Skip to main content

Trends in Emergency Department Resource Utilization for Poisoning-Related Visits, 2003–2011

Journal of Medical Toxicology volume 12, pages 248–254 (2016)Cite this article

Abstract

In recent years, there has been an increase in poisoning-related emergency department (ED) visits. This study examines trends in ED resource utilization for poisoning-related visits over time. A retrospective review of data from the National Hospital Ambulatory Medical Care Survey, 2003–2011, was conducted. All ED visits with a reason for visit or ICD-9 code related to poisoning were included. We examined the number of ED visits and resources used including diagnostic studies and procedures performed, medications provided, admission rates, and length of stay. The proportion of visits involving resource use was tabulated and trends analyzed using survey-weighted logistic regression, grouping into 2-year periods to ensure adequate sample size. Of an estimated 843 million ED visits between 2003 and 2011, 8 million (0.9 %) were related to poisoning. Visits increased from 1.8 million (0.8 %) visits in 2003–2004 to 2.9 million (1.1 %) visits in 2010–2011, p = 0.001. Use of laboratory studies, EKGs, plain radiographs, and procedures remained stable across the study period. CT use was more than doubled, increasing from 5.2 to 13.7 % of visits, p = 0.001. ED length of stay increased by 35.5 % from 254 to 344 min, p = 0.001. Admission rates increased by 45.3 %, from 15.0 to 21.8 %, p = 0.046. Over the entire study period, 52.0 % of poisoned patients arrived via ambulance, and 3.0 % of patients had been discharged from the hospital within the previous 7 days. Poisoning-related ED visits increased over the 8-year study period; poisonings are resource-intensive visits and require increasingly longer lengths of ED stay or hospital admission.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Warner M, Chen LH, Makuc DM, Anderson RN, Miniño AM. Drug poisoning deaths in the United States, 1980-2008. NCHS Data Brief. 2011;81:1–8.

    PubMed  Google Scholar 

  2. Dosh A, Boudreaux ED, Wang N, Pelletier AJ, Camargo CA. National study of U.S. emergency department visits for attempted suicide and self-inflicted injury, 1997-2001. Ann Emerg Med. 2005;46:369–75.

    Article  Google Scholar 

  3. Inocencio TJ, Carroll NV, Read EJ, Holdford DA. The economic burden of opioid-related poisoning in the United States. Pain Med. 2013;14:1534–47.

    Article  PubMed  Google Scholar 

  4. Mowry JB, Spyker DA, Brooks DE, McMillan N, Schauben JL. 2014 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 32nd Annual Report. Clin Toxicol (Phila). 2015;53:962–1147.

    CAS  Article  Google Scholar 

  5. Derlet RW, Richards JR. Overcrowding in the nation’s emergency departments: complex causes and disturbing effects. Ann Emerg Med. 2000;35:63–8.

    CAS  Article  PubMed  Google Scholar 

  6. Derlet RW, Richards JR, Kravitz RL. Frequent overcrowding in U.S. emergency departments. Acad Emerg Med. 2001;8:151–5.

    CAS  Article  PubMed  Google Scholar 

  7. Weiss SJ, Derlet R, Arndahl J, et al. Estimating the degree of emergency department overcrowding in academic medical centers: results of the National ED Overcrowding Study (NEDOCS). Acad Emerg Med. 2004;11:38–50.

    Article  PubMed  Google Scholar 

  8. Trzeciak S, Rivers EP. Emergency department overcrowding in the United States: an emerging threat to patient safety and public health. Emerg Med J. 2003;20:402–5.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  9. Richardson DB. Increase in patient mortality at 10 days associated with emergency department overcrowding. Med J Aust. 2006;184:213–6.

    PubMed  Google Scholar 

  10. Miro O, Antonio MT, Jimenez S, et al. Decreased health care quality associated with emergency department overcrowding. Euro J Emerg Med. 1999;6:105–7.

    CAS  Article  Google Scholar 

  11. Krochmal P, Riley TA. Increased health care costs associated with ED overcrowding. Am J Emerg Med. 1994;12:265–6.

    CAS  Article  PubMed  Google Scholar 

  12. Miller TR, Lestina DC. Costs of poisoning in the United States and savings from poison control centers: a benefit-cost analysis. Ann Emerg Med. 1997;29:239–45.

    Article  PubMed  Google Scholar 

  13. McCaig LF, Burt CW. Poisoning-related visits to emergency departments in the United States, 1993–1996. J Toxicol Clin Toxicol. 1999;37:817–26.

    CAS  Article  PubMed  Google Scholar 

  14. Chafee-Bahamon C, Lovejoy Jr FH. Effectiveness of a regional poison center in reducing excess emergency room visits for children’s poisonings. Pediatrics. 1983;72:164–9.

  15. Liebelt EL, DeAngelis CD. Evolving trends and treatment advances in pediatric poisoning. J Am Med Assoc. 1999;282:1113–5.

    CAS  Article  Google Scholar 

  16. Walton WW. An evaluation of the Poison Prevention Packaging Act. Pediatrics. 1982;69:363–70.

    CAS  PubMed  Google Scholar 

  17. Mazer-Amirshahi M, Reid N, van den Anker J, Litovitz T. Effect of cough and cold medication restriction and label changes on pediatric ingestions reported to United States poison centers. J Pediatr. 2013;163:1372–6.

    Article  PubMed  Google Scholar 

  18. Gorard DA. Escalating polypharmacy. QJM. 2006;99:797–800.

    CAS  Article  PubMed  Google Scholar 

  19. Veehof L, Stewart R, Haaijer-Ruskamp F, Jong BM. The development of polypharmacy: a longitudinal study. Fam Pract. 2000;17:261–7.

    CAS  Article  PubMed  Google Scholar 

  20. Aparasu RR, Mort JR, Brandt H. Polypharmacy trends in office visits by the elderly in the United States, 1990 and 2000. Res Soc Adm Pharm. 2005;1:446–59.

    Article  Google Scholar 

  21. Compton WM, Volkow ND. Major increases in opioid analgesic abuse in the United States: concerns and strategies. Drug Alcohol Depend. 2006;81:103–7.

    Article  PubMed  Google Scholar 

  22. Mazer-Amirshahi M, Mullins PM, Rasooly I, van den Anker J, Pines JM. Rising opioid prescribing in adult U.S. emergency department visits: 2001–2010. Acad Emerg Med. 2014;21:236–43.

    Article  PubMed  Google Scholar 

  23. Mazer-Amirshahi M, Mullins PM, Rasooly IR, van den Anker J, Pines JM. Trends in prescription opioid use in pediatric emergency department patients. Pediatr Emerg Care. 2014;30:230–5.

    Article  PubMed  Google Scholar 

  24. National Institute on Drug Abuse. Nationwide Trends. https://www.drugabuse.gov/publications/drugfacts/nationwide-trends. Accessed 19 May 2016.

  25. Xiang Y, Zhao W, Xiang H, Smith GA. ED visits for drug-related poisoning in the United States, 2007. Am J Emerg Med. 2012;30:293–301.

    Article  PubMed  Google Scholar 

  26. Martins SS, Sampson L, Cerdá M, Galea S. Worldwide prevalence and trends in unintentional drug overdose: a systematic review of the literature. Am J Public Health. 2015;105:e29–49.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Paulozzi LJ, Strickler GK, Kreiner PW. Controlled substance prescribing patterns-prescription behavior surveillance system, eight states, 2013. MMWR Surveill Summ. 2015;64:1–14.

    Article  PubMed  Google Scholar 

  28. Larkin GL, Claassen C. Trends in emergency department use of gastric lavage for poisoning events in the United States, 1993-2003. Clin Toxicol (Phila). 2007;45:164–8.

    Article  Google Scholar 

  29. Chyka PA, Seger D, Krenzelok EP, Vale JA, American Academy of Clinical Toxicology, European Association of Poisons Centres and Clinical Toxicologist. Position paper: single-dose activated charcoal. Clin Toxicol (Phila). 2005;43:61–87.

    CAS  Article  Google Scholar 

  30. Taylor TB. Threats to the healthcare safety net. Acad Emerg Med. 2001;8:1080–7.

    CAS  Article  PubMed  Google Scholar 

  31. Meggs WJ, Czaplijski T, Benson N. Trends in emergency department utilization, 1988-1997. Acad Emerg Med. 1999;6:1030–5.

    CAS  Article  PubMed  Google Scholar 

  32. Gardner RL, Sarkar U, Maselli JH, Gonzales R. Factors associated with longer ED lengths of stay. Am J Emerg Med. 2007;25:643–50.

    Article  PubMed  Google Scholar 

  33. Choosing Wisely. American College of Emergency Physicians. http://www.choosingwisely.org/societies/american-college-of-emergency-physicians/. Accessed 13 Mar 2016.

  34. Patel MM, Tsutaoka BT, Banerji S, Blanc PD, Olson KR. ED utilization of computed tomography in a poisoned population. Am J Emerg Med. 2002;20:212–7.

    Article  PubMed  Google Scholar 

  35. Baumann BM, Chen EH, Mills AM, et al. Patient perceptions of computed tomographic imaging and their understanding of radiation risk and exposure. Ann Emerg Med. 2011;58:1–7.e2.

    Article  PubMed  Google Scholar 

  36. Larochelle MR, Liebschultz JM, Zhang F, Ross-Degnan D, Wharam JF. Opioid prescribing after nonfatal overdose and association with repeated overdose: a cohort study. Ann Intern Med. 2016;164:1–9.

    Article  PubMed  Google Scholar 

  37. Centers for Disease Control and Prevention. Ambulatory health care data. http://www.cdc.gov/nchs/ahcd/about_ahcd.htm. Accessed 23 Nov 2015.

  38. McCaig LF, Burt CW. Understanding and interpreting the National Hospital Ambulatory Medical Care Survey: key questions and answers. Ann Emerg Med. 2012;60:716–21.

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

  1. Department of Emergency Medicine, MedStar Washington Hospital Center, 110 Irving St NW, Washington, DC, 20010, USA

    Maryann Mazer-Amirshahi & Christie Sun

  2. Georgetown University School of Medicine, Washington, DC, USA

    Maryann Mazer-Amirshahi

  3. George Washington University School of Medicine and Health Sciences, Washington, DC, USA

    Peter Mullins

  4. Department of Emergency Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Jeanmarie Perrone

  5. Department of Emergency Medicine, New York University, New York, NY, USA

    Lewis Nelson

  6. Department of Emergency Medicine, George Washington University, Washington, DC, USA

    Jesse M. Pines

  7. Center for Clinical Practice Innovation, George Washington University, Washington, DC, USA

    Jesse M. Pines

Authors
  1. Maryann Mazer-Amirshahi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christie Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peter Mullins
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jeanmarie Perrone
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lewis Nelson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jesse M. Pines
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maryann Mazer-Amirshahi.

Ethics declarations

Sources of Funding

No funding was provided for this study.

Financial Disclosures

The authors have no financial relationships relevant to this article to disclose.

Conflict of Interest

The authors declare that they have no conflicts of interest.

Additional information

Presented as an abstract at the American College of Medical Toxicology (ACMT) Annual Scientific Meeting, Huntington Beach, CA, March 2016, and at the Society for Academic Emergency Medicine (SAEM) Annual Meeting, New Orleans, LA, May 2016.

Electronic supplementary material

ESM 1

(DOCX 78 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Mazer-Amirshahi, M., Sun, C., Mullins, P. et al. Trends in Emergency Department Resource Utilization for Poisoning-Related Visits, 2003–2011. J. Med. Toxicol. 12, 248–254 (2016). https://doi.org/10.1007/s13181-016-0564-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13181-016-0564-6

Keywords

  • Emergency department
  • Poisoning
  • Resource utilization