a Wisconsin Poison Center , Milwaukee , WI , USA.
b Department of Emergency Medicine, Section of Medical Toxicology , Medical College of Wisconsin , Milwaukee , WI , USA.
Clin Toxicol (Phila). 2018 Dec;56(12):1213-1415. doi: 10.1080/15563650.2018.1533727. Epub 2018 Dec 21.
This is the 35th Annual Report of the American Association of Poison Control Centers' (AAPCC) National Poison Data System (NPDS). As of 1 January 2017, 55 of the nation's poison centers (PCs) uploaded case data automatically to NPDS. The upload interval was 8.07 [7.32, 12.65] (median [25%, 75%]) minutes, creating a near real-time national exposure and information database and surveillance system.
We analyzed the case data tabulating specific indices from NPDS. The methodology was similar to that of previous years. Where changes were introduced, the differences are identified. Cases with medical outcomes of death were evaluated by a team of medical and clinical toxicologist reviewers using an ordinal scale of 1-6 to assess the Relative Contribution to Fatality (RCF) of the exposure.
In 2017, 2,607,413 closed encounters were logged by NPDS: 2,115,186 human exposures, 51,164 animal exposures, 435,540 information contacts, 5,424 human confirmed nonexposures, and 99 animal confirmed nonexposures. US PCs also made 2,680,625 follow-up calls in 2017. Total encounters showed a 3.79% decline from 2016, while health care facility (HCF) human exposure cases increased by 3.06%. All information contacts decreased by 11.5%, medication identification (Drug ID) requests decreased by 30.2%, and human exposure cases decreased by 2.03%. Human exposures with less serious outcomes have decreased 2.48% per year since 2008, while those with more serious outcomes (moderate, major or death) have increased 4.44% per year since 2000. Consistent with the previous year, the top 5 substance classes most frequently involved in all human exposures were analgesics (11.08%), household cleaning substances (7.43%), cosmetics/personal care products (6.76%), sedatives/hypnotics/antipsychotics (5.74%), and antidepressants (5.02%). As a class, sedative/hypnotics/antipsychotics exposures increased most rapidly, by 1962 cases/year (4.91%/year), over the last 17 years for cases with more serious outcomes. The top 5 most common exposures in children age 5 years or less were cosmetics/personal care products (12.59%), household cleaning substances (10.96%), analgesics (9.18%), foreign bodies/toys/miscellaneous (6.39%), and topical preparations (4.84%). Drug identification requests comprised 22.1% of all information contacts. NPDS documented 3,208 human exposures resulting in death; 2,682 (83.6%) of these were judged as related (RCF of 1-Undoubtedly responsible, 2-Probably responsible, or 3-Contributory).
These data support the continued value of PC expertise and need for specialized medical toxicology information to manage more serious exposures, despite a decrease in cases involving less serious exposures. Unintentional and intentional exposures continue to be a significant cause of morbidity and mortality in the US. The near real-time status of NPDS represents a national public health resource to collect and monitor US exposure cases and information contacts. The continuing mission of NPDS is to provide a nationwide infrastructure for surveillance for all types of exposures (e.g., foreign body, infectious, venomous, chemical agent, or commercial product), and the identification and tracking of significant public health events. NPDS is a model system for the near real-time surveillance of national and global public health.
这是美国毒物控制中心协会（AAPCC）国家毒物数据系统（NPDS）第 35 份年度报告。截至 2017 年 1 月 1 日，全国 55 个毒物中心（PC）自动向 NPDS 上传病例数据。上传间隔为 8.07 [7.32, 12.65]（中位数[25%，75%]）分钟，创建了一个近乎实时的国家暴露和信息数据库和监测系统。
我们分析了从 NPDS 中提取具体指标的病例数据。方法与前几年类似。如有更改，将识别差异。对医疗结局为死亡的病例，由一组医学和临床毒理学家评审员使用 1-6 的等级量表评估接触暴露的相对致死贡献（RCF）。
2017 年，NPDS 记录了 2607413 例封闭事件：2115186 例人体暴露，51164 例动物暴露，435540 例信息接触，5424 例人体确认非暴露，99 例动物确认非暴露。美国毒物中心在 2017 年还拨打了 2680625 个随访电话。总接触量比 2016 年下降了 3.79%，而医疗保健机构（HCF）的人体暴露病例增加了 3.06%。所有信息接触量下降了 11.5%，药物识别（Drug ID）请求下降了 30.2%，人体暴露病例下降了 2.03%。自 2008 年以来，严重程度较低的人体暴露病例每年减少 2.48%，而严重程度较高的病例（中度、重度或死亡）每年增加 4.44%。与前一年一样，在所有人体暴露中最常涉及的前 5 种物质类别是镇痛药（11.08%）、家用清洁剂（7.43%）、化妆品/个人护理产品（6.76%）、镇静剂/催眠药/抗精神病药（5.74%）和抗抑郁药（5.02%）。镇静剂/催眠药/抗精神病药的暴露量在过去 17 年中增加最快，每年增加 1962 例（4.91%/年），对严重程度较高的病例更是如此。5 岁及以下儿童最常见的 5 种暴露物是化妆品/个人护理产品（12.59%）、家用清洁剂（10.96%）、镇痛药（9.18%）、异物/玩具/杂物（6.39%）和局部制剂（4.84%）。药物识别请求占所有信息接触量的 22.1%。NPDS 记录了 3208 例人体暴露导致死亡；其中 2682 例（83.6%）被认为与接触有关（RCF 为 1-毫无疑问负责，2-可能负责，或 3-有贡献）。
这些数据支持毒物专家的持续价值和对专门医疗毒理学信息的需求，以管理更严重的暴露，尽管涉及不太严重暴露的病例有所减少。意外和故意暴露仍然是美国发病率和死亡率的一个重要原因。NPDS 的近乎实时状态代表了一个国家公共卫生资源，用于收集和监测美国的暴露病例和信息接触。NPDS 的持续使命是为所有类型的暴露（如异物、传染性、有毒、化学剂或商业产品）提供一个全国性的监测基础设施，并识别和跟踪重大公共卫生事件。NPDS 是一个近乎实时监测国家和全球公共卫生的模式系统。
