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The absence of validated U.S. rates of nonfatal suicidal behavior places risk management and injury prevention programs at danger of being poorly informed and inadequately conceptualized. In this study we compare estimated rates of intentional self-harm from two ongoing surveys (National Electronic Injury Surveillance System-All Injury Program-NEISS-AIP; National Hospital Ambulatory Medical Care Survey-NHAMCS) to data from the Toxic Exposure Surveillance System. Results suggest that, for every 2002-2003 suicide, there were 12 (NEISSAIP) or 15 (NHAMCS) self-harm--related emergency department visits, and for every intentional self-poisoning death there were 33 intentional overdoses reported to poison control centers, of which two ultimately went untreated.

OBJECTIVE. This study tested the hypothesis that underutilization of poison control centers is associated with increased rates of hospitalizations attributable to poisonings in rural areas. METHODS. To measure the potential impact of poison control centers on hospitalization rates in rural areas among people who visit emergency departments because of poisoning, we estimated the reduction in hospitalization rates associated with increased rates of calls to centers. We used the 2003 State Inpatient Database and State Emergency Department Database from the Healthcare Cost and Utilization Project to calculate the numbers of emergency department visits and hospitalizations for each county in the 12 states analyzed. We used Toxic Exposure Surveillance System data from the American Association of Poison Control Centers to calculate the number of human exposure calls per capita according to county. RESULTS. In rural counties, a 1% higher poison control center human poison exposure call rate was associated with a 0.19 % lower hospitalization rate among people who visited emergency departments because of poisoning. If the observed association is causative, then 43.3 calls would prevent 1 hospital admission, yielding $7321 in net cost savings and a return on investment of 5.9:1 (from the health care system perspective). CONCLUSIONS. Our results establish the existence of the hypothesized association between rural poison control center utilization rates and hospitalization rates among emergency department-treated poisoning patients. Key Words poisoning, poison control center, hospitalization rate, rural, benefit, cost-effectiveness Abbreviations PCC--poison control center ED-- emergency department AAPCC--American Association of Poison Control Centers, POISON CONTROL CENTERS (PCCs) provide a telephone consultation service, staffed by toxicology professionals. Without charge, callers receive immediate information and treatment advice regarding suspected toxic exposures to drugs, chemicals, or [...]

This analysis of 25 368 occupational and 7565 environmental exposure cases characterizes the occupational and environmental exposures reported to the American Association of Poison Control Centers Toxic Exposure Surveillance System. Compared with other poisonings, occupational and environmental exposures were predominantly inhalation exposures rather than ingestions, were more often subacute or chronic, and demonstrated greater morbidity, mortality, and increased use of health care resources. As regional poison centers evolve to fill a critical information void in the management and assessment of environmental and occupational exposures, the American Association of Poison Control Centers Toxic Exposure Surveillance System provides an important, untapped passive surveillance mechanism. (Am J Public Health 1993;83: 739-743), Data from the American Assn of Poison Control Centers Toxic Exposure Surveillance System indicate that environmental and occupational exposures to poisons occurred most often through inhalation and are also characterized by their chronic nature. The Toxic Exposure Surveillance System of the American Association of Poison Control Centers was developed to track the incidence of different types of poisonings. A large amount of data on environmental and occupational exposure has been collected. In 1988, 25,368 incidences of occupational exposure were recorded. There were also 7,565 instances of environmental exposure noted, which is 1.8 times the environmental exposures to poison from 1983 to 1988. This database has an advantage over other reporting systems in that results are reported anonymously and patients need not fear possible reprisal because of an investigation of their employer. For the system to be used effectively in a nationwide evaluation of environmental poisoning, a few changes are needed. These would include the implementation of standards to ensure coding accuracy.

This analysis of life-threatening and fatal pediatric poisonings was conducted to aid poison prevention educational efforts, guide product reformulations and aversive agent use, reassess over-the-counter status for selected pharmaceuticals, and identify research areas for clinical advances in the treatment of pediatric poisonings. A hazard factor was devised to assess more objectively the pediatric poisoning hazard posed by pharmaceutical and nonpharmaceutical products. By considering the frequency and extent of injury following actual exposures, the hazard factor reflects more than the acute toxicity of individual ingredients and is also influenced by such variables as packaging, accessibility, availability (as a reflection of marketing), formulations, and closure types. Of the 3 810 405 exposures involving children younger than 6 years of age reported to poison centers in 1985 through 1989, 2117 patients experienced a major outcome (life-threatening effect or residual disability) and an additional 111 fatalities occurred. The three most commonly implicated substance categories, accounting for 30.4% of reported exposures, include cosmetics and personal care products, cleaning substances, and plants. All had low hazard factors, with significant hazards being limited to a small number of products identified herein. Thus this analysis of hazard factors demonstrates that frequent exposure does not imply toxicity. Iron supplements were the single most frequent cause of pediatric unintentional ingestion fatalities, accounting for 30.2% of reported pediatric pharmaceutical unintentional ingestion fatalities reported over an 8-year period. Antidepressants, cardiovascular medications, and methyl salicylate follow in frequency of pediatric pharmaceutical deaths. Hydrocarbons (including five lamp oil deaths) and pesticides were each implicated in 12 pediatric ingestion fatalities during the 8-year period. Selenious acid-containing gun bluing was involved in four deaths. These data allow a more informed approach to poison prevention efforts in the 1990s.

During a 7-year period, 2382 cases of battery ingestion were reported to a national registry. Button cells were ingested by 2320 of these patients; 62 patients ingested cylindrical cells. These cases are analyzed to reassess current therapeutic recommendations, hypotheses about battery-induced injury, and strategies for prevention and intervention. Hearing aids were the most common intended use of ingested cells (952 cases, 44.6%); and in 312 (32.8%) of these cases, the battery actually was removed by a child from the child's own aid. Overall, 9.9% of patients were symptomatic. Two children experienced severe esophageal injury following the ingestion of large diameter cells and required repeated dilatation. In this series and in prior reports, most batteries which lodged in the esophagus and caused esophageal injury were large diameter (20 to 23 mm). However, neither battery diameter nor symptom occurrence could be used to detect all patients with esophageal battery position. Outcome was not affected by battery discharge state, but was influenced by chemical system. Lithium cells, with their larger diameters and greater voltage, were associated disproportionately with adverse effects. Mercuric oxide cells were substantially more likely to fragment, compared with other chemical systems. No clinical evidence of mercury toxicity occurred in this series, although one patient demonstrated minimal elevation of blood mercury levels. In this series and 10 prior reports, all patients with elevated blood mercury levels had ingested batteries which fragmented and showed evidence of radio-opaque droplets in the gut. Special monitoring may be advisable for individuals who have ingested 15.6-mm-diameter mercuric oxide cells. Ipecac was administered in 37 cases of button cell ingestion, causing battery expulsion in only one patient. Retrograde battery movement from the stomach to the esophagus necessitating emergent endoscopic retrieval occurred as a complication of ipecac administration in another patient. The use of endoscopic and surgical intervention declined more than fivefold during the study period. Endoscopic retrieval success was a function of battery location, with batteries in the esophagus more readily retrieved than those in more distal gastrointestinal locations (90.0% vs 46.7%, respectively). A current management protocol is presented advocating a noninvasive approach for most cases of button cell ingestion where an esophageal position is excluded. Manufacturers are urged to provide more securely fastened, child-resistant battery compartments on hearing aids as well as other batter-powered products in household use. Pediatrics 1992;89:747-757

Two cases of pediatric accidental ingestion of an acetonitrile-containing cosmetic are reported. One of the children, a 16-month-old, boy, was found dead in bed the morning after ingesting the product. No Therapy had been undertaken, as the product was mistakenly assumed to be an acetone-containing nail polish remover. The second child, a 2-year-old boy, experienced signs of severe cyanide poisoning, but survived with vigorous supportive care. Both children had blood cyanide levels in the potentially lethal range. The observed delayed onset of severe toxic reactions supports the proposed mechanism of acetonitrile conversion to inorganic cyanide via hepatic microsomal enzymes. Physicians and poison centers should be alerted to the existence of this highly toxic product, sold for removal of sculptured nails and likely to be confused with the less toxic acetone-containing nail polish nail removers. We urge regulatory agencies to reconsider the wisdom of marketing a cosmetic that poses such an extreme health hazard.

Accidental ingestion of prescription drugs by children less than five years old continues to be a serious health problem. A survey was conducted at 9 poison control centers of about 1,900 incidents of poisoning. Accidental ingestion occurred most often in 2-year-old children, accounting for 42 percent of incidents. Eighty-two percent of incidents occurred in the child's own home. Thirty-five percent of the drugs consumed at home belonged to someone other than the immediate family, most frequently a grandparent. Poisons taken by the children were frequently away from their usual storage location, in non-child-resistant packaging, in a non-prescription container, or in no container at all. Twenty-two percent of all childproof packages did not work, and over 60 percent of all medications had no child-resistant barrier at the time of ingestion. Accessible storage locations such as the kitchen counter, a table top, or the top of a dresser or bedside table substantially increased the risk of accidental ingestion. These facts suggest the need for more effective childproof packaging that is easier for adults to use.