Forging a Poison Prevention and Control System (2004) / Chapter Skim
Currently Skimming:
7 Data and Surveillance
7 Data and Surveillance
Pages 176-200
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 176... ...
Information on the epidemiology, treatment, and outcomes of poisonings can help inform regulatory decisions and compliance, public policy initiatives, and the development and assessment of clinical management guidelines. Data from various sources are used by federal, state, and local health agencies and others for surveillance of poisonings and their sequelae.
|
From page 177... ...
CURRENTLY AVAILABLE SYSTEMS The following section describes the characteristics and the strengths and weaknesses of current data systems, beginning with the Toxic Exposure Surveillance System (TESS) and other poison-specific data sources, and followed by data sources derived from health records and health care datasets, other exposure-related data sources, and survey data sources.
|
From page 178... ...
178 of costly. case carry likely local coverage types severity; small to in be resources activities.
|
From page 179... ...
representative chosen assigned. Basis National Cases Data Data Data Derived the the System at at Sources Health series for case data data Discharge Data Statistics emergency participating (ED)
|
From page 180... ...
downloaded and not sample Data Similar Similar Dataset for the the the Survey to to to cost Discharge between source Discharge Discharge data. care cost NHAMC.
|
From page 181... ...
to surveillance Data Sampling Widely Identifies Uses Unique and EDs. of new with of all events.
|
From page 182... ...
182 be not other subsets home injury not to for not of poisoning issues abuse abuse. cannot of under does causes of data limited; surveys; acute minimally assess data age; relevant fatalities to poisoning from for of sampling surveillance.
|
From page 183... ...
183 http:// (ATSDR) : Registry Disease and Substances Toxic for Agency the http://www.bls.gov/iif/oshcfoi1.htm of http://www.cdc.gov/nchs/about/major/nhanes/history.htm http://www.cpsc.gov/cpscpub/pubs/3002.html http://www.samhsa.gov/oas/nhsda/methods.cfm (HSEES)
|
From page 184... ...
Data Sources Specific to Poison Control Toxic Exposure Surveillance System General features When the Surgeon General created the National Clearinghouse for Poison Control Centers (NCHPCC) in 1957, the mandate included coordination of a data collection system, or the flow of information from the poison control centers to NCHPCC.
|
From page 185... ...
Specific uses of TESS in product safety assessment have included: · Postmarketing surveillance of newly marketed drugs · Routine reviewing to prevent poisoning and limit morbidity and mortality · Comparing brands with product categories weekdays weekend days y Cases/Da Exposure Human Date FIGURE 7-1 Frequency of human exposures reported to U.S. poison control centers.
|
From page 186... ...
No patient identifiers are provided to TESS, thus assuring patient confidentiality. Among the recent changes to the TESS program are: · In addition to the encoded fields submitted to TESS, poison control centers must also document each case through a narrative medical record.
|
From page 187... ...
Among the essential features of a high-quality data system are definitions of the data elements, setting of standards, and monitoring and reporting of data quality. The 128-page TESS instruction manual (American Association of Poison Control Centers, 2001)
|
From page 188... ...
poison control centers subscribe to Poisindex, but generic codes are available, so that theoretically the centers are not required to subscribe to Poisindex to submit data to TESS. Toxicosurveillance Toxicosurveillance involves the identification of sentinel events that may represent emergency nonexposures such as intentional bioterrorist events or other toxin or chemical exposures.
|
From page 189... ...
In addition to the national toxicosurveillance effort performed in conjunction with AAPCC, some poison control centers participate in local syndromic surveillance and report notifiable conditions affecting multiple individuals to local and/or state health officials. For example, the Minnesota Poison Control System, in cooperation with the Minnesota Department of Health, provides active surveillance to detect infectious 120 100 All water calls .
|
From page 190... ...
. · Review of the same retrospectively identified data, supplemented with additional clinical information usually garnered through medical record review or, in certain cases, through special toxicological testing facilitated by the poison control centers as part of a study.
|
From page 191... ...
. In addition to a regional perspective, this category of surveillance has the advantages of being relatively low cost (the internal data are freely available to the poison control centers)
|
From page 192... ...
Data Sources Derived from Health Records and Health Care Datasets As shown in Table 7-2, a number of different datasets with vital statistics or health care information derived from medical records can be used for poisoning and drug overdose surveillance purposes. National Vital Statistics System National mortality data have provided a particular focus for surveillance analyses relevant to poisoning and drug overdose (Chyka and Somes, 2001; Cobb and Etzel, 1991; Fingerhut and Cox, 1998; HoppeRoberts et al., 2000; Klein-Schwartz and Smith, 1997; Shepherd and KleinSchwartz, 1998)
|
From page 193... ...
. In comparison with TESS surveillance: · Death certificate-derived data capture far greater numbers of fatal poisonings and drug overdoses, in part because prehospital fatal poisoning events are unlikely to lead to poison control center consultations (Hoppe-Roberts et al., 2000)
|
From page 194... ...
Hospital Discharge Data Systems Hospital discharge data systems (HDDS) at the local, regional, or state level represent a major source of health care data that potentially can be used for poisoning and drug overdose surveillance purposes (Agran et al., 2003; Hoyt et al., 1999; King, 1991; Smith et al., 1985, 1991; Sumner and Langley, 2000)
|
From page 195... ...
These are: · National Hospital Discharge Survey (a national sample of hospital data) ; · National Hospital Ambulatory Medical Care Survey (a national sample of hospital-based emergency departments and ambulatory care centers)
|
From page 196... ...
Several databases derived from focused data collection activities are also relevant to specific aspects of poisoning injury surveillance. The Drug Abuse Warning Network (DAWN)
|
From page 197... ...
This DAWN program can provide national estimates. The second DAWN program consists of collection of information based on medical examiners' or coroners' case data from 128 jurisdictions in 42 metropolitan areas (U.S.
|
From page 198... ...
Survey Data Relevant to Poisoning and Drug Overdose Surveillance In addition to data derived from poisoning and drug exposure sources and from general vital statistics and medical encounters, national survey data are also relevant to poisoning surveillance. Of these, the most comprehensive is the annual National Health Interview Survey (NHIS)
|
From page 199... ...
The Youth Behavior Risk Factor Surveillance System survey has ascertained drug abuse, but has not elicited general information on poisoning. Outside of NCHS and other CDC branches, the public interview survey most relevant to poisoning and drug overdose is SAMHSA's annual National Household Survey on Drug Abuse.
|
From page 200... ...
. Direct review of hospital charts has demonstrated that only about 20 to 30 percent of poisoning cases managed in the emergency department are reported to poison control centers (Blanc et al., 1993b; Harchelroad et al., 1990; Hoyt et al., 1999)
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.