201404 Characteristics of young children with inappropriate ED visits for a poisoning exposure

Tuesday, November 10, 2009

S. David Baker, PharmD, DABAT , Columbus Children's Hospital, Central Ohio Poison Center, Columbus, OH
Marcel Casavant, MD FACEP FACMT , Columbus Children's Hospital, Central Ohio Poison Center, Columbus, OH
Barbara J. Polivka, PhD, RN , College of Nursing, The Ohio State University, Columbus, OH
Background/Purpose: Poisoning remains a major costly public health problem. Many poison exposures can be handled at home after contacting a poison control center (PCC) thus reducing these costs. Yet emergency departments (ED) and urgent care (UC) centers continue to be inappropriately accessed for minor poisonings. We compared characteristics of young children treated in an ED/UC for a poisoning exposure determined not to need an ED/UC visit with those determined to need an ED/UC visit.

Methods: This retrospective study combined hospital administrative decision support system data with National Electronic Injury Surveillance System (NEISS) data collected at an urban mid-western children's hospital. Cases included children <6 years old admitted to the ED/UC in 2001-2005 with a poisoning exposure. All cases were reviewed independently by two poison control experts to determine need for ED/UC visit. Data were analyzed using logistic regression.

Results/Outcomes: Of the 2,499 cases, 19% (n=466) were determined not to have needed an ED/UC visit. Those identified as not needing an ED/UC visit were more likely to be African American (OR = 1.4, 95%CI = 1.1,1.8), insured by Medicaid (OR=1.3, (95% CI=1.02,1.7), exposed to a non-pharmacological agent (OR = 1.4, 95%CI=1.1,1.9), and to live in the same zip code as the hospital or a contiguous zip code. (OR=1.4, 95% CI=1.1,1.9).

Conclusions: Educational efforts concerning the PCC's role and capabilities need to be targeted to those most likely to inappropriately use the ED/UC. Reducing unnecessary ED/UC visits for poison exposures can reduce health care costs.

Learning Objectives:
Describe the characteristic of young children treated in an emergency department (ED) or urgent care (UC) center for a poisoning exposure who were determined not to have needed an ED/UC visit for the exposure.

Keywords: Injury, Children

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I conceived of this research design, completed the data merging and analysis. I have previously published in the area of poison exposures in young children and poison prevention.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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