Poisons and panic!

Home management of the majority of poison center callers is safe and cost-effective; but in the absence of poison center consultation, could callers correctly assess the severity of a poisoning? This study was conducted to determine indirectly whether callers can correctly assess the toxicity of a substance involved in a poison exposure by determining whether caller panic levels correlated with the expected toxicity of the exposure. Using a digital call recorder, 100 calls to the National Capital Poison Center involving children < 10 y were reviewed. The panic level of each caller was assessed and scored on a 4-point rating scale and, compared to the toxicity of the substance implicated (also on a 4-point rating scale). Most callers were mothers (85%), most patients were < 4 y (86%), and most exposure routes were ingestions (89%). Although there were only 12 male callers, male callers were significantly more panicked than females. Overall, there was a correlation between the panic level of the poison center callers and the toxicity of the substance involved in the exposure, with the mean panic level increasing as the toxicity increased. However, only 36% of patients had a panic level that was exactly appropriate for the toxicity level. Most callers were more panicked than they needed to be (57%), including 14% of callers who were much more panicked than they needed to be. Seven percent of callers were too calm; they appeared not to understand how toxic the exposure really was. Based on these data, one could predict that the majority of callers were sufficiently panicked that, had the poison center not been available to provide immediate consultation, the callers may have over-reacted and called 911 or gone straight to a hospital. Yet only 1 of the 57 overly-panicked callers was calling about a patient who actually required medical intervention. Of great concern, the 7% of patients who were too calm may have required medical intervention that, due to underestimation of the severity of the exposure, may have been withheld or delayed. Three of these "too calm" cases actually required medical intervention. Although subject to a number of design limitations, this study suggests that callers frequently over-react to poison exposures. In the absence of a well-utilized poison control system, excessive panic may contribute to excessive use of emergency departments and ambulance services and create excessive health care costs for poisoning emergencies.