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

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 sedativehypnotics (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 boardcertified 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.

Reducing Childhood Admissions to the PICU for Poisoning (ReCAP2) by Predicting Unnecessary PICU Admissions After Acute Intoxication

“…Previous single-center studies (11–16) have identified predictors similar to the findings in our model to determine whether children may be safely monitored in a short-stay observation unit outside of the PICU (17, 18). Clonidine and antidiabetic medications were significant in our multivariable models for children under 6 years old.…”

The Toxicology Investigators Consortium Case Registry—the 2016 Experience

“…In 2016, 14 abstracts and five manuscripts using ToxIC Registry data were published and are listed on http://www. ToxICRegistry.org (Farrugia et al [2]; Beauchamp et al [3]; Judge et al [4]; Riederer et al [5]; Wang et al [6]).…”

Necessity of Intensive Care Requirement in Childhood Intoxicity

“…7 27,28 acil durumda hızlı müdahale eden takımların oluşturulması ve ekip çalışması sayesinde, 9 pek çok hastanın çocuk genel servisi içerisinde güvenle takip edilebileceği düşünülmektedir. 7,29 Çocuklara yönelik zehirlenme şiddet ve risk skorlarının geliştirilmesi ile hangi hastanın yoğun bakım ünitesi yatışına ihtiyaç duyacağının belirlenmesi önem kazanmaktadır. Yetişkinlerde, zehirlenmenin şiddetini ve yoğun bakım ihtiyacını öngörecek, başvuru anındaki bulgular ve klinik takiplere dayanarak oluşturulan risk skorları mevcuttur.…”