Control Center Database Research Articles

Self-harm by single- and multi-agent medication poisoning in a retrospective analysis of a Poison Control Center database from January 2018 to December 2022.

Medication poisoning is the most common method of self-harm. Longitudinal studies incorporating pre- and post-COVID-19 pandemic data are required to describe the phenomenon and to evaluate the long-term impact on mental health. Calls to the Poison Control Center of Policlinico Umberto I Hospital - Sapienza University of Rome, Italy, were analyzed retrospectively for characteristics and clinical presentation of cases of interest from January 2018 to December 2022. A total of 756 cases of self-harm by medication poisonings were recorded in the study period. A reduction in rate of cases in 2020 was followed by a return to pre-pandemic levels by 2021. When separately analyzing single- and multi-agent cases, occurrence of cases involving just one medication increased since early 2021, with a peak in 2022 (7.8% of total calls, 95% CI 6.2-9.5, from 4.9%, 95% CI 4.1-5.8 in 2018). This increase in the rate of cases, mostly of none or mild severity, was driven by youth aged 12-21, in which the relative proportion of single- versus multi-agent cases showed an increasing trend since 2020 (from 42.6% in 2018 to 78.6% in 2022). Acetaminophen was the medication most frequently involved and benzodiazepines the largest class. A psychiatric background was increasingly seen in 2022, especially in age group 12-21. Single-agent medication self-harm may be an increasingly prevailing phenomenon. Young adolescents with a psychiatric background might be most vulnerable to this behavior in the COVID-19 pandemic aftermath. Healthcare professionals should expect favorable clinical outcome and improve both counseling and psychotherapy supervision in individuals at risk.

Epidemiological analysis of death among patients on maintenance hemodialysis: results from the beijing blood purification quality Control and Improvement Center

BackgroundChina has the largest number of patients on maintenance hemodialysis (MHD) worldwide. Despite continuous improvements in hemodialysis techniques, patients on MHD have a higher mortality rate than the general population. Understanding the characteristics of death in this population can better promote clinical practice, thereby improving patients’ survival.MethodsWe collected demographic and clinical data for patients on MHD registered in the Beijing Blood Purification Quality Control and Improvement Center database from 2014 to 2020. The annual mortality rate was calculatedand the primary cause of end-stage renal disease (ESRD), dialysis vintage, and cause of death among deceased patients were analyzed.Results(1) 24,363 patients on MHD were included, of which 6,065 patients died from 2014 to 2020. The annual mortality rate fluctuated between 7.4% and 8.0%. The median age of death was 70.0 (60.8–79.0) years and the male to female ratio was 1.27:1 (2). The top three primary causes of ESRD in deceased patients were chronic glomerulonephritis (CGN), diabetic nephropathy (DN), and hypertensive nephropathy (HN). Comparison of the annual mortality rate showed DN > HN > CGN (3). The median dialysis vintage of deceased patients was 3.7 (1.8–6.9) years, which slowly increased annually. Patients with diabetes had a shorter dialysis vintage than patients without diabetes (3.4 vs. 4.1 years, Z = 8.3, P < 0.001) (4). The major causes of death were cardiovascular disease (20.2%), sudden death (18.1%), infection (17.9%), and cerebrovascular disease (12.6%). Proportions of death from cardiovascular disease, infection, and sudden death were higher in patients with diabetes (22.2%, 20.2%, and 20.0%) than patients without diabetes (18.4%, 15.8%, and 16.3%). Sudden death was the leading cause of death in young (18–44 years; 27.0%) and middle aged (45–64 years; 20.8%) patients, whereas infection was the leading cause of death in patients aged ≥ 75 years (24.5%).ConclusionThe annual mortality rate of patients on MHD in Beijing was relatively stable from 2014 to 2020. Sudden death was more likely to occur in young and middle-aged patients, and more patients aged ≥ 75 years died from infections.

Eyes Instead of Ears: Eye Injuries Following Ocular Exposure to Otic Medications.

To determine the epidemiology of ocular exposures and toxicoses in dogs and cats from otic products, 79 dog and cat cases with an ocular exposure to a topical otic medication were retrieved from the American Society for the Prevention of Cruelty to Animals Animal Poison Control Center database. Prescription products were involved in 75/79 (95%) of cases, and over-the-counter products in 4 (5%). Clinical signs included conjunctivitis, blepharospasm, epiphora, ocular discharge, and corneal ulceration. Medication error, specifically involving mistaken identification (i.e., an otic product confused with an ophthalmic product), occurred in 68/79 (86%) of cases. In 4 of these 68 cases, an otic instead of an ophthalmic medication was mistakenly dispensed to the pet owner. Unintentional delivery (i.e., accidental ocular exposure in the course of an otic application) occurred in 9/79 (11%) of cases, and 2 (3%) cases involved intentional delivery of otic products to the eyes. Because mistaken identification was the most common cause of ocular toxicoses from otic products, separate storage and/or distinctive packaging for ophthalmic versus otic products could reduce medication errors. Animal poison control center epidemiological data can be used as a source of information regarding veterinary medication errors.

Retrospective analysis of hops toxicosis in dogs (2002-2014): 71 cases.

To describe a population of dogs with hops toxicosis, including clinical signs observed, treatments performed, patient outcome, and overall prognosis. Clinical findings and treatment interventions were evaluated for their potential effects on outcome. This study also aims to review hops toxicosis and treatment options. Retrospective observational study. Poison Control Center. Seventy-one dogs presenting for hops ingestion. None. Records of 71 dogs with known hops ingestion from the ASPCA - Animal Poison Control Center (ASPCA-APCC) database and the Tufts University medical record system were reviewed. Fifty-nine (77%) of the dogs survived. The most common clinical signs on presentation were hyperthermia and tachycardia, with presenting temperatures and heart rates significantly higher in nonsurvivors. There was no significant difference between survivors and nonsurvivors in regard to signalment. Time to presentation was shorter in survivors (5.0vs 5.5 h; P<0.0001). The median amount of hops ingested was higher in nonsurvivors (2vs 2.5 oz; P<0.0001). Hops ingestion caused hyperthermia in 96% (68/71) of dogs. The median time to death in the nonsurvivor group was 10.7hours (2-30 h). None of the decontamination, cooling, or treatment measures (dantrolene, cyproheptadine, sedatives) evaluated in this population were associated with improved survival. After adjusting for cooling, time to presentation, and dantrolene administration, every degree of elevation in temperature was associated with a 78% increased chance of death. All dogs that survived to discharge had complete resolution of clinical signs. Hops toxicosis can result in significant hyperthermia, tachypnea, and tachycardia. Seventy-seven percent of dogs survived with intensive treatment. Continued education of the potential for hops toxicosis is advised.

Topical Minoxidil Exposures and Toxicoses in Dogs and Cats: 211 Cases (2001-2019).

Topical minoxidil is a medication for hair loss, initially available in the United States by prescription only and available since 1996 as an over-the-counter product. To determine the epidemiology of minoxidil exposures and toxicoses in dogs and cats, 211 dog and cat cases with topical minoxidil exposure were identified from the American Society for the Prevention of Cruelty to Animals Animal Poison Control Center database. In 87 cases with clinical signs of toxicosis (62 cats, 25 dogs), case narratives were reviewed and coded for exposure-related circumstances. Unintentional delivery, especially while pet owners applied minoxidil for his/her own hair loss (e.g., pet licked owner's skin or pillowcase, pet was splashed during a medication spill), was the most common cat exposure circumstance. Exploratory behavior (e.g., searching through trash) was the most common dog exposure circumstance. Clinical signs occurred in dogs and cats even with low exposure amounts, such as drops or licks. In patients that developed clinical signs, most developed moderate or major illness (56.0% dogs, 59.7% cats). Death occurred in 8/62 (12.9%) cats that developed clinical signs after the pet owner's minoxidil use. Pet owners should be educated on the risk of dog and cat toxicosis from accidental minoxidil exposure.

How COVID-19 Lockdown in Italy Has Affected Type of Calls and Management of Toxic Exposures: a Retrospective Analysis of a Poison Control Center Database From March 2020 to May 2020.

IntroductionBetween early March 2020 and the end of May 2020, Italy issued strict measures to limit further spread of coronavirus disease 2019 (COVID-19) and became the first European country that imposed a lockdown on the population. The aim of this study was to assess the impact of these restricted conditions on the activity of the Poison Control Center (PCC) of Policlinico Umberto I Hospital-Sapienza University of Rome.MethodsThis was a retrospective analysis of calls received by the PCC during the lockdown period March 9, 2020 through May 31, 2020 compared to the same time period in year 2019 (reference).ResultsWe observed a reduction in calls from hospitals and emergency departments and an increase in calls from private citizens about exposures to products or intoxications during the lockdown. There were increases in unintentional exposures and exposures to hand and surface sanitizers among household and cleaning products. There was a decrease in calls concerning medications, which were mostly from hospitals and emergency departments. We observed increases in exposures requiring clinical observations among adults and referral to the emergency department among pre-school children.ConclusionsPublic health protection measures against COVID-19 to improve hygiene and maintain clean environments can increase exposures to hazardous products in the domestic environment. We observed an increase in unintentional exposures to household and cleaning products during the lockdown and an increase in ED referrals for pre-school children compared to the previous year. Our data suggest the need for improvements in public campaigns that promote safer handling of household products and prevent unnecessary exposures during a lockdown. The public health promotion activity can benefit the community after the pandemic and prepare the community for lockdowns in the future.

Household disinfectant exposure during the COVID-19 pandemic: a retrospective study of the data from an Italian poison control center.

Since the beginning of the COVID-19 pandemic it has been recommended that chemical disinfectants are used to protect surfaces. This study aimed to determine whether the number of exposure calls related to household disinfectants (HD) received between January 30, 2020 to May 18, 2020 varied from the same time period in the previous year. A retrospective review of the poison control center database from the Fondazione Universitario Policlinico Agostino Gemelli IRCCS, Rome, Italy, was conducted. Calls from Italian citizens, hospitals, and general practitioners received during the same time period in 2019 and 2020 were compared. The center received 1972 exposure calls during the study period. A 5% increase in calls regarding exposure to HDs was noted from 2019 to 2020 (9.8% to 15.2%, p<0.001). The majority of enquiries regarded bleach-containing products, hand sanitizers, ethanol, and hydrogen peroxide. Most calls were received from patients in their homes (n, 259; prevalence, 86%; increase, 107%) and concerned accidental exposure (n, 280; prevalence, 93%; increase, 76%), while cases of intentional exposure decreased (n, 14; prevalence, 5%; decrease, 33%). The main route of exposure was ingestion (n, 170; prevalence, 57%; increase, 45%), but the highest increase was observed in inhalation cases (n, 82; prevalence, 27%; increase, 122%). As the incidence of enquiries regarding products that can represent an important health hazard, when improperly used, increased in 2020 suggests that the COVID-19 public health messaging on the proper use of HDs should be improved.

Remote certification of out-of-hospital deaths in a Canadian Province: An 8-year experience of a novel practice.

Introduction:Certification of out-of-hospital deaths is challenging as physicians are often unavailable at the scene. In these situations, emergency medical services will generally transport the decedent to the nearest hospital. In 2011, a remote death certification program was implemented in the province of Québec, Canada. The program was managed through an online medical control center and enabled death certification by a remote physician. We sought to evaluate the implementation and feasibility of the remote death certification program and to describe the challenges we experienced.Methods:We retrospectively reviewed all remote death certification requests received at the online medical control center between 2011 and 2019. Data were collected from the online medical control center database and records. Feasibility was determined by evaluating the remote death certification rate.Results:Overall, 84.1% of remote death certification requests were realized, producing a total of 9776 death certificates. Male decedents accounted for 61.5% of remote death certification requests and were more likely than females to undergo a coroner’s investigation for cause of death (36.3% vs 20.8%, p = 0.017). Urban/mixed regions had higher rates of achieved remote death certifications (mean 87.3% vs 76.9%, p = 0.033) and putrefied bodies (mean 3.8% vs 2.2%, p = 0.137) compared to rural regions. Among unrealized remote death certification requests, the most common reason was failure of relatives to designate a funeral home (36.8%).Conclusion:Our 8-year experience with the remote death certification program demonstrates that despite facing numerous challenges, this process is feasible and offers a valuable option to manage out-of-hospital deaths. The remote death certification program is spreading in the remaining regions of Québec. Future studies will aim to quantify how much time this process saves for emergency medical services in each region of the province.

Dermatological topical products used in the US population and their toxicity to dogs and cats.

Many dermatological topicals are available for human use and may be toxic to dogs and cats. No epidemiological studies have been performed in the US population on the use of dermatological topical prescription drugs, and their toxicosis to dogs and cats. Summarize the variety of dermatological topical prescriptions potentially used by pet owners in the United States (US), and describe the epidemiology of dog and cat exposures and toxicities. A dataset of 10,170 individuals from the National Health and Nutrition Examination Survey (NHANES) representative of 311,065,381 US residents. There were 61,169 dog and cat cases with exposure to dermatological topicals from the American Society for the Prevention of Cruelty to Animals (ASPCA) Animal Poison Control Center (APCC) database. Prescription medication data were analyzed from NHANES 2011-2014 survey respondents. The APCC database was searched for records of dermatological topical drug cases between January 2001 and January 2018. Prescription dermatological topical medications were used by 1.33±0.21% of the US population. Dermatological topical products (177, veterinary and human) resulted in 61,169 exposure calls to the APCC. Clinical signs developed in 38% (22,910). A human-labelled product was involved in 15% (3,463) with 74% (2,545) involving a prescription product. Pets in households with humans receiving dermatological prescription topicals may be at risk for toxicosis. Multiple human-labelled dermatological topicals can cause death or major illness to dogs and cats at low dosages. Increased public awareness, especially attention to home storage practices for human-labelled dermatological topicals, may reduce the risk of exposure and toxicosis to dogs and cats.

Uncertainty Bounds of Transmission Line Parameters Estimated From Synchronized Measurements

The parameters of the transmission lines are used in several monitoring and control tools of the power system control center. An accurate knowledge of the power system model (including transmission lines impedances) impacts positively the situational awareness of the power system operators. It also improves the protection and corrective measures that may be applied in case of a disturbance. Nevertheless, line parameters that are stored in the control center database are typically subjected to errors, and therefore it is necessary to regularly refine them. The presence of a phasor measurement unit (PMU) at both ends of the transmission line allows the calculation of the transmission line parameters using synchronized current and voltage phasor measurements. Although the use of PMU measurements is a straightforward way to calculate the transmission line parameters, the uncertainty of the synchronized phasor measurements should be incorporated to the calculated transmission line parameter values. In this paper, an analytical expression for the bounds of the calculated transmission line parameters from PMU measurements is derived, considering both instrument transformers and PMU errors. The calculated bounds of uncertainty are evaluated through Monte Carlo simulations, while the importance of knowing the bounds of the calculated line parameters is underlined through the derivation of power–voltage curves considering the lower and upper bounds of the parameters. The simulation results are obtained using the IEEE 14-bus system.

SUN-084 HEMOGLOBIN VIARIABILITY AND MORTALITY OF PERITONEAL DIALYSIS PATIENTS

The study investigated the independent association between hemoglobin variability and mortality in a retrospective cohort of 3161 peritoneal dialysis patients. The retrospective cohort analysis used data in Zhejiang Province Dialysis Control Center database. In the cohort, a total of 3161 maintenance peritoneal dialysis patients were recruited. Hemoglobin variability (Hb-var) was defined as the difference between maximum and minimum of hemoglobin values during follow-up period (time＞12 months from 2008 to 2017) in each patient. 3161 patients were divided into 6 groups: 10 g/L≤Hb-var＜20 g/L、20 g/L≤Hb-var＜30 g/L、30 g/L≤Hb-var＜40 g/L、40 g/L≤Hb-var＜50 g/L、50 g/L≤Hb-var＜60 g/L、Hb-var≥60g/L. The baseline demographic characteristics and laboratory measures in the cohort, Hb-var group, survival and death group was shown in Table 1, Table 2 and Table 3, respectively. The difference of age, follow-up time, albumin, BMI, calcium, creatine, fasting blood glucose, hemoglobin levels, potassium, sodium, phosphorus, PTH, cardiovascular disease, cerebrovascular disease, diabetes mellitus and reason of peritoneal dialysis between survival and death group displayed statistically significant. As shown in Figure 1, we found that the AUC of hemoglobin and mortality ROC curve was 0.638, therefore we determined that the optimal entry point of hemoglobin level was 123g/L. Next, Kaplan-Meier curve showed that hemoglobin levels continuously lower than 123g/L can increase the risk of death in peritoneal dialysis patients. The Hb-var showed no association with all cause death using Kaplan-Meier curve (Figure 2) instead. We concluded that hemoglobin levels continuously lower than 123g/L can increase the risk of death in peritoneal dialysis patients. Hb-var was not associated with all cause death.

Characteristics of Laboratory Confirmed Ethylene Glycol and Methanol Exposures Reported to a Regional Poison Control Center

Ethylene glycol (EG) and methanol (MET) exposures are rare but can cause significant morbidity and mortality. Though frequently treated similarly, EG and MET exposures have characteristics that are not well differentiated in the literature. We sought to describe the clinical characteristics of EG and MET exposures, confirmed with quantitative serum levels. An IRB-approved retrospective review of the University of Kansas Health System Poison Control Center database from July 2005 to July 2015 identified all EG/MET exposures evaluated at a health care facility. Initial measurements were EG/MET levels, serum pH, serum creatinine, anion gap, serum ethanol level, max anion gap, max osmolar gap, therapy performed (hemodialysis, fomepizole, ethanol) and death. The search identified 75 cases, with 59 cases having only detectable EG levels and 15 cases having only detectable MET levels. The average EG level was 126 mg/dL (range 5 - 834). The average detectable methanol level was 78 mg/dL (range 5 - 396). The average maximum anion gap of the EG positive group was 20 mEq/L (range 8 - 35). The average maximum anion gap of the MET positive group was 14 mEq/L (range 6 - 34). One death was reported in the EG positive group, with an initial level of 266 mg/dL. In this study of EG/MET exposures, EG exposures were more common than MET exposures, but they had similar demographics, laboratory findings, and interventions. Continued studies are warranted to characterize these uncommon exposures further.

Clinical signs associated with ingestion of black walnut tree (Juglans nigra) wood, nuts, and hulls in dogs: 93 cases (2001-2012).

To identify clinical signs associated with oral exposure to black walnut tree (Juglans nigra) wood, nuts, or nut hulls in dogs and to compare clinical syndromes between dogs that ingested wood and dogs that ingested the walnuts or nut hulls. Retrospective case series. 93 dogs. Records of dogs with oral exposure to black walnut wood, nuts, or nut hulls between November 2001 and December 2012 were retrieved from the Animal Poison Control Center database. Records were reviewed, and data regarding signalment; exposure; time of onset, type, and duration of clinical signs; serum biochemical abnormalities; treatment; and response to treatment were collected. Results were compared statistically between dogs that ingested wood and those that ingested nut components. 28 cases involved exposure to wood, and 65 involved exposure to nuts or hulls. Spontaneous vomiting was commonly observed (13/28 [46%] and 31/65 [48%] dogs that ingested wood and nut components, respectively). Neurologic or musculoskeletal signs were significantly more common in dogs that ingested wood (26/28 [93%]) than in those that ingested nuts or hulls (15/65 [23%]). Relative risk of developing neurologic signs after ingestion of wood was approximately 4 times that after ingestion of nuts or hulls. Ingestion of black walnut wood by dogs resulted in a clinical syndrome in which neurologic or musculoskeletal signs were most frequently reported, whereas ingestion of black walnuts or their hulls was most commonly associated with vomiting. To our knowledge, this is the first report describing 2 different clinical syndromes associated with exposure to black walnut tree components in dogs.

Lighting system design based on a sensor network for energy savings in large industrial buildings

This paper presents a new method based on a sensor network for designing a lighting control system for an industrial building. An illumination mapping between the work plane and the horizontal plane was derived for sensor placement to generate rules for sensor layout. Online sensor data sampling and a control center database with a real-time update algorithm were applied to lessen the effects of interference and luminous decay. We implemented the method for the lighting system of an industrial building in Xi’an, China. Skylights combined with artificial lighting were designed for daytime lighting. The optimized placement and a scene-control strategy for the artificial lighting system were generated by simulations with DIALux and Autodesk Ecotect Analysis. Daily lighting consumption data for August, 2014, demonstrated that the control system strategy realized lighting energy savings of up to an average of 80% on cloudy days. The design can be used as a reference for new industrial construction or retrofit applications.

Retrospective evaluation of methionine intoxication associated with urinary acidifying products in dogs: 1,525 cases (2001-2012).

To describe the signalment, clinical findings, timing of signs, outcome, and prognosis in a population of dogs exposed to methionine through the ingestion of urine acidifying products. Retrospective observational study from January 1, 2001 to December 31, 2012. Animal Poison Control Center. A total of 1,197 case calls yielding 1,525 dogs identified with presumed methionine ingestion. None. Records of dogs with presumptive methionine ingestion were reviewed from the American Society for the Prevention of Cruelty to Animals Animal Poison Control Center database. Ingested methionine doses ranged from 3.9 mg/kg to 23,462 mg/kg. Clinical signs developed in 47% of dogs. The most common clinical signs were gastrointestinal (GI) and neurologic. The mean onset of GI signs was 2.8 hours following ingestion. The mean onset of neurologic signs was 6.8 hours following ingestion. GI signs were identified with ingested doses ≥22.5 mg/kg. Vomiting was the most common GI sign. Neurologic signs were identified with ingested doses ≥94.6 mg/kg. Ataxia was the most common neurologic sign. Resolution of clinical signs occurred within 48 hours of ingestion, and no fatalities were reported. Prognosis for dogs with methionine intoxication is excellent. Vomiting and ataxia were the most common clinical signs associated with methionine toxicosis.

Concentrated tea tree oil toxicosis in dogs and cats: 443 cases (2002–2012)

To determine the frequency, types, and severity of clinical signs; geographic distribution; and treatment information associated with toxicosis caused by 100% tea tree oil (TTO) in dogs and cats in the United States and Canada. Retrospective case series. 337 dogs and 106 cats with evidence of exposure to 100% TTO. 10-year incident data were retrieved from the ASPCA Animal Poison Control Center database from January 2002 to December 2012. Only evidenced or witnessed incidents assessed as toxicosis or suspected toxicosis were included. Signalment, amount of TTO used, intention of use, and outcome information were evaluated. Severity of illness and correlations with breed, sex, age, and weight were determined. TTO was intentionally used in 395 of 443 (89%) animals. The amount used ranged from 0.1 to 85 mL. Incidents were reported from 41 states, the District of Columbia, and 4 Canadian provinces. Exposure route was cutaneous in 221 (50%) animals, cutaneous and oral in 133 (30%), and oral in 67 (15%). Clinical signs developed within 2 to 12 hours and lasted up to 72 hours. The most common signs were increased salivation or drooling, signs of CNS depression or lethargy, paresis, ataxia, and tremors. A significant association with severity of illness was found for age and weight, with higher prevalence of major illness in younger and smaller cats. Intentional or accidental use of 100% TTO in dogs or cats caused serious signs of CNS depression, paresis, ataxia, or tremors within hours after exposure and lasting up to 3 days. Younger cats and those with lighter body weight were at greater risk of developing major illness.

Adverse reactions from essential oil‐containing natural flea products exempted from Environmental Protection Agency regulations in dogs and cats

To describe adverse effects in dogs and cats exposed to Environmental Protection Agency exempted plant-derived flea preventatives containing mixtures of essential oils. Retrospective study from 2006 to 2008. Records of dog and cat cases were reviewed from the American Society for the Prevention of Cruelty to Animals, Animal Poison Control Center database. Thirty-nine cats and 9 dogs with history of exposure to natural flea preventatives. The following information was retrieved from each incident: number of animals, species involved, frequency, types, onset time, duration of clinical signs, exposure appropriateness, final outcome, and treatment information. Ninety-two percent of animals (n= 44) showed presence of one or more adverse effects. The frequency of adverse effects in dogs (n= 8; 89%) and cats (n= 36; 92%) was similar. Onset time of adverse effects in 39 of 44 animals occurred within 24 hours. The duration of signs in 24 animals ranged from 30 minutes to 149 hours. The products were used as per label in 77% animals (n= 37). Of 28 animals with known outcome, 50% (n= 14) recovered with bathing alone while others received intravenous fluids, muscle relaxants, and anticonvulsive medications. Death (1 cat; n= 1/28; 4%) or euthanasia (1 cat and 1 dog; n= 2/28; 7%) was reported in 3 animals. Dogs and cats can experience significant adverse effects when exposed to plant-derived flea preventatives even when used according to label directions. The number of reports of exposure in cats was higher than dogs, but the frequency of reported adverse effects was similar between the 2 species. Agitation and hypersalivation were common in cats, whereas lethargy and vomiting were common in dogs.

Comparison of Incidence of Hospital Utilization for Poisoning and other Injury Types

We investigated the incidence of hospital utilization for injuries and compared poisoning with other forms of injury. Previous studies have suggested poison control centers reduce health-care costs by decreasing hospital utilization. We conducted a one-year retrospective study involving patients treated for injuries at acute-care hospitals in Kentucky in 2008. We also compared inpatient discharges with discharges directly from the emergency department (ED) to determine hospitalization rates. The primary data sources were the Kentucky Hospital Billing database and the Kentucky Regional Poison Control Center (KRPCC) database. In 2008, there were 377,642 hospital encounters for injuries in Kentucky. The most common mechanisms of injury were falls, struck by/against, motor vehicle traffic crashes, and overexertion. Three causes of injury were greater than one standard deviation above the mean in percentage of inpatient admissions: poisoning (41.3%), firearms (38.4%), and drowning (22.4%). During this same year, KRPCC reported 46,258 poisonings, with 76.5% of patients managed outside of a health-care facility, 11.4% of patients treated and released from the ED, 7.1% of patients admitted to inpatient care, 2.3% of patients admitted to psychiatric care, and 2.7% lost to follow-up. Three causes of injury had the greatest percentage of patients admitted for inpatient medical care--poisoning, firearms, and drowning--suggesting a high level of severity in these injuries presenting to the ED. We believe availability and use of a poison control center reduced hospital utilization for poisoning primarily by managing a large number of low-severity patients outside of the hospital system.

Methylphenidate toxicosis in dogs: 128 cases (2001–2008)

To determine clinical signs and outcomes of methylphenidate hydrochloride (MPH) toxicosis in dogs; to assess effects of amount (ie, dose) and formulation (immediate or extended release) of ingested MPH on onset, duration, and severity of clinical signs; and to describe management of MPH intoxication. Retrospective case series. 128 dogs with MPH toxicosis or exposure. Data from an Animal Poison Control Center (APCC) database from November 1, 2001, to November 30, 2008, were reviewed. Records of dogs were searched for APCC classifications of confirmed (n = 71) or suspected (39) MPH toxicosis; dogs (18) that ingested MPH but did not develop clinical signs of toxicosis were also included. Signalment, dose, clinical signs, treatment, and outcome were evaluated. Clinical signs of toxicosis were reported in 107 of 128 (84%) dogs that ingested MPH; these included hyperactivity in 42 (33%), tachycardia in 27 (21%), vomiting in 19 (15%), agitation in 16 (13%), and hyperthermia in 13 (10%). Doses ranged from 0.36 mg/kg (0.164 mg/lb) to 117.0 mg/kg (53.18 mg/lb). Severity of clinical signs was not strongly associated with dose. More severe and prolonged clinical signs were associated with ingestion of extended-release formulations of MPH; 3 dogs that consumed these formulations (doses, 10.2 mg/kg [4.64 mg/lb], 15.4 mg/kg [700 mg/lb], and 31.1 mg/kg [14.14 mg/lb]) died. Favorable outcomes were reported for most (31/34 [91%]) dogs. Ingestion of even small amounts of MPH can cause severe clinical signs in dogs. Monitoring and supportive care are recommended regardless of dose.

Complications of oral exposure to fentanyl transdermal delivery system patches.

Fentanyl is a synthetic opioid available therapeutically as an intravenous, transbucal, or transdermal preparation. It is also used as a drug of abuse through a variety of different methods, including the oral abuse of transdermal fentanyl patches. This is a series of patients with oral fentanyl patch exposure reported to our center and represents the first series of oral fentanyl patch exposures collected outside of the postmortem setting. In this series, we examined the New York Poison Control Center database for all cases of oral abuse of fentanyl reported between January 2000 and April 2008. Twenty cases were reported, nine were asymptomatic or had symptoms of opioid withdrawal; 11 had symptoms of opioid intoxication. Eight patients were administered naloxone and all showed improvement in clinical status. Only one case resulted in a confirmed fatality-this patient had an orally adherent patch discovered at intubation. Oral exposure may result in life-threatening toxicity. Patients should be closely assessed and monitored for the opioid toxidrome, and if symptomatic, should be managed with opioid antagonists and ventilatory support.