Specialist discrimination of toxic exposure severity at a poison control center

Abstract

Background. Perceived severity has been shown to affect decision-making processes in telephone triage. However, the accuracy of specialists in poison information's (SPIs') perceptions of severity of poison exposures is unknown. Objective. The purpose of this study was to describe the ability of SPIs to predict severity of medical outcome on the basis of the information obtained during the initial poison control center's phone call. Methods. This study analyzed 22,576 cases of human poison exposure in one regional poison control center. At the time of the initial call, SPIs assigned a predicted severity rating. SPIs then assigned a medical outcome rating when closing each case. Animal exposures not coded, not followed, and confirmed nonexposures were excluded. Results. For overall SPI's discrimination of more severe versus less severe cases, Az = 0.94 with asymmetric 95% confidence intervals (0.87, 0.97), indicating excellent discrimination. The sensitivity of SPIs in discriminating a major effect from any other effect was 0.62. The false-negative rate for discrimination of a moderate, major, or fatal effect from a minor effect or no effect was 0.32, with sensitivity = 0.68. Conclusions. The overall ability of the SPIs to predict exposure severity is excellent but less accurate with less frequently encountered, more severe cases. A better understanding of SPI's decision-making processes, including the relationship between perceived severity and decision-making strategies, is necessary for the development of educational strategies and decision support technologies.