Utilization of Observation Units for the Care of Poisoned Patients: Trends from the Toxicology Investigators Consortium Case Registry

Bryan S. Judge, Lindsey M. Ouellette, Melissa VandenBerg, Brad D. Riley, Paul M. Wax, Behalf Of The Toxicology Investigators Consortium (Toxic) Case Registry On Behalf Of The Toxicology Investigators Consortium (Toxic) Case Registry

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Many poisoned patients may only require a period of observation after their exposure. There are limited data describing the use of observation units for managing poisoned adult and pediatric patients. We performed a retrospective review of all patients reported to the ToxIC Case Registry between January 1, 2012 and December 31, 2013. Eligible patients included those who received a bedside consultation by a medical toxicologist and whose care was provided in an observation unit, or those who were admitted under the care of a medical toxicologist in an observation unit. A total of 15,562 poisonings were reported to the registry during the study period, of which 340 (2.2 %) involved patients who were cared for in an observation unit. Of these patients, 22.1 % were 18 years of age or younger, and the remaining 77.9 % were greater than 18 years of age. The most common reason for exposure was the intentional ingestion of a pharmaceutical agent in both adult (30.2 %) and pediatric patients (36.0 %). Alcohols (ethanol) (24.9 %), opioids (20.0 %), and sedative-hypnotics (17.7 %) were the most common agent classes involved in adult patient exposures. The most common agent classes involved in pediatric exposures were antidepressants (12.0 %), anticonvulsants (10.7 %), and envenomations (10.7 %). In adult patients, the most common signs and symptoms involved the nervous system (52.0 %), a toxidrome (17.0 %), or a major vital sign abnormality (14.7 %). In pediatric patients, the most common signs and symptoms involved the nervous system (53.3 %), a toxidrome (21.3 %), or a major vital sign abnormality (17.3 %). The results of this study demonstrate that a wide variety of poisoned patients have been cared for in an observation unit in consultation with a board-certified medical toxicologist. Patterns for the reasons for exposure, agents responsible for the exposure, and toxicological treatments will continue to evolve. Further study is needed to identify better those poisoned patients who can be appropriately managed in an observation unit.

Original languageEnglish (US)
JournalJournal of Medical Toxicology
DOIs
StateAccepted/In press - Aug 15 2015

Fingerprint

Pediatrics
Toxicology
Registries
Patient Care
Research Personnel
Observation
Neurology
Hypnotics and Sedatives
Anticonvulsants
Opioid Analgesics
Antidepressive Agents
Ethanol
Vital Signs
Alcohols
Nervous System
Signs and Symptoms
Referral and Consultation
Pharmaceutical Preparations
Poisoning
Eating

Keywords

  • Medical toxicology
  • Observation units
  • Overdose
  • Poisonings
  • Registry
  • Toxicology

ASJC Scopus subject areas

  • Health, Toxicology and Mutagenesis
  • Toxicology

Cite this

Judge, B. S., Ouellette, L. M., VandenBerg, M., Riley, B. D., Wax, P. M., & On Behalf Of The Toxicology Investigators Consortium (Toxic) Case Registry, B. O. T. T. I. C. T. C. R. (Accepted/In press). Utilization of Observation Units for the Care of Poisoned Patients: Trends from the Toxicology Investigators Consortium Case Registry. Journal of Medical Toxicology. https://doi.org/10.1007/s13181-015-0498-4

Utilization of Observation Units for the Care of Poisoned Patients : Trends from the Toxicology Investigators Consortium Case Registry. / Judge, Bryan S.; Ouellette, Lindsey M.; VandenBerg, Melissa; Riley, Brad D.; Wax, Paul M.; On Behalf Of The Toxicology Investigators Consortium (Toxic) Case Registry, Behalf Of The Toxicology Investigators Consortium (Toxic) Case Registry.

In: Journal of Medical Toxicology, 15.08.2015.

Research output: Contribution to journalArticle

Judge, BS, Ouellette, LM, VandenBerg, M, Riley, BD, Wax, PM & On Behalf Of The Toxicology Investigators Consortium (Toxic) Case Registry, BOTTICTCR 2015, 'Utilization of Observation Units for the Care of Poisoned Patients: Trends from the Toxicology Investigators Consortium Case Registry', Journal of Medical Toxicology. https://doi.org/10.1007/s13181-015-0498-4
Judge BS, Ouellette LM, VandenBerg M, Riley BD, Wax PM, On Behalf Of The Toxicology Investigators Consortium (Toxic) Case Registry BOTTICTCR. Utilization of Observation Units for the Care of Poisoned Patients: Trends from the Toxicology Investigators Consortium Case Registry. Journal of Medical Toxicology. 2015 Aug 15. https://doi.org/10.1007/s13181-015-0498-4
Judge, Bryan S. ; Ouellette, Lindsey M. ; VandenBerg, Melissa ; Riley, Brad D. ; Wax, Paul M. ; On Behalf Of The Toxicology Investigators Consortium (Toxic) Case Registry, Behalf Of The Toxicology Investigators Consortium (Toxic) Case Registry. / Utilization of Observation Units for the Care of Poisoned Patients : Trends from the Toxicology Investigators Consortium Case Registry. In: Journal of Medical Toxicology. 2015.
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abstract = "Many poisoned patients may only require a period of observation after their exposure. There are limited data describing the use of observation units for managing poisoned adult and pediatric patients. We performed a retrospective review of all patients reported to the ToxIC Case Registry between January 1, 2012 and December 31, 2013. Eligible patients included those who received a bedside consultation by a medical toxicologist and whose care was provided in an observation unit, or those who were admitted under the care of a medical toxicologist in an observation unit. A total of 15,562 poisonings were reported to the registry during the study period, of which 340 (2.2 {\%}) involved patients who were cared for in an observation unit. Of these patients, 22.1 {\%} were 18 years of age or younger, and the remaining 77.9 {\%} were greater than 18 years of age. The most common reason for exposure was the intentional ingestion of a pharmaceutical agent in both adult (30.2 {\%}) and pediatric patients (36.0 {\%}). Alcohols (ethanol) (24.9 {\%}), opioids (20.0 {\%}), and sedative-hypnotics (17.7 {\%}) were the most common agent classes involved in adult patient exposures. The most common agent classes involved in pediatric exposures were antidepressants (12.0 {\%}), anticonvulsants (10.7 {\%}), and envenomations (10.7 {\%}). In adult patients, the most common signs and symptoms involved the nervous system (52.0 {\%}), a toxidrome (17.0 {\%}), or a major vital sign abnormality (14.7 {\%}). In pediatric patients, the most common signs and symptoms involved the nervous system (53.3 {\%}), a toxidrome (21.3 {\%}), or a major vital sign abnormality (17.3 {\%}). The results of this study demonstrate that a wide variety of poisoned patients have been cared for in an observation unit in consultation with a board-certified medical toxicologist. Patterns for the reasons for exposure, agents responsible for the exposure, and toxicological treatments will continue to evolve. Further study is needed to identify better those poisoned patients who can be appropriately managed in an observation unit.",
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