Evolution of Data Collection and Poisoning Surveillance

Collection of data by early poison control centers was fragmented and generally nonstandardized. In 1957, NCHPCC collected limited data from centers and published a yearly statistical report for the aggregate of reporting centers approximately 24 months after the end of the data collection year.

AAPCC developed the Toxic Exposure Surveillance System, a data collection system, in 1983. TESS is the data source for AAPCC annual reports (Watson et al., 2003). TESS was developed in part to supply marketable, comprehensive data for pharmaceutical companies and federal agencies (e.g., Consumer Product Safety Commission, or CPSC). TESS also provides poison control centers with a standardized poisoning exposure record. This system initially used “mark sense” forms (to be described later in this chapter), but has been advanced to digital format. Annual TESS summary data for reporting poison control centers are published annually in the American Journal of Emergency Medicine (Watson et al., 2003).

During the past several years, changes to TESS have been funded by CDC and its Agency for Toxic Substances and Disease Registry. Funding in excess of $6 million has largely supported enhancement of the proprietary software underlying TESS and has not subsidized data collection by poison control centers.

TESS provides useful exposure data, but captures only a fraction of the most seriously poisoned patients (Blanc et al., 1995; Hoppe-Roberts et al., 2000). From a historical perspective, a key shortcoming of TESS is that it did not develop as a public access database comparable to governmental sources of other vital statistics.

The TESS data collection program is proprietary to AAPCC and thus is not managed by any public health or government agency. Consistent with this fact, the underlying software for both data collection and analysis was developed and remains owned by a private company with ties to AAPCC. As new data fields have been added to TESS over time, individual poison control centers must provide the additional time and personnel required to acquire the data without full compensating revenue. However, approximately $250,000 from the sale of data is returned to individual centers annually based on the number of cases submitted as partial compensation. This compensation from the AAPCC central office ranges from $3,000 to $7,000 per center each year. Individual centers reporting to the Committee estimated the net cost of providing such data (i.e., beyond that compensated) ranges from $50,000 to $100,000 per year. Federal agencies such as CPSC and the FDA, as well as most state agencies, also purchase TESS data reports.

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