic

oth

er

Site of Exposure

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

Comparison of Penetrance between 1998 and 2003

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

Thank You