Determinants of U.S. poison center utilization.
BACKGROUND
High poison center utilization has been associated with decreased emergency department usage and hospitalization rates. However, utilization requires awareness of the poison center. Penetrance, defined as the number of human poison exposures reported to a poison center per 1,000 population, has been used as a marker of poison center awareness.


OBJECTIVE
To identify factors that influence poison center penetrance to optimize the life- and cost-saving benefits of poison control centers.


METHODS
Human poison exposures that were reported to the National Poison Data System in 2001 were analyzed to identify and rank factors affecting poison center penetrance.


RESULTS
Overall penetrance correlated with pediatric penetrance (R(2) = 0.75, p < 0.01). As pediatric penetrance increased, there was a significant decline in the percent of children reported to a poison center that were already in or en route to a healthcare facility at the time of the call to the poison center (R(2) = 0.41, p < 0.01). Larger poison center service populations were associated with lower penetrance (R(2) = 0.23, p < 0.01). Inverse predictors of penetrance included inability to speak English well, Black/African American race, and distance from the poison center (multiple regression). Positive predictors included the percentage of the population younger than 5 years, the percentage of the adult population with a bachelor's degree, poison center certification, poison center educator FTEs (full time equivalents), Asian population percentage, and population density.


CONCLUSIONS
The inverse correlation between pediatric penetrance and healthcare facility utilization supports prior observations of excessive healthcare utilization when a poison center is not called. Since race, language and distance are barriers to poison center utilization, and since healthcare utilization increases when poison center penetrance declines, low penetrance suggests a lack of awareness of the poison center rather than a low incidence of poisonings.


CONCLUSIONS
Strategies to raise penetrance should be informed by an understanding of the barriers to utilization - language, Black/African American race, distance from the poison center, poverty, and lower education levels.
National Capital Poison Center, Washington, DC 20016, USA. toby@poison.org
Toby
T
Litovitz
Blaine E
BE
Benson
Jessica
J
Youniss
Edward
E
Metz
D000328:Adult; D001741:Black or African American; D002648:Child; D003625:Data Collection; D004522:Educational Status; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007802:Language; D011039:Poison Control Centers / Q000706:statistics & numerical data*; D011042:Poisons; D011153:Population; D044469:Racial Groups; D016896:Treatment Outcome
D011042:Poisons