title: Emergency department poisoning visits in children younger than 6 years: comparing referrals by a regional poison control center to referrals by other sources.
abstract: OBJECTIVE
  The study purpose was to compare medical appropriateness and costs of regional poison control center (RPCC) versus non-RPCC referrals to children's hospital emergency department (ED) for acute poison exposure.
  
  
  METHODS
  This is a retrospective cross-sectional study of children (<6 years) during an 8-month period, who presented for poison exposure. Demographic and clinical patient characteristics were abstracted onto a uniform data form. Medical appropriateness was determined by presence of 1 of 4 criteria by 3 independent reviewers blinded to the patients' race, source of referral, charges, and disposition.
  
  
  RESULTS
  Determination of medical appropriateness was matched by all 3 reviewers in 187 patients who make up the study population. There were 92 RPCC-referred cases and 95 non-RPCC-referred controls. Groups were comparable by age, sex, toxin, and symptoms. For RPCC referrals, 84 were self-transported, and 8 were transported by emergency medical services. For non-RPCC referrals, 60 were self-referred/transported, 26 were transported by emergency medical services, and 9 were physician referred. Regional poison control center referrals had a 39.1% higher rate of medical appropriateness than did non-RPCC referrals (odds ratio, 13.0; 95% confidence interval, 3.6-36.1). For this sample, mean charges for inappropriate ED poison exposure visits were $313.42, and the cost per RPCC call was $25, thus giving a potential return on investment of 12.54 to 1 favoring RPCC triage.
  
  
  CONCLUSIONS
  When compared with other referral sources, RPCC triage results in fewer unnecessary ED visits in this age group. Increasing prehospital use of poison centers would likely decrease unnecessary ED referrals and related costs.
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA. jacksobf@musc.edu
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Jackson
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: McCain
authors.forename: Michele H
authors.initials: MH
authors.lastname: Nichols
authors.forename: Ann P
authors.initials: AP
authors.lastname: Slattery
authors.forename: William D
authors.initials: WD
authors.lastname: King
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Losek
mesh_terms: D000552:Ambulances; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004630:Emergencies / Q000453:epidemiology*; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D015277:Hotlines; D006801:Humans; D007223:Infant; D008297:Male; D010820:Physicians; D011039:Poison Control Centers; D011041:Poisoning / Q000453:epidemiology*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012040:Regional Health Planning; D012189:Retrospective Studies; D016037:Single-Blind Method; D063189:Symptom Assessment; D014187:Transportation of Patients; D014218:Triage / Q000379:methods