Transcript Poison Control Centers And TESS

Poison Control Centers and
TESS
Role of Regional Poison Control
Center
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24-hour resource for poison
information, prevention, education and
clinical toxicology consultation
Types of calls include: pediatric
ingestions, overdoses, abuse, adverse
reactions, therapeutic misadventures,
environmental, occupational, natural
products, plants, envenomations, etc.
US Poison Centers
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Available 24-7
65 US Poison Centers
Universal access through 1-800-222-1222
Specialized services
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Language translation
Hearing Impaired
Available to public and health professionals
New Telephone Number
Nationwide toll-free
number routes caller to
one of 65 poison
centers based on area
code and exchange
Coverage: 50 States,
DC and Puerto Rico
Poison Center Staff
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Specialists in Poison Information:
pharmacists and nurses with additional
training in clinical toxicology
Clinical Toxicologists
Medical Toxicologists
Educators
Regional Poison Control
Centers
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Numerous resources on-site
Interface with regional treatment
facilities
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pre -hospital providers
clinical laboratories
health care facilities
Outreach education
Regional Poison Control
Centers
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Disaster preparedness and response
Epidemiologic surveillance
Calls to US Poison Centers
2001
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2.2 million poison exposures
860,000 information calls
111,000 animal exposures
Exposure Management
Public Call
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History of exposure
Assessment of toxicity
Triage – home, ED
Home treatment recommendations
Healthcare provider recommendations
Prevention education
Follow-up
Exposure Management
HCF Call
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History of exposure
Assessment of toxicity
Differential diagnosis
Clinical toxicology consultation
Specific treatment recommendations
Follow-up
Poisoning History
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Patient Status
Substance
Amount
Time Since Exposure
Reason
Past Medical History
First Aid Provided
Age/gender/weight
Follow-up call
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Public
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To ensure that recommendations were understood
Situation resolving
Documentation of outcome
HCF
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Review and update recommendations as patient
status changes
Documentation of outcome
TESS
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Toxic Exposure Surveillance System is
the database of the American
Association of Poison Control Centers
Compiled by the AAPCC in cooperation
with majority of US Poison Centers
64 poison centers reported in 2001
Requirement for certified regional
poison centers
Toxic Exposure Surveillance
System
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Single largest database on poison
exposures in US
1983 to present
Hospitalized and home management for
poison exposures
> 31 million poison exposures reported
to date
Strong consistent temporal relationship
History of TESS
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Deficiencies of US National Clearinghouse for
PCCs
PCC Driven
FDA fellowship to organize, pilot and
implement a functional system, develop
software, instructions, generic classification
scheme, uniform reporting forms
Pilot tested in 1983
National implementation in 1984
TESS Data Collection
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Computerized data collection program
at each poison center
Data collected at time of telephone call
Autoupload of data to AAPCC in real
time
Medical records retained on-site
Human Exposures
8000
7500
7000
6500
Cases/Day
6000
Weekdays
5500
Weekends
5000
4500
4000
3500
3000
1/1/2000
7/1/2000
12/30/2000
6/30/2001
12/29/2001
6/29/2002
12/28/2002
All Info Calls 2000-2002
4500
4000
3500
Cases/Day
3000
2500
weekday
weekend
2000
1500
1000
500
0
8/28/1999
3/15/2000
10/1/2000
4/19/2001
11/5/2001
Date
5/24/2002
12/10/2002
6/28/2003
Use of TESS Data
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TESS Annual Report
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September issue of Am J Emerg Med
www.aapcc.org
Identification of new product risks
Post-marketing surveillance
Public health surveillance
Regulatory actions
Education program development
Research
TESS Data Collection
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Case Information
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Call type
Caller Site
Exposure Site
Reason
Relationship of caller to patient (optional)
Location information (zipcode/exchange)
Caller/Exposure Site
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Own Residence
Other Residence
Health Care Facility
School
Restaurant
Public area
Workplace
Other
Unknown
Reason for Exposure
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Unintentional
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General
Environmental
Occupational
Therapeutic error
Unintentional misuse
Food poisoning
Bite/sting
Unknown
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Intentional
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Other
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Suicide
Misuse
Abuse
Unknown
Malicious
Contamination
Adverse Reaction
TESS Data Collection
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Patient Data
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Age
Gender
Pregnant
TESS Data Collection
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Exposure Information
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Time since exposure (optional)
Substance
Clinical Effects
Route of Exposure
Therapy provided
Management Site
Medical Outcome
Substance Information
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Coded to brand and formulation if
known
Coded by generic or category if
unknown
Number of substances
Quantity
Certainty
Dosage form
Clinical Effects
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Cardiovascular
Dermatologic
Gastrointestinal
Heme/hepatic
Neurologic
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Ocular
Respiratory
Renal/genitourinary
Respiratory
Miscellaneous
Specific definitions – some require objective findings
Coded as related, unrelated or unknown if related
Therapy Provided
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No therapy
Observation only
Refused
Unknown
Decontamination
Other therapies
Management Site
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Onsite – non health care facility
Already in/enroute to HCF
Referred to HCF
Other (nursing home, detox, jail)
Unknown
Management Site - HCF
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Treated and released from ED
Admitted to critical care
Admitted to non-critical care
Admitted for psychiatric care
Lost to follow-up
Refused referral (referred only)
Medical Outcome
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No effect
Minor effect
Moderate effect
Major effect
Death
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Duration of symptoms
Unknown, non-toxic
Unknown, minimally
toxic
Unknown,
potentially toxic
Unrelated
TESS Data Collection
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Scenarios
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Pesticide exposures
Therapeutic errors
Information not available from
TESS
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Narrative description
Patient identifiers: name, address,
birthdate
Socioeconomic data
Use of TESS Data
Specific Examples
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Iron formulations
Acetonitrile
Pesticides
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Arsenic containing rodenticides
Mouthwash
Rx  OTC switch (ibuprofen, H2
antagonists, nicotine patch)
Quality Control
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Data Collection Manual and Workbook
Center specific chart audits
Electronic data checks and edits
Data quality factors
Fatality verifications
What TESS Can Not Do
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Poison Exposure vs Poisoning
Absence of clinical effects
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Prompt treatment or guidance by PCC
Limited toxicity of substance
Limited amounts/concentrations of substance
Exposure suspected but did not occur
Telephone reporting
Passive reporting
Increased reports ≠increased hazard
Calculate incidence of poisoning
Exposure Site
Residence
HCF
Workplace
School
Site of
Caller (%)
Site of
Exposure
(%)
76.3
13.9
1.6
0.8
89
0.3
2.5
1.6
Route
Route
Ingestion
% All
76.2
% Fatal
76.4
Dermal
7.6
1.1
Inhalation
6.1
8.5
Ocular
5.4
0.1
Management Site
Refused
Referral
2%
Unknown
1%
Other
1%
On-site
74%
HCF
22%
TESS 2001
Management Site
Health Care Facility
ICU admit
14%
Non ICU
7%
Psych
8%
Lost
16%
ED Only
74%
TESS 2001
Most common substances by
Age
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< 6 years
Cosmetics
Cleaners
Analgesics
Foreign bodies
Topicals
Plants
Cold preps
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Adults
Analgesics
Sedative/hypnotics
Cleaners
Antidepressants
Bites/stings
Alcohols
Food poisoning
TESS 2001
Substances Related to Deaths
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Analgesics (pain
killers)
Antidepressants
Sedatives/hypnotics/
antipsychotics
Stimulants and
street drugs
Cardiovascular drugs
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Alcohols
Anticonvulsants
Muscle Relaxants
Gases and Fumes
Chemicals
Impact of Space Shuttle
Figure 1. TX and LA Inform ation Calls 2/3/2002 to 2/8/2003
700
600
calls per day
500
400
w eekend days
w eekdays
1-Feb-03
300
200
100
0
2/3/2002
3/25/2002
5/14/2002
7/3/2002
8/22/2002 10/11/2002 11/30/2002 1/19/2003
date
Information calls to PCCs
Fig 2. All US PCC calls (excluding TX, LA) 2/3/02 through 2/8/03
4500
4000
3500
calls per day
3000
w eekday info
calls
w eekend day
info calls
1-Feb-03
2500
2000
1500
1000
500
0
2/3/2002
3/25/2002
5/14/2002
7/3/2002
8/22/2002 10/11/2002 11/30/2002 1/19/2003
date
Carbon monoxide
TESS Carbon Monoxide Human Exposures by day 1/93 to 2//03
600
500
N
400
300
200
100
0
12/31/1992
5/15/1994
9/27/1995
2/8/1997
6/23/1998
date
11/5/1999
3/19/2001
8/1/2002
Snake Bites
25
20
Cases/Day
15
10
5
0
8/28/1999
3/15/2000
10/1/2000
4/19/2001
11/5/2001
5/24/2002
12/10/2002
6/28/2003
Pesticide Exposures (Excl Rodenticides) by Day
600
Cases per day, all ages, all routes
500
400
300
200
100
0
6/15/1994
10/28/1995
3/11/1997
7/24/1998
12/6/1999
4/19/2001
9/1/2002
1/14/2004
Summary
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Comprehensive poisoning surveillance
database
Includes cases managed in and outside
HCF
Voluntary
Telephone reports
Consistent temporal nature
Identification of public health hazards
Questions
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