Do poison center guidelines adversely affect patient outcomes as triage referral values increase?
BACKGROUND
The purpose of this study was to determine whether patient outcomes were adversely affected as healthcare referral values increased for two common poisonings: acute, unintentional acetaminophen (APAP) poisonings and acute, unintentional iron (Fe) poisonings. We hypothesized that symptom rates would increase with high referral values.


METHODS
Qualifying 1997 exposures were separated by substance (APAP or Fe) and then further stratified into three healthcare referral value ranges. Symptomatic and asymptomatic patients were totaled for each stratum. Expected vs. observed distributions of symptomatic and asymptomatic patients across triage referral strata for a given substance and treatment location were compared using chi-square test for independence. The Wilcoxon-Mann-Whitney test was used to compare the distribution of patients across referral strata for home vs. healthcare facility locations for a specific substance.


RESULTS
There were no statistically significant differences in the distribution of symptomatic patients within referral value strata for APAP or for Fe. There was also no difference in distribution of symptomatic patients across strata when comparing home vs. healthcare facility for APAP and Fe.


CONCLUSIONS
Referral values as high as 201 mg/kg for APAP and 61 mg/kg for Fe do not appear to adversely affect patient outcomes.
D000082:Acetaminophen / Q000506:poisoning; D006801:Humans; D007501:Iron / Q000506:poisoning; D017063:Outcome Assessment, Health Care; D011039:Poison Control Centers / Q000592:standards*; D011041:Poisoning / Q000628:therapy*; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation / Q000706:statistics & numerical data; D014218:Triage / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology
D000082:Acetaminophen; D007501:Iron