Benson B E, Smith C A, McKinney P E, Litovitz T L, Tandberg W D
New Mexico Poison & Drug Information Center, University of New Mexico, Albuquerque 87131, USA.
J Toxicol Clin Toxicol. 2001;39(5):433-8. doi: 10.1081/clt-100105411.
The purpose of this study was to determine the extent to which poison center triage guidelines influence healthcare facility referral rates for acute, unintentional acetaminophen-only poisoning and acute, unintentional adult formulation iron poisoning.
Managers of US poison centers were interviewed by telephone to determine their center's triage threshold value (mg/kg) for acute iron and acute acetaminophen poisoning in 1997. Triage threshold values and healthcare facility referral rates were fit to a univariate logistic regression model for acetaminophen and iron using maximum likelihood estimation.
Triage threshold values ranged from 120-201 mg/kg (acetaminophen) and 16-61 mg/kg (iron). Referral rates ranged from 3.1% to 24% (acetaminophen) and 3.7% to 46.7% (iron). There was a statistically significant inverse relationship between the triage value and the referral rate for acetaminophen (p < 0.001) and iron (p = 0.0013). The model explained 31.7% of the referral variation for acetaminophen but only 4.1% of the variation for iron.
There is great variability in poison center triage values and referral rates for iron and acetaminophen poisoning. Guidelines can account for a meaningful proportion of referral variation. Their influence appears to be substance dependent. These data suggest that efforts to determine and utilize the highest, safe, triage threshold value could substantially decrease healthcare costs for poisonings as long as patient medical outcomes are not compromised.
本研究旨在确定中毒控制中心的分诊指南对急性、非故意仅对乙酰氨基酚中毒以及急性、非故意成人剂型铁中毒患者转诊至医疗机构的比例的影响程度。
通过电话采访美国中毒控制中心的管理人员，以确定其中心在1997年对急性铁中毒和急性对乙酰氨基酚中毒的分诊阈值（mg/kg）。使用最大似然估计法，将分诊阈值和医疗机构转诊率纳入对乙酰氨基酚和铁的单变量逻辑回归模型。
分诊阈值范围为120 - 201mg/kg（对乙酰氨基酚）和16 - 61mg/kg（铁）。转诊率范围为3.1%至24%（对乙酰氨基酚）和3.7%至46.7%（铁）。对乙酰氨基酚（p < 0.001）和铁（p = 0.0013）的分诊值与转诊率之间存在统计学上显著的负相关关系。该模型解释了对乙酰氨基酚转诊差异的31.7%，但仅解释了铁转诊差异的4.1%。
中毒控制中心对铁中毒和对乙酰氨基酚中毒的分诊值及转诊率存在很大差异。指南可解释相当比例的转诊差异。其影响似乎因物质而异。这些数据表明，只要不影响患者医疗结局，确定并采用最高的安全分诊阈值的努力可大幅降低中毒的医疗成本。
