Factors that trigger emergency physicians to contact a poison centre: findings from a Swiss study.
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.
Swiss Toxicological Information Centre, Associated Institute of the University of Zurich, , Zurich, Switzerland.
David
D
Schurter
Christine
C
Rauber-Lüthy
Maximilian
M
Jahns
Monika
M
Haberkern
Hugo
H
Kupferschmidt
Aristomenis
A
Exadaktylos
Urs
U
Eriksson
Alessandro
A
Ceschi
D000059:Accidents / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000553:Ambulatory Care; D019548:Crime Victims / Q000706:statistics & numerical data*; D003657:Decision Making; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011041:Poisoning / Q000175:diagnosis* / Q000628:therapy; D010818:Practice Patterns, Physicians' / Q000458:organization & administration / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D017678:Sex Distribution; D013406:Suicide, Attempted / Q000706:statistics & numerical data*; D013557:Switzerland; D014218:Triage / Q000379:methods / Q000458:organization & administration
Accident & Emergency Medicine; Toxicology