Utah Poison Control Center, 2000 E 30 S, Salt Lake City, UT 84112, United States of America; Department of Pharmacotherapy, University of Utah, 2000 E 30 S, Salt Lake City, UT 84112, United States of America.
Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, 301 Pharmacy Lane, Chapel Hill, NC 27599, United States of America; UNC Health Sciences at MAHEC, 121 Hendersonville Rd, Asheville, NC 28803, United States of America.
Am J Emerg Med. 2020 Aug;38(8):1554-1559. doi: 10.1016/j.ajem.2019.158418. Epub 2019 Aug 27.
Poison control centers (PCC) are an effective means to prevent unnecessary emergency department (ED) visits associated with poisoning exposures. However, not all patients with poison exposures utilize the PCC. The purpose of this study was to identify unintentional pediatric poisoning exposures presenting to a large US children's hospital that could have been managed onsite (i.e., at home) if consultation with a PCC had occurred prior to the ED visit.
Using ED encounters from a tertiary children's hospital, unintentional pharmaceutical, chemical, or fume exposures occurring between October 1, 2014 and September 30, 2015 were identified from ICD-9-CM billing codes. Two specialists in poison information reviewed the medical records of the identified patients who had no contact with the PCC and determined whether these encounters were preventable through PCC triage. Descriptive statistics examined the differences between the encounters. Data were analyzed in R v3.2.4 (Vienna, Austria) and SAS v9.4 (SAS Institute, Cary, NC).
In the total study population (n = 231), 98 (42.4%) were PCC triaged and 133 (57.6%) were caregiver self-referred to the ED. For those who self-referred, 62 (46.6%) patients would have been recommended to be managed onsite instead of presenting at the ED for medical care. Analgesics and household cleaning products were the most common pharmaceutical and chemical exposures, respectively.
Nearly half of ED visits for pediatric patients with unintentional poisoning exposures could have been avoided by contacting a PCC. Educational and self-efficacy-based interventions are needed to expand the public's use of PCC services.
中毒控制中心（PCC）是预防与中毒暴露相关的不必要急诊（ED）就诊的有效手段。然而，并非所有暴露于毒物的患者都使用 PCC。本研究的目的是确定在 ED 就诊前，如果先与 PCC 联系，本可以在现场（即在家中）管理的大型美国儿童医院就诊的儿童意外伤害性中毒暴露。
使用来自三级儿童医院的 ED 就诊记录，根据 ICD-9-CM 计费代码，确定 2014 年 10 月 1 日至 2015 年 9 月 30 日期间发生的非故意药物、化学物质或烟雾暴露。两位毒理信息专家审查了未与 PCC 联系的已识别患者的病历，并确定这些就诊是否可以通过 PCC 分诊来预防。描述性统计检验了就诊之间的差异。在 R v3.2.4（奥地利维也纳）和 SAS v9.4（SAS 研究所，北卡罗来纳州卡里）中分析数据。
在总研究人群（n=231）中，98 例（42.4%）经 PCC 分诊，133 例（57.6%）为护理人员自行转至 ED。对于自行转至 ED 的患者，62 例（46.6%）患者将被推荐在现场管理，而不是接受医疗护理。镇痛药和家用清洁产品分别是最常见的药物和化学物质暴露。
近一半的因非故意中毒暴露而到 ED 就诊的儿科患者可通过联系 PCC 避免。需要进行教育和基于自我效能的干预措施，以扩大公众对 PCC 服务的使用。
