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2014 ; 52
(10
): 1032-283
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2013 Annual Report of the American Association of Poison Control Centers
National Poison Data System (NPDS): 31st Annual Report
#MMPMID25559822
Mowry JB
; Spyker DA
; Cantilena LR Jr
; McMillan N
; Ford M
Clin Toxicol (Phila)
2014[Dec]; 52
(10
): 1032-283
PMID25559822
show ga
BACKGROUND: This is the 31st Annual Report of the American Association of Poison
Control Centers' (AAPCC) National Poison Data System (NPDS). As of January 1,
2013, 57 of the nation's poison centers (PCs) uploaded case data automatically to
NPDS. The upload interval was 8.08 [7.10, 11.63] (median [25%, 75%]) minutes,
creating a near real-time national exposure and information database and
surveillance system. METHODOLOGY: We analyzed the case data tabulating specific
indices from NPDS. The methodology was similar to that of previous years. Where
changes were introduced, the differences are identified. Poison center (PC) cases
with medical outcomes of death were evaluated by a team of 38 medical and
clinical toxicologist reviewers using an ordinal scale of 1-6 to assess the
Relative Contribution to Fatality (RCF) of the exposure to the death. RESULTS: In
2013, 3,060,122 closed encounters were logged by NPDS: 2,188,013 human exposures,
59,496 animal exposures, 806,347 information calls, 6,116 human-confirmed
nonexposures, and 150 animal-confirmed nonexposures. Total encounters showed a
9.3% decline from 2012, while health care facility human exposure calls were
essentially flat, decreasing by 0.1%.All information calls decreased 21.4% and
health care facility (HCF) information calls decreased 8.5%, medication
identification requests (drug ID) decreased 26.8%, and human exposures reported
to US PCs decreased 3.8%. Human exposures with less serious outcomes have
decreased 3.7% per year since 2008 while those with more serious outcomes
(moderate, major or death) have increased by 4.7% per year since 2000. The top
five substance classes most frequently involved in all human exposures were
analgesics (11.5%), cosmetics/personal care products (7.7%), household cleaning
substances (7.6%), sedatives/hypnotics/antipsychotics (5.9%), and antidepressants
(4.2%). Sedative/hypnotics/antipsychotics exposures as a class increased most
rapidly (2,559 calls/year) over the last 13 years for cases showing more serious
outcomes. The top five most common exposures in children of 5 years or less were
cosmetics/personal care products (13.8%), household cleaning substances (10.4%),
analgesics (9.8%), foreign bodies/toys/miscellaneous (6.9%), and topical
preparations (6.1%). Drug identification requests comprised 50.7% of all
information calls. NPDS documented 2,477 human exposures resulting in death with
2,113 human fatalities judged related (RCF of 1, undoubtedly responsible; 2,
probably responsible; or 3, contributory). CONCLUSIONS: These data support the
continued value of PC expertise and need for specialized medical toxicology
information to manage the more severe exposures, despite a decrease in calls
involving less severe exposures. Unintentional and intentional exposures continue
to be a significant cause of morbidity and mortality in the United States. The
near real-time, always current status of NPDS represents a national public health
resource to collect and monitor US exposure cases and information calls. The
continuing mission of NPDS is to provide a nationwide infrastructure for public
health surveillance for all types of exposures, public health event
identification, resilience response and situational awareness tracking. NPDS is a
model system for the nation and global public health.