Systematic differences between healthcare professionals and poison information staff in the severity scoring of pesticide exposures

Abstract

Context. Severity scores are used in triage and for data comparison in cases of poisoning. Exposure severity scores have not been generally validated and their utilization by healthcare staff other than specialists in poison information (SPIs) is untested. Objective. To compare the poisoning severity grading allocated in pesticide exposure cases by healthcare professional enquirers and poison information staff. Methods. Pesticide exposures reported to the U.K. National Poisons Information Service (NPIS) systems in a prospective study were graded for severity by healthcare professional enquirers and NPIS SPIs who used established poisons severity-grading algorithms. The scores were compared in children and adults, for the two professional groupings, both overall and for separate pesticides. Results. Overall SPIs graded severity resulting from pesticide exposure at a lower level than the enquirer. For children, enquirer mean severity score was 1.62 (95% confidence interval (CI) 1.57–1.66) and SPIs mean severity score was 1.16 (95% CI 1.13–1.19) (p < 0.001). For adults, enquirer mean severity score was 1.91 (95% CI 1.84–1.97) and SPIs mean severity score was 1.74 (95% CI 1.69–1.79) (p < 0.001). Importantly, the differences in the scores between the two professional groups were greater in children [+0.46 (95% CI 0.41–0.51)] than in adults [+0.17 (95% CI 0.11–0.24)] (p < 0.001). Findings for individual pesticides were less consistent but in general showed similar trends. The exception was glyphosate for which severity grading by poison information staff was higher for children [SPIs 1.68 (95% CI 1.38–1.96) than the enquirers 1.26 (95% CI 1.08–1.44), p < 0.02]. Conclusions. Our findings suggest inherent differences in the perception of pesticide toxicity between healthcare professionals and SPIs. There was also a difference in the scoring approach depending on the pesticide involved. Additional investigations are required to define the role and accuracy of severity scoring in different types of poisoning and the applicability to different types of severity assessors.

Keywords:

• Specialists in poison information
• Pesticides
• Children
• Poisoning
• Severity grading

Acknowledgments

We acknowledge the support of our colleagues in the NPIS units who contributed by helping to collect the data that were used in the formulation of this article. The work was conceived by DNB, analyzed by the authors, and the initial manuscript was drafted by RDA and AG. DNB is the guarantor of the data. The U.K. Health and Safety Executive and the Chemicals Regulation Directorate funded this study. The funding sponsor had no role in the design of the study other than to request a range of pesticides about which they were specifically interested in gathering exposure data.The study sponsor also played no role in writing the report or the decision to submit the article for publication.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this paper.