Department of Systems Improvement, Primary Children's Hospital, Intermountain Healthcare.
Pediatr Emerg Care. 2021 Dec 1;37(12):e1397-e1401. doi: 10.1097/PEC.0000000000002059.
The purpose of this study is to describe the demographics and clinical characteristics of patients referred to a pediatric emergency department (ED) for unintentional poisoning exposures by a poison control center (PCC) compared with patients/caregivers who self-refer.
The electronic data warehouse at a pediatric hospital was queried from October 1, 2014, to September 30, 2015, for unintentional poisoning-related ED visits and subsequent inpatient admissions. Eligible patients aged 18 years and younger were identified by International Classification of Diseases, Ninth Revision, Clinical Modification codes for pharmaceuticals, non-pharmaceuticalchemicals, fumes/vapors, foreign bodies, adverse food reactions, food poisoning, and bites/stings. Referral classification (PCC referral vs self-refer) was determined by PCC and hospital medical records.Descriptive statistics were used to characterize the patient demographics and ED visits by referral classification and age group. Simple and multiple logistic regression models examined the individual and combined impact of demographic and clinical characteristics on self-referral.
Of the 705 patients identified, 84.4% presented as caregiver/self-referred compared with PCC-referred. As compared with those who self-referred, a higher percentage of patients who contacted the PCC before ED presentation were white (93.9% [89.4-98.2%] vs 83.8% [80.7-86.7%]) and had commercial insurance (62.7% [51.5-69.5%] vs 53.0% [48.9-57.0%]). Pharmaceutical (71.9%) and chemical (14.0%) exposures were the most common exposure types for PCC-referred patients whereas foreign bodies (54.3%) were the most common for self-referred patients. The largest predictors of self-referral were age, insurance, and exposure type.
Among patients presenting at 1 pediatric ED, disparities with PCC utilization exist among age groups, racial identification, and poison exposure type. Educational outreach interventions are needed to ensure optimal use of the PCC services by patients, caregivers, and health care professionals.
本研究旨在描述由中毒控制中心（PCC）转介至儿科急诊部门（ED）的非故意中毒患者的人口统计学和临床特征，并与自行转介的患者/照护者进行比较。
从 2014 年 10 月 1 日至 2015 年 9 月 30 日，通过儿科医院的电子数据库，查询与非故意中毒相关的 ED 就诊和随后的住院病例。通过国际疾病分类，第九修订版，临床修正版（ICD-9-CM）药物、非药物化学品、烟雾/蒸气、异物、食物不良反应、食物中毒和咬伤/蜇伤的代码，确定年龄在 18 岁及以下的合格患者。参考分类（PCC 转介与自行转介）由 PCC 和医院病历确定。采用描述性统计方法，根据转介分类和年龄组描述患者的人口统计学和 ED 就诊特征。简单和多变量逻辑回归模型检查人口统计学和临床特征对自行转介的单独和综合影响。
在 705 名患者中，84.4%为照护者/自行转介，而由 PCC 转介的患者占 15.6%。与自行转介的患者相比，在 ED 就诊前联系 PCC 的患者中，白人的比例更高（93.9%[89.4%-98.2%] vs. 83.8%[80.7%-86.7%]），商业保险的比例更高（62.7%[51.5%-69.5%] vs. 53.0%[48.9%-57.0%]）。PCC 转介的患者最常见的中毒暴露类型是药物（71.9%）和化学物质（14.0%），而自行转介的患者最常见的中毒暴露类型是异物（54.3%）。自行转介的最大预测因素是年龄、保险和暴露类型。
在就诊于 1 家儿科 ED 的患者中，在年龄组、种族识别和中毒暴露类型方面，与 PCC 使用相关的差异存在。需要开展教育外展干预措施，以确保患者、照护者和医疗保健专业人员能够最佳利用 PCC 服务。
