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The Toxicology Investigators Consortium Case Registry—the 2015 Experience

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Abstract

The American College of Medical Toxicology established the Toxicology Investigators Consortium (ToxIC) Case Registry in 2010. The Registry contains all medical toxicology consultations performed at participating sites. The Registry has continued to grow since its inception, and as of December 31, 2015, contains 43,099 cases. This is the sixth annual report of the ToxIC Registry, summarizing the additional 8115 cases entered in 2015. Cases were identified by a query of the Registry for all cases entered between January 1 and December 31, 2015. Specific data reviewed for analysis included demographics (age, race, gender), source of consultation, reason for consultation, agents and agent classes involved in exposures, signs, symptoms, clinical findings, fatalities, and treatment. By the end of 2015, there were 50 active sites, consisting of 101 separate health-care facilities; 51.2 % of cases involved females. Adults between the ages of 19 and 65 made up the majority (64.2 %) of Registry cases. Caucasian race was the most commonly reported (55.6 %); 9.6 % of cases were identified as Hispanic ethnicity. Inpatient and emergency department referrals were by far the most common referral sources (92.9 %). Intentional pharmaceutical exposures remained the most frequent reason for consultation, making up 52.3 % of cases. Of these intentional pharmaceutical exposures, 69 % represented an attempt at self-harm, and 85.6 % of these were a suicide attempt. Nonopioid analgesics, sedative-hypnotics, and antidepressant agents were the most commonly reported agent classes in 2015. Almost one-third of Registry cases involved a diagnosed toxidrome (32.8 %), with a sedative-hypnotic toxidrome being the most frequently described. Significant vital sign abnormalities were recorded in 25.3 % of cases. There were 98 fatalities reported in the Registry (1.2 %). Adverse drug reactions were reported in 4.3 % of cases. Toxicological treatment was given in 65.3 % of cases, with 33.0 % receiving specific antidotal therapy. Exposure characteristics and trends overall were similar to prior years. While treatment interventions were required in the majority of cases, fatalities were rare.

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Acknowledgments

The authors express their sincere gratitude to the staff at the American College of Medical Toxicology for supporting the ToxIC Registry project. We very much appreciate the contribution to the Registry from each of the ToxIC sites. The following is a list of the principle coordinators from each site contributing cases in 2015.

Toxicology Investigators Consortium

Albuquerque, NM

Steven Seifert, MD

Atlanta, GA

Adam Pomerleau, MD

Ziad Kazzi, MD

Boston, MA (Beth Israel Deaconess Medical Center)

Michael Ganetsky, MD

Boston, MA (Children’s Hospital of Boston)

Michele Burns, MD

Charlotte, NC

Michael Beuhler, MD

Charlottesville, VA

Joshua D. King, MD

Chicago, IL

Steven Aks, DO

Dallas, TX

Jakub Furmaga, MD

Paul Wax, MD

Denver, CO

Jeffrey Brent, MD

Christopher Hoyte, MD

Evanston, IL

Jerrold Leikin, MD

Fresno, CA

Rais Vohra, MD

Grand Rapids, MI

Bryan Judge, MD

Brad Riley, MD

Greenville, SC

William J Meggs, MD

Haifa, Israel

Didi Bentur, MD

Harrisburg, PA

Phil Moore, MD

Hartford, CT

Lynn Farrugia, MD

Houston, TX

Spencer Greene, MD

Indianapolis, IN

Daniel Rusyniak, MD

Kansas City, MO

Jennifer Lowry, MD

Adam Algren, MD

Loma Linda, CA

Brian Wolk, MD

Los Angeles, CA

Michael Levine, MD

Manhasset, NY

Josh Nogar, MD

Milwaukee, WI

Mark Kostic, MD

David Gummin, MD

Morristown, NJ

Diane Calello, MD

New Brunswick, NJ

Ann-Jeannette Geib, MD

New York, NY (Mount Sinai Hospital)

Stephanie Hernandez, MD

New York, NY (NYU Langone Medical Center)

Silas Smith, MD

New York, NY (Bellevue Medical Center)

Lewis Nelson, MD

Newark, NJ

Steven Marcus, MD

Omaha, NE

Ronald Kirschner, MD

Philadelphia (Einstein Medical Center)

Adam Rowden, MD

Philadelphia, PA (Hahnemann University Hospital)

David Vearrier, MD

Rita McKeever, MD

Phoenix, AZ

Michelle Ruha, MD

Pittsburgh, PA

Anthony Pizon, MD

Portland, OR

Robert Hendrickson, MD

Nate McKeown, MD

Richmond, VA

Brandon Wills, DO

Kirk Cumpston, DO

Riyadh, Saudi Arabia

Mohammed Alhelail, MD

Rochester, NY

Timothy Wiegand, MD

Salt Lake City, UT

E. Martin Caravati, MD

San Antonio, TX

Daniel Sessions, MD

Joseph Maddry, MD

San Diego, CA

Alicia Minns, MD

San Francisco, CA

Derrick Lung MD

Craig Smollin MD

St. Louis, MO

Thomas Kibby, MD

Evan Schwarz MD

St. Paul, MN

Samuel Stellpflug, MD

Kristin Engebretsen, MD

Staten Island, NY

Nima Majlesi, MD

Syracuse, NY

Ross Sullivan, MD

Tampa, FL

Tamas Peredy, MD

Toronto, Canada

Yaron Finkelstiein, MD

Worcester, MA

Jennifer Carey, MD

Author information

Authors and Affiliations

  1. Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA

    Lynn A. Farrugia

  2. Saint Francis Hospital and Medical Center, 114 Woodland St., Hartford, CT, 06105, USA

    Sean H. Rhyee

  3. American College of Medical Toxicology, 10645 N. Tatum Blvd., Suite 200-111, Phoenix, AZ, 85028, USA

    Sharan L. Campleman

  4. Banner-University Medical Center Phoenix, 925 E. McDowell Rd, Phoenix, AZ, 85006, USA

    Anne-Michelle Ruha

  5. University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY, 14642, USA

    Timothy Weigand

  6. UT Southwestern Medical School, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA

    Paul M. Wax

  7. University of Colorado School of Medicine, 13001 E 17th Pl., Aurora, CO, 80045, USA

    Jeffrey Brent

Authors
  1. Lynn A. Farrugia
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  2. Sean H. Rhyee
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  3. Sharan L. Campleman
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  4. Anne-Michelle Ruha
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  5. Timothy Weigand
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  6. Paul M. Wax
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  7. Jeffrey Brent
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Consortia

On behalf of the Toxicology Investigators Consortium

  • Steven Seifert
  • , Adam Pomerleau
  • , Ziad Kazzi
  • , Michael Ganetsky
  • , Michele Burns
  • , Michael Beuhler
  • , Joshua D. King
  • , Steven Aks
  • , Jakub Furmaga
  • , Paul Wax
  • , Jeffrey Brent
  • , Christopher Hoyte
  • , Jerrold Leikin
  • , Rais Vohra
  • , Bryan Judge
  • , Brad Riley
  • , William J. Meggs
  • , Didi Bentur
  • , Phil Moore
  • , Lynn Farrugia
  • , Spencer Greene
  • , Daniel Rusyniak
  • , Jennifer Lowry
  • , Adam Algren
  • , Brian Wolk
  • , Michael Levine
  • , Josh Nogar
  • , Mark Kostic
  • , David Gummin
  • , Diane Calello
  • , Ann-Jeannette Geib
  • , Stephanie Hernandez
  • , Silas Smith
  • , Lewis Nelson
  • , Steven Marcus
  • , Ronald Kirschner
  • , Adam Rowden
  • , David Vearrier
  • , Rita McKeever
  • , Michelle Ruha
  • , Anthony Pizon
  • , Robert Hendrickson
  • , Nate McKeown
  • , Brandon Wills
  • , Kirk Cumpston
  • , Mohammed Alhelail
  • , Timothy Wiegand
  • , E. Martin Caravati
  • , Daniel Sessions
  • , Joseph Maddry
  • , Alicia Minns
  • , Derrick Lung
  • , Craig Smollin
  • , Thomas Kibby
  • , Evan Schwarz
  • , Samuel Stellpflug
  • , Kristin Engebretsen
  • , Nima Majlesi
  • , Ross Sullivan
  • , Tamas Peredy
  • , Yaron Finkelstiein
  •  & Jennifer Carey

Corresponding author

Correspondence to Lynn A. Farrugia.

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Conflict of Interest

None.

Funding Sources

This study received funding from the NIH National Institute of Neurological Disorders and Stroke 3U01NS083452-01 (Bird, SB), NIH National Institute on Drug Abuse 1R56DA38366 (Boyer, EW/ Carlson, RG) and 1R01DA037317-01 (Manini, A), and BTG International Inc.

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Farrugia, L.A., Rhyee, S.H., Campleman, S.L. et al. The Toxicology Investigators Consortium Case Registry—the 2015 Experience. J. Med. Toxicol. 12, 224–247 (2016). https://doi.org/10.1007/s13181-016-0580-6

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  • DOI: https://doi.org/10.1007/s13181-016-0580-6

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