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 §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

Age patterns

Age patterns - Children National statistics  1,142,796 (52.7%) < 6 years  151,221 (7%) 6-12 years § 160,505 (7.4%) years §total children 67.2% Kentucky Statistics  (50.6%) < 6 years  3,007 (6.6%) 6-12 years § 3,081 (6.8%) years §Total children 64%

Age pattern - Adults

Incidence of Poisoning by age group Population of KY §25.1 % of population is < 18 years of age §12.5% >65 years of age Poisoning cases §64% 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)

Fatal outcomes by age group (Kentucky)

Gender National Statistics §Male - 1,049,953 (48.4%) §Female 1,108,938 (51.1) §Male <6yr (56.1%) §Female <6yr (45.9%) Kentucky Statistics §Male 22,763 (49%) §Female 23,521 (51%) §Male <6yr (52.7%) §Female <6yr (47.2%)

Fatalities by age and gender (National)

Site of Exposure

Route of exposure

Comparison of Penetrance between 1998 and 2003

Human Exposures reported to two poison centers 1996 through 2002

Total calls to the poison center for assistance

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 pharmaceuticals §58 % of all exposures were non- pharmaceuticals §92 % of fatalities were pharmaceuticals §8 % of fatalities were non-pharmaceuticals

Top ten substance groups §Personal Care Products (perfumes, cosmetics dental care products, etc.) §Cough/Cold Products and Antihistamines §Cleaning substances §Pain Relievers (Tylenol, Aspirin, Ibuprofen, etc.) §Foreign Bodies

Top ten substance groups §Plants and Mushrooms §Topical Ointments and Creams §Insecticides and Rat Poisons §Antimicrobials (Antibiotics, etc.) §Hydrocarbons (gasoline, kerosene, etc.)

Other examples of what is tracked in database. §Clinical effects l Cardiovascular, Dermal, Gastrointestinal, Hemetological and Hepatic, Neurological, Respiratory, Ocular, Other (e.g. acidosis, hypoglycemia, fever, etc) §Therapies l 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 l 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) l assessment is second-hand l Access to pertinent data is by effort of others

Challenges in data collection §Time l 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 §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 reporting §can reference real time to historical values §In 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 search §Substances categorized into groupings assigned by the American Association of Poison Control Centers. (in use since 1983) §No relation to E-codes

Research § Retrospective l e.g. Tobacco spit ingestion, toxicity of citirizine §Prospective l e.g Mississippi River Delta Pesticide Project, Morbidity of copperhead snake bite

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