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Factors that trigger emergency physicians to contact a poison centre: findings from a Swiss study
  1. David Schurter1,2,
  2. Christine Rauber-Lüthy1,
  3. Maximilian Jahns3,
  4. Monika Haberkern3,
  5. Hugo Kupferschmidt1,
  6. Aristomenis Exadaktylos3,
  7. Urs Eriksson2,
  8. Alessandro Ceschi1,4
  1. 1Swiss Toxicological Information Centre, Associated Institute of the University of Zurich, Zurich, Switzerland
  2. 2Department of Internal Medicine, GZO—Zurich Regional Health Center, Wetzikon, Switzerland
  3. 3Department of Emergency Medicine, University of Bern, Inselspital, Bern, Switzerland
  4. 4Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich, Switzerland
  1. Correspondence to Alessandro Ceschi, MD, Head, Division of Science, Swiss Toxicological Information Centre, Associated Institute of the University of Zurich, Freiestrasse 16, CH-8032 Zurich; Alessandro.Ceschi{at}usz.ch

Abstract

Objective Poison centres offer rapid and comprehensive support for emergency physicians managing poisoned patients. This study investigates institutional, case-specific and poisoning-specific factors which influence the decision of emergency physicians to contact a poison centre.

Methods Retrospective, consecutive review of all poisoning-related admissions to the emergency departments (EDs) of a primary care hospital and a university hospital-based tertiary referral centre during 2007. Corresponding poison centre consultations were extracted from the poison centre database. Data were matched and analysed by logistic regression and generalised linear mixed models.

Results 545 poisonings were treated in the participating EDs (350 (64.2%) in the tertiary care centre, 195 (35.8%) in the primary care hospital). The poison centre was consulted in 62 (11.4%) cases (38 (61.3%) by the tertiary care centre and 24 (38.7%) by the primary care hospital). Factors significantly associated with poison centre consultation included gender (female vs male) (OR 2.99; 95% CI 1.69 to 5.29; p<0.001), number of ingested substances (>1 vs 1) (OR 2.84; 95% CI 1.65 to 4.9; p<0.001) and situation (accidental vs intentional) (OR 2.76; 95% CI 1.05 to 7.25; p=0.039). In contrast, age, medical history and hospital size did not influence poison centre consultation. Poison centre consultation was significantly higher during the week, and significantly less during night shifts. The poison centre was consulted significantly more when patients were admitted to intensive care units (OR 5.81; 95% CI 3.25 to 10.37; p<0.001). Asymptomatic and severe versus mild cases were associated with more frequent consultation (OR 4.48; 95% CI 1.78 to 11.26; p=0.001 and OR 2.76; 95% CI 1.42 to 5.38; p=0.003).

Conclusions We found low rates of poison centre consultation by emergency physicians. It appears that intensive care unit admission and other factors reflecting either complexity or uncertainty of the clinical situation are the strongest predictors for poison centre consultation. Hospital size did not influence referral behaviour.

  • Toxicology
  • Accident & Emergency Medicine

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