Risk Assessment by Physicians and by the Poison Center: Are Nondrug Exposures Handled Too Actively?

Abstract

Background: The study was intended to evaluate the possible impact of poison center advice on physicians' treatment and referral of nondrug exposures.Methods: Doctors seeking advice on nondrug poisoning were asked for their management plan before any recommendations were given. The proportions of cases in different treatment and referral categories were compared to the poison center recommendations. Rate ratios were used as effect measure.Results: A total of 175 cases were included in the study. For 90% of these, the exposure was estimated by the poison center to be of no or minor risk. The inquiring physicians had intended to treat 43 more cases than the poison center recommended, rate ratios: 1.6 (95% CI: 1.3–2.0). The most marked difference was for treatment by gastrointestinal decontamination, rate ratios: 5.0 (95% CI: 2.5–9.8). For referral, 42 more cases would have been observed in a stationary hospital unit, rate ratios: 2.3 (95% CI: 1.6–3.3) and 28 excess cases would have been observed in an outpatient facility, rate ratios: 2.0 (95% CI: 1.3–1.6). A more active attitude for treatment and referral by the inquirers was independently associated with patients ≤ 14 years of age, lack of symptoms at presentation, and insignificant exposures. Conclusions: Doctors seeking advice on the management of nondrug poisoning intended to treat and refer to health care facilities more actively than recommended by the poison center. The tendency was most pronounced for children exposed to substances of minor toxicological significance and treatment with gastrointestinal decontamination.