Human Plant Exposures Reported to a Regional (Southwestern) Poison Control Center Over 8 Years.

BACKGROUND: There is little published data about human plant exposures reported to US poison control centers (PCCs). METHODS: A retrospective chart review of all reported plant exposures to a single regional PCC between January 1, 2003 and December 31, 2010 was done to understand better the characteristics of plant exposure cases. Specific generic plant codes were used to identify cases. Recorded variables included patient demographics, plant involved, exposure variables, symptoms, management site, treatments, and outcome. Univariate and multivariate regression was used to identify outcome predictors. RESULTS: A total of 6492 charts met inclusion criteria. The average age was 16.6 years (2 months-94 years); 52.4% were male. The most common exposure reason was unintentional (98%), and the majority (92.4%) occurred at the patient's home. Ingestions (58.3%) and dermal exposures (34.3%) accounted for most cases. Cactus (27.5%), oleander (12.5%), Lantana (5.7%), and Bougainvillea (3.8%) were most commonly involved. Symptoms developed in 47.1% of patients, and were more likely to occur following Datura (66.7%), and Morning Glory or Milkweed (25% each) exposures. Almost 94% of patients were managed onsite (home) and only 5.2% involved evaluation in a health care facility (HCF). Only 37 (0.6%) patients required hospital admission, and 2.9% of cases resulted in more than minimal effects. Exposures resulting in more than minimal clinical effects were predicted by several variables: abnormal vital signs (OR = 35.62), abnormal labs (OR = 14.87), and management at a HCF (OR = 7.37). Hospital admissions were increased for patients already at a HCF (OR = 54.01), abnormal vital signs (OR = 23.28), and intentional exposures (OR = 14.7). CONCLUSION: Plant exposures reported to our poison control center were typically unintentional ingestions occurring at home. Most patients were managed onsite and few developed significant symptoms.

Poison control centers decrease emergency healthcare utilization costs.

INTRODUCTION: Patient home management by a regional poison control center has potential to save public healthcare dollars by preventing unnecessary utilization of emergency department services. We wished to conservatively quantify such savings at a large regional poison center and compare savings to funds received in state support. METHODS: Banner Poison Control Center (BPCC) serves a population of about four million in central AZ. A telephone survey of callers who were managed at home in February and March of 2007 after nontoxic exposures was used to calculate what percentage of such callers would have sought unnecessary medical care in emergency departments. Twelve emergency departments geographically dispersed in the region were surveyed, and a state database of hospital charges was queried to determine hospital charges and physician professional charges for conservative management of a patient who would have been advised to remain at home by BPCC. RESULTS: BPCC managed 28,883 callers at home in 2007. Seventy percent of home-managed patients would have sought unnecessary care in emergency departments. Using most conservative assumptions, a median of $33 million [range $18 million to $45 million] in unnecessary health care charges were prevented by BPCC home-management in 2007. A median of about $36 in unnecessary health care charges were prevented for each dollar of state funding BPCC received. CONCLUSIONS: Home management by BPCC provides large dollar savings to residents compared to dollars received in state support.

Serum sickness following administration of Antivenin (Crotalidae) Polyvalent in 181 cases of presumed rattlesnake envenomation.

OBJECTIVE: To describe the incidence and characteristics of serum sickness (SS) following administration of Wyeth Antivenin (Crotalidae) Polyvalent (ACP). METHODS: A retrospective chart review was conducted involving presumed rattlesnake bite victims referred to our poison center. Serum sickness was defined as unexplained rash developing 3 to 21 days following the administration of ACP. Patients were monitored until complete resolution of all symptoms. Data collected included total number of ACP vials administered, associated signs and symptoms, duration of signs and symptoms, and medications used to treat SS. RESULTS: Of the 181 cases included in our study, SS occurred in 102 (56%) patients. The frequency of SS in patients receiving fewer than 20, 20 to 29, 30 to 39, or 40 or more vials was 34%, 36%, 88%, and 100%, respectively. Duration of SS averaged 6.1 days (range, 1-21 days). Associated symptoms included subjective fever (49%), arthralgia (20%), and pruritus (40%). Reported medications used included prednisone (98%), antihistamines (92%), and histamine-2 blockers (3%). CONCLUSIONS: Serum sickness following administration of Wyeth ACP is common, with a strong correlation between ACP dosage and SS frequency.

Antibiotics after rattlesnake envenomation.

To record the outcome, with regard to infection rate, of patients with rattlesnake bites (RSBs) who do not receive prophylactic antibiotics, a prospective observational study was performed of patients with RSBs treated at our institution during a consecutive 18-month period. The inclusion criteria were RSBs <24 h old and completion of follow-up (telephone call, mail reply, medical toxicologist, or private physician examination) 7-10 days following envenomation. Fifty-six consecutive patients (Median age: 32.8 years [range 4-67 years]) were enrolled. One patient was excluded because of presentation 38 h after envenomation and two patients failed to complete the required follow-up. One patient received a dose of antibiotics before transfer. Antibiotics were discontinued upon arrival. Of the total 56 RSB patients, 34 (61%) RSBs involved the upper extremity and 22 (39%) involved the lower extremity. Six patients (11%) applied ice and two (4%) used a tourniquet before evaluation. The mean arrival time was 2.7 h (Range <1-24 h). Forty-three patients (81%) received antivenin. Fifty-three patients (100%) had extremity swelling and 38 patients (72%) had tender proximal lymph nodes. Of the 53 patients who completed the study, 3 (6%) received antibiotics from their primary care physicians at 7-10 day follow-up, with no cases (0%) of documented infection. Prophylactic antibiotics are not indicated in patients with rattlesnake bites.