Henry Spiller - Academia.edu (original) (raw)

Papers by Henry Spiller

Research paper thumbnail of Pediatric Suspected Suicides and Nonfatal Suicide Attempts Reported to United States Poison Control Centers Before and During the COVID-19 Pandemic

Journal of Medical Toxicology, Mar 6, 2023

Research paper thumbnail of Household cleaning product-related ocular exposures reported to the United States poison control centres

Research paper thumbnail of Green Tobacco Sickness in Children and Adolescents

Public Health Reports, Nov 1, 2005

Research paper thumbnail of 0028 Methamphetamine exposures reported to United States poison control centers, 2000–2019

Research paper thumbnail of Safety Interventions and Liquid Laundry Detergent Packet Exposures

Pediatrics, 2019

OBJECTIVES:To investigate exposures to liquid laundry detergent packets among children <6 year... more OBJECTIVES:To investigate exposures to liquid laundry detergent packets among children <6 years old in the United States and to evaluate the impact of the American Society for Testing and Materials voluntary product safety standard.METHODS:Data from the National Poison Data System involving exposures to liquid laundry detergent packets from 2012 to 2017 were analyzed.RESULTS:From January 2012 to December 2017, there were 72 947 single and polysubstance exposures to liquid laundry detergent packets. Most exposures (91.7%) were documented among children <6 years old. The annual number and rate of exposures for children <6 years old increased by 110.4% and 111.9%, respectively, from 2012 to 2015. From 2015 to 2017, the number and rate of exposures in this age group decreased by 18.0%. Among individuals ≥6 years old, the annual number and rate of exposures increased by 292.7% and 276.7%, respectively, from 2012 to 2017. Annual hospital admissions among children <6 years old ...

Research paper thumbnail of Severe elemental mercury poisoning managed with selenium and N-acetylcysteine administration

Toxicology Communications, 2017

A healthy 15-year-old male spilled elemental mercury contaminating his garage and bedroom. The pa... more A healthy 15-year-old male spilled elemental mercury contaminating his garage and bedroom. The patient developed new onset hypertension, significant weight loss, pain (muscular, testicular, and abdominal), insomnia, delusions, hallucinations, tachycardia, palmar desquamation, diaphoresis, tremor, and ataxia leading to two consecutive hospitalizations. Blood and urine mercury were 23 and 330 mg/L, respectively. He received 21 days of chelation with 2,3-Dimercaptosuccinic acid during his second hospital stay. He continued to deteriorate. Three weeks post-chelation, he was transferred to our facility and his exam was unchanged. He could not stand or feed himself unassisted. He was started on selenium 500 mcg/day and N-acetylcysteine (NAC) 50 mg/kg/day. By day 3 of Se and NAC, he showed noticeable improvement, and by day 11, delusions, delirium, tachycardia, and abdominal pain resolved. Muscle strength, weight gain, speech, unassisted ambulation, and emotional liability improved. After five months with Se and NAC (1) he had regained 45 pounds, (2) restored to premorbid emotional, academic, and athletic performance, and (3) tachycardia, hypertension, rash, palmar skin changes, tremor, and insomnia had resolved. Features of this case include (1) improvement after selenium and NAC supplementation (2) contrasted with continued deterioration after DMSA chelation.

Research paper thumbnail of Incidents of potential public health significance identified using national surveillance of US poison center data (2008-2012)

Clinical toxicology (Philadelphia, Pa.), 2014

The Centers for Disease Control and Prevention (CDC) and the American Association of Poison Contr... more The Centers for Disease Control and Prevention (CDC) and the American Association of Poison Control Centers conduct national surveillance on data collected by US poison centers to identify incidents of potential public health significance (IPHS). The overarching goals of this collaboration are to improve CDC's national surveillance capacity for public health threats, identify early markers of public health incidents and enhance situational awareness. The National Poison Data System (NPDS) is used as a surveillance system to automatically identify data anomalies. To characterize data anomalies and IPHS captured by national surveillance of poison center data over 5 years. Data anomalies are identified through three surveillance methodologies: call-volume, clinical effect, and case-based. Anomalies are reviewed by a team of epidemiologists and clinical toxicologists to determine IPHS using standardized criteria. The authors reviewed IPHS identified by these surveillance activities ...

Research paper thumbnail of Characterizing risk factors for pediatric lamp oil product exposures

Clinical Toxicology, 2013

Poisonings-from lamp oil ingestion continue to occur worldwide among the pediatric population des... more Poisonings-from lamp oil ingestion continue to occur worldwide among the pediatric population despite preventive measures such as restricted sale of colored and scented lamp oils. This suggests that optimal prevention practices for unintentional pediatric exposures to lamp oil have yet to be identified and/or properly implemented. Objective-To characterize demographic, health data, and potential risk factors associated with reported exposures to lamp oil by callers to poison centers (PCs) in the US and discuss their public health implications. Study design-. This was a two part study in which the first part included characterizing all exposures to a lamp oil product reported to the National Poison Data System (NPDS) with regard to demographics, exposure, health, and outcome data from 1/1/2000 to 12/31/2010. Regional penetrance was calculated using NPDS data by grouping states into four regions and dividing the number of exposure calls by pediatric population per region (from the 2000 US census). Temporal analyses were performed on NPDS data by comparing number of exposures by season and around the July 4th holiday. Poisson regression was used to model the count of exposures for these analyses.

Research paper thumbnail of Comparison of US population and live birth rates with poison exposures reported to the National Poison Data System (NPDS): children ages 0–5 years from 2000 to 2012

Clinical Toxicology, 2013

Research paper thumbnail of Cleaning and Disinfectant Chemical Exposures and Temporal Associations with COVID-19 — National Poison Data System, United States, January 1, 2020–March 31, 2020

MMWR. Morbidity and Mortality Weekly Report, 2020

associated deaths* had been reported to CDC from all 50 states, the District of Columbia, and fou... more associated deaths* had been reported to CDC from all 50 states, the District of Columbia, and four U.S. territories (2). CDC recommends, with precautions, the proper cleaning and disinfection of high-touch surfaces to help mitigate the transmission of SARS-CoV-2 (3). To assess whether there might be a possible association between COVID-19 cleaning recommendations from public health agencies and the media and the number of chemical exposures reported to the National Poison Data System (NPDS), CDC and the American Association of Poison Control Centers surveillance team compared the number of exposures reported for the period January-March 2020 with the number of reports during the same 3-month period in 2018 and 2019. Fifty-five poison centers in the United States provide free, 24-hour professional advice and medical management information regarding exposures to poisons, chemicals, drugs, and medications. Call data from poison centers are uploaded in near real-time to NPDS. During January-March 2020, poison centers received 45,550 exposure calls related to clean

Research paper thumbnail of Carbon Monoxide Poisoning after an Ice Storm in Kentucky, 2009

Public Health Reports, 2011

Objectives. Carbon monoxide (CO) poisoning is a leading cause of morbidity and mortality during n... more Objectives. Carbon monoxide (CO) poisoning is a leading cause of morbidity and mortality during natural disasters. On January 26–27, 2009, a severe ice storm occurred in Kentucky, causing widespread, extended power outages and disrupting transportation and communications. After the storm, CO poisonings were reported throughout the state. The objectives of this investigation were to determine the extent of the problem, identify sources of CO poisoning, characterize cases, make recommendations to reduce morbidity and mortality, and develop prevention strategies. Methods. We obtained data from the Kentucky Regional Poison Center (KRPC), hyperbaric oxygen treatment (HBOT) facilities, and coroners. Additionally, the Kentucky Department for Public Health provided statewide emergency department (ED) and hospitalization data. Results. During the two weeks after the storm, KRPC identified 144 cases of CO poisoning; exposure sources included kerosene heaters, generators, and propane heaters. ...

Research paper thumbnail of Evaluation of toxicity after acute accidental methotrexate ingestions in children under 6 years old: a 16-year multi-center review

Clinical toxicology (Philadelphia, Pa.), Jan 21, 2017

There is little data on the frequency of adverse events following acute methotrexate ingestions i... more There is little data on the frequency of adverse events following acute methotrexate ingestions in pediatric patients. Likewise, recommendations for observation length, site and management strategies in this population are not well established. Therefore, most recommendations are modeled after management of chronic overdose in patients with underlying medical conditions. The primary objective of this study is to determine the frequency of acute toxicity after acute methotrexate accidental unsupervised ingestions in patients less than six years. In addition, we describe the frequency of late toxicity and characterize the management site and approaches. This is a retrospective cohort study of pediatric accidental unsupervised methotrexate ingestions reported to six poison centers in the United States over a 16 year period. Demographic information, exposure details, signs, symptoms, treatments, length and location of observation and outcomes were collected. 103 patients met inclusion c...

Research paper thumbnail of in the United States

experience with and analytical confi rmation of “ bath salts ” and “ legal highs ” (synthetic cat... more experience with and analytical confi rmation of “ bath salts ” and “ legal highs ” (synthetic cathinones)

Research paper thumbnail of Dental Local Anesthesia-Related Pediatric Cases Reported to U.S. Poison Control Centers

Purpose: The purpose of this study was to use National Poison Data System (NPDS) data to identify... more Purpose: The purpose of this study was to use National Poison Data System (NPDS) data to identify cases of local anesthetic (LA) adverse events related to dentistry for children. Methods: NPDS data were queried for all human cases from 2004 to 2018 that identified a parenteral LA agent as the substance, in children 12 years old and younger, which led to a medical outcome classification ranging from moderate to death. For cases that met inclusion criteria, deidentified records with case notes were requested. Results: Twenty-seven dental cases that met review criteria and had available case notes were reviewed. Most subjects were female (N equals 20 out of 27, 74 percent), and the average subject age was 6.8 years. Twenty cases (74 percent) had a moderate effect, seven cases (26 percent) had a major effect, and no fatalities were reported. The most common clinical effects classification was a seizure (N equals 13, 48 percent). One case of LA overdose was identified. Conclusions: No ca...

Research paper thumbnail of Suicide attempts by self-poisoning in the United States among 10–25 year olds from 2000 to 2018: substances used, temporal changes and demographics

Clinical Toxicology

Objective: To evaluate the substances used, outcomes, temporal and demographics associated with s... more Objective: To evaluate the substances used, outcomes, temporal and demographics associated with suicide attempts by self-poisoning in children and young adults aged 10-25 years old from 2000 to 2018. Methods: This is a retrospective review of suspected-suicide self-poisoning cases reported to the National Poison Data System (NPDS) from US Poison Centers from 2000 to 2018 for patients 10-25 years old. For comparison of annual rates, we obtained population data by year of age from the US Census Bureau. We evaluated changes in: monthly and annual incidence/rate per 100,000 population, substances used and outcome by patient age and demographics. Results: There were 1,677,435 cases of suicide attempt by self-poisoning among individuals 10-25 years old reported to US PCCs from 2000 to 2018. There were 410,940 self-poisoning cases (24.5%) with a serious medical outcome, and the proportion of exposures that resulted in a serious medical outcome increased with increasing age group. For the age groups of 10-12, 13-15 and 16-18 years of age, there was a significant increase after 2011, which was influenced primarily by females. The substance groups with the greatest number of serious medical outcomes were OTC analgesics, antidepressants, antihistamines and antipsychotics. ADHD medications were common in the younger age groups of 10-15 years, while the sedative/hypnotics occurred more commonly in the older age groups. The groups with the greatest increase in serious medical outcomes after 2011 were antidepressants, OTC analgesics, antihistamines and ADHD medications. Opiates were less commonly involved (7.4%) in cases with serious medical outcomes and decreased significantly in the 19-25 yearold age groups after 2012. States with a lower population per square mile had a greater number of reported cases with serious medical outcomes. There was a significant decrease in the number of cases in the age groups of 10-18 years during the traditional non-school months of June-August compared with September-May. This seasonal trend occurred among cases with all outcomes and among cases with serious medical outcomes. This decrease did not occur in the age group of 19-21 years, and there was an increase during summer months in the age group 22-25 years. Conclusions: The substances used during self-poisoning varies by age group but appears to include substances available to that age group, with a significant increase after 2011, increased rates in more rural states, and a seasonal variation of increased rates during school months among adolescents but not among young adults. Two of the top substances, OTC analgesics and antihistamines, in all age groups, comprising more than a third of all substances used, are widely available over-the-counter with no restrictions regarding access. Of additional concern, ADHD medications had the highest risk of a serious medical outcome.

Research paper thumbnail of Prevalence and Clinical Characteristics of Unintentional Ingestion of Marijuana in Children Younger Than 6 Years in States With and Without Legalized Marijuana Laws

Pediatric Emergency Care

Objective: The aim of this studywas to examine the relationship between state marijuana legalizat... more Objective: The aim of this studywas to examine the relationship between state marijuana legalization and the rates of unintentional ingestions of marijuana in children younger than 6 years. Methods: This was a retrospective review of all marijuana ingestions in the National Poison Data System in children younger than 6 years between January 1, 2000, and July 31, 2017. Data analysis from NPDS included, age, sex, state and year of occurrence, clinical effects, therapies, health care facility utilization, and medical outcome. Population of children younger than 6 years was obtained from the US Census Bureau. Public records search provided state legal status of marijuana and year of state marijuana legalization. Results: From 2000 through 2008, there was no significant change in the annual number or rate of ingestions of marijuana in children younger than 6 years across the United States. Following 2009, there was mean annual increase of 27% per year, rising to 742 ingestions per year or 2.98 ingestions per 100,000 population, respectively, in 2017. More than 70% of all cases occurred in states with legalized marijuana. Of all pediatric patients, 54.6% received some form of hospital-based care, of which 7.5% required critical care. Pediatric patients experienced awide range of symptoms from drowsiness and confusion, to seizures and coma. Medical treatments ranged from hydration therapy to sedation and intubation. Poison centers safely managed 23.4% of these pediatric cases by phone, without the need for hospital evaluation. Conclusion: There was a strong association between the legalization of marijuana and ingestions of marijuana by children younger than 6 years.

Research paper thumbnail of Opioid drug poisonings in Ohio adolescents and young adults, 2002-2014

Clinical toxicology (Philadelphia, Pa.), 2018

Opioids represent a drug class that adolescents and young adults intentionally misuse and abuse. ... more Opioids represent a drug class that adolescents and young adults intentionally misuse and abuse. When taken on their own or with other substances in this manner, opioids pose an increased risk of overdose and potential death. To determine trends of opioid drug poisonings among adolescents and young adults in Ohio from 2002 to 2014 using Poison Control Center (PCC) data. Data were obtained from Ohio PCCs from 2002 to 2014 for opioid drug poisonings amongst 10-29 year olds. Trends were evaluated with Poisson regression. Ohio counties with higher opioid drug poisoning rates were identified using age-adjusted resident population estimates. Chi-square tests were conducted to compare these county rates to the Ohio rate. Both unintentional and intentional Ohio PCC opioid drug poisonings peaked in 2009, and there were significant declines through 2014. Almost 40% of intentional opioid drug poisonings were for young adults aged 18-24 years. Suspected suicide poisonings were 64.9% female, mis...

Research paper thumbnail of Ocular Exposures Reported to United States Poison Control Centers

Ophthalmic epidemiology, Jan 21, 2018

To investigate the epidemiology of ocular exposures reported to poison control centers in the Uni... more To investigate the epidemiology of ocular exposures reported to poison control centers in the United States. A retrospective analysis of ocular exposures from 2000 to 2016 was conducted using National Poison Data System data. United States poison control centers received 1,436,683 reports of ocular exposures during 2000-2016, averaging 7,043 exposures per month. The annual frequency of ocular exposures declined significantly by 37.2% from 2006 to 2016. The ocular exposure rate per 10,000 US residents was highest among children < 6 years of age (10.7), particularly among 2-year-olds (20.5), and was lowest among adults ≥ 20 years of age (1.9). The majority of the exposures resulted in minor effects (51.4%). Among exposed individuals, 23.0% were treated and released and 0.3% were admitted to a healthcare facility. Household cleaning products (22.2%), cosmetics/personal care products (15.7%), and pesticides (7.4%) were the most common substance categories associated with exposures, b...

Research paper thumbnail of E-Cigarette and Liquid Nicotine Exposures Among Young Children

Pediatrics, 2018

To investigate exposures to liquid nicotine (including electronic cigarette devices and liquids) ... more To investigate exposures to liquid nicotine (including electronic cigarette devices and liquids) among children <6 years old in the United States and evaluate the impact of legislation requiring child-resistant packaging for liquid nicotine containers. Liquid nicotine exposure data from the National Poison Data System for January 2012 through April 2017 were analyzed. There were 8269 liquid nicotine exposures among children <6 years old reported to US poison control centers during the study period. Most (92.5%) children were exposed through ingestion and 83.9% were children <3 years old. Among children exposed to liquid nicotine, 35.1% were treated and released from a health care facility, and 1.4% were admitted. The annual exposure rate per 100 000 children increased by 1398.2% from 0.7 in 2012 to 10.4 in 2015, and subsequently decreased by 19.8% from 2015 to 8.3 in 2016. Among states without a preexisting law requiring child-resistant packaging for liquid nicotine contain...

Research paper thumbnail of Antidepressant and antipsychotic medication errors reported to United States poison control centers

Pharmacoepidemiology and drug safety, Jan 8, 2018

To investigate unintentional therapeutic medication errors associated with antidepressant and ant... more To investigate unintentional therapeutic medication errors associated with antidepressant and antipsychotic medications in the United States and expand current knowledge on the types of errors commonly associated with these medications. A retrospective analysis of non-health care facility unintentional therapeutic errors associated with antidepressant and antipsychotic medications was conducted using data from the National Poison Data System. From 2000 to 2012, poison control centers received 207 670 calls reporting unintentional therapeutic errors associated with antidepressant or antipsychotic medications that occurred outside of a health care facility, averaging 15 975 errors annually. The rate of antidepressant-related errors increased by 50.6% from 2000 to 2004, decreased by 6.5% from 2004 to 2006, and then increased 13.0% from 2006 to 2012. The rate of errors related to antipsychotic medications increased by 99.7% from 2000 to 2004 and then increased by 8.8% from 2004 to 2012....

Research paper thumbnail of Pediatric Suspected Suicides and Nonfatal Suicide Attempts Reported to United States Poison Control Centers Before and During the COVID-19 Pandemic

Journal of Medical Toxicology, Mar 6, 2023

Research paper thumbnail of Household cleaning product-related ocular exposures reported to the United States poison control centres

Research paper thumbnail of Green Tobacco Sickness in Children and Adolescents

Public Health Reports, Nov 1, 2005

Research paper thumbnail of 0028 Methamphetamine exposures reported to United States poison control centers, 2000–2019

Research paper thumbnail of Safety Interventions and Liquid Laundry Detergent Packet Exposures

Pediatrics, 2019

OBJECTIVES:To investigate exposures to liquid laundry detergent packets among children <6 year... more OBJECTIVES:To investigate exposures to liquid laundry detergent packets among children <6 years old in the United States and to evaluate the impact of the American Society for Testing and Materials voluntary product safety standard.METHODS:Data from the National Poison Data System involving exposures to liquid laundry detergent packets from 2012 to 2017 were analyzed.RESULTS:From January 2012 to December 2017, there were 72 947 single and polysubstance exposures to liquid laundry detergent packets. Most exposures (91.7%) were documented among children <6 years old. The annual number and rate of exposures for children <6 years old increased by 110.4% and 111.9%, respectively, from 2012 to 2015. From 2015 to 2017, the number and rate of exposures in this age group decreased by 18.0%. Among individuals ≥6 years old, the annual number and rate of exposures increased by 292.7% and 276.7%, respectively, from 2012 to 2017. Annual hospital admissions among children <6 years old ...

Research paper thumbnail of Severe elemental mercury poisoning managed with selenium and N-acetylcysteine administration

Toxicology Communications, 2017

A healthy 15-year-old male spilled elemental mercury contaminating his garage and bedroom. The pa... more A healthy 15-year-old male spilled elemental mercury contaminating his garage and bedroom. The patient developed new onset hypertension, significant weight loss, pain (muscular, testicular, and abdominal), insomnia, delusions, hallucinations, tachycardia, palmar desquamation, diaphoresis, tremor, and ataxia leading to two consecutive hospitalizations. Blood and urine mercury were 23 and 330 mg/L, respectively. He received 21 days of chelation with 2,3-Dimercaptosuccinic acid during his second hospital stay. He continued to deteriorate. Three weeks post-chelation, he was transferred to our facility and his exam was unchanged. He could not stand or feed himself unassisted. He was started on selenium 500 mcg/day and N-acetylcysteine (NAC) 50 mg/kg/day. By day 3 of Se and NAC, he showed noticeable improvement, and by day 11, delusions, delirium, tachycardia, and abdominal pain resolved. Muscle strength, weight gain, speech, unassisted ambulation, and emotional liability improved. After five months with Se and NAC (1) he had regained 45 pounds, (2) restored to premorbid emotional, academic, and athletic performance, and (3) tachycardia, hypertension, rash, palmar skin changes, tremor, and insomnia had resolved. Features of this case include (1) improvement after selenium and NAC supplementation (2) contrasted with continued deterioration after DMSA chelation.

Research paper thumbnail of Incidents of potential public health significance identified using national surveillance of US poison center data (2008-2012)

Clinical toxicology (Philadelphia, Pa.), 2014

The Centers for Disease Control and Prevention (CDC) and the American Association of Poison Contr... more The Centers for Disease Control and Prevention (CDC) and the American Association of Poison Control Centers conduct national surveillance on data collected by US poison centers to identify incidents of potential public health significance (IPHS). The overarching goals of this collaboration are to improve CDC's national surveillance capacity for public health threats, identify early markers of public health incidents and enhance situational awareness. The National Poison Data System (NPDS) is used as a surveillance system to automatically identify data anomalies. To characterize data anomalies and IPHS captured by national surveillance of poison center data over 5 years. Data anomalies are identified through three surveillance methodologies: call-volume, clinical effect, and case-based. Anomalies are reviewed by a team of epidemiologists and clinical toxicologists to determine IPHS using standardized criteria. The authors reviewed IPHS identified by these surveillance activities ...

Research paper thumbnail of Characterizing risk factors for pediatric lamp oil product exposures

Clinical Toxicology, 2013

Poisonings-from lamp oil ingestion continue to occur worldwide among the pediatric population des... more Poisonings-from lamp oil ingestion continue to occur worldwide among the pediatric population despite preventive measures such as restricted sale of colored and scented lamp oils. This suggests that optimal prevention practices for unintentional pediatric exposures to lamp oil have yet to be identified and/or properly implemented. Objective-To characterize demographic, health data, and potential risk factors associated with reported exposures to lamp oil by callers to poison centers (PCs) in the US and discuss their public health implications. Study design-. This was a two part study in which the first part included characterizing all exposures to a lamp oil product reported to the National Poison Data System (NPDS) with regard to demographics, exposure, health, and outcome data from 1/1/2000 to 12/31/2010. Regional penetrance was calculated using NPDS data by grouping states into four regions and dividing the number of exposure calls by pediatric population per region (from the 2000 US census). Temporal analyses were performed on NPDS data by comparing number of exposures by season and around the July 4th holiday. Poisson regression was used to model the count of exposures for these analyses.

Research paper thumbnail of Comparison of US population and live birth rates with poison exposures reported to the National Poison Data System (NPDS): children ages 0–5 years from 2000 to 2012

Clinical Toxicology, 2013

Research paper thumbnail of Cleaning and Disinfectant Chemical Exposures and Temporal Associations with COVID-19 — National Poison Data System, United States, January 1, 2020–March 31, 2020

MMWR. Morbidity and Mortality Weekly Report, 2020

associated deaths* had been reported to CDC from all 50 states, the District of Columbia, and fou... more associated deaths* had been reported to CDC from all 50 states, the District of Columbia, and four U.S. territories (2). CDC recommends, with precautions, the proper cleaning and disinfection of high-touch surfaces to help mitigate the transmission of SARS-CoV-2 (3). To assess whether there might be a possible association between COVID-19 cleaning recommendations from public health agencies and the media and the number of chemical exposures reported to the National Poison Data System (NPDS), CDC and the American Association of Poison Control Centers surveillance team compared the number of exposures reported for the period January-March 2020 with the number of reports during the same 3-month period in 2018 and 2019. Fifty-five poison centers in the United States provide free, 24-hour professional advice and medical management information regarding exposures to poisons, chemicals, drugs, and medications. Call data from poison centers are uploaded in near real-time to NPDS. During January-March 2020, poison centers received 45,550 exposure calls related to clean

Research paper thumbnail of Carbon Monoxide Poisoning after an Ice Storm in Kentucky, 2009

Public Health Reports, 2011

Objectives. Carbon monoxide (CO) poisoning is a leading cause of morbidity and mortality during n... more Objectives. Carbon monoxide (CO) poisoning is a leading cause of morbidity and mortality during natural disasters. On January 26–27, 2009, a severe ice storm occurred in Kentucky, causing widespread, extended power outages and disrupting transportation and communications. After the storm, CO poisonings were reported throughout the state. The objectives of this investigation were to determine the extent of the problem, identify sources of CO poisoning, characterize cases, make recommendations to reduce morbidity and mortality, and develop prevention strategies. Methods. We obtained data from the Kentucky Regional Poison Center (KRPC), hyperbaric oxygen treatment (HBOT) facilities, and coroners. Additionally, the Kentucky Department for Public Health provided statewide emergency department (ED) and hospitalization data. Results. During the two weeks after the storm, KRPC identified 144 cases of CO poisoning; exposure sources included kerosene heaters, generators, and propane heaters. ...

Research paper thumbnail of Evaluation of toxicity after acute accidental methotrexate ingestions in children under 6 years old: a 16-year multi-center review

Clinical toxicology (Philadelphia, Pa.), Jan 21, 2017

There is little data on the frequency of adverse events following acute methotrexate ingestions i... more There is little data on the frequency of adverse events following acute methotrexate ingestions in pediatric patients. Likewise, recommendations for observation length, site and management strategies in this population are not well established. Therefore, most recommendations are modeled after management of chronic overdose in patients with underlying medical conditions. The primary objective of this study is to determine the frequency of acute toxicity after acute methotrexate accidental unsupervised ingestions in patients less than six years. In addition, we describe the frequency of late toxicity and characterize the management site and approaches. This is a retrospective cohort study of pediatric accidental unsupervised methotrexate ingestions reported to six poison centers in the United States over a 16 year period. Demographic information, exposure details, signs, symptoms, treatments, length and location of observation and outcomes were collected. 103 patients met inclusion c...

Research paper thumbnail of in the United States

experience with and analytical confi rmation of “ bath salts ” and “ legal highs ” (synthetic cat... more experience with and analytical confi rmation of “ bath salts ” and “ legal highs ” (synthetic cathinones)

Research paper thumbnail of Dental Local Anesthesia-Related Pediatric Cases Reported to U.S. Poison Control Centers

Purpose: The purpose of this study was to use National Poison Data System (NPDS) data to identify... more Purpose: The purpose of this study was to use National Poison Data System (NPDS) data to identify cases of local anesthetic (LA) adverse events related to dentistry for children. Methods: NPDS data were queried for all human cases from 2004 to 2018 that identified a parenteral LA agent as the substance, in children 12 years old and younger, which led to a medical outcome classification ranging from moderate to death. For cases that met inclusion criteria, deidentified records with case notes were requested. Results: Twenty-seven dental cases that met review criteria and had available case notes were reviewed. Most subjects were female (N equals 20 out of 27, 74 percent), and the average subject age was 6.8 years. Twenty cases (74 percent) had a moderate effect, seven cases (26 percent) had a major effect, and no fatalities were reported. The most common clinical effects classification was a seizure (N equals 13, 48 percent). One case of LA overdose was identified. Conclusions: No ca...

Research paper thumbnail of Suicide attempts by self-poisoning in the United States among 10–25 year olds from 2000 to 2018: substances used, temporal changes and demographics

Clinical Toxicology

Objective: To evaluate the substances used, outcomes, temporal and demographics associated with s... more Objective: To evaluate the substances used, outcomes, temporal and demographics associated with suicide attempts by self-poisoning in children and young adults aged 10-25 years old from 2000 to 2018. Methods: This is a retrospective review of suspected-suicide self-poisoning cases reported to the National Poison Data System (NPDS) from US Poison Centers from 2000 to 2018 for patients 10-25 years old. For comparison of annual rates, we obtained population data by year of age from the US Census Bureau. We evaluated changes in: monthly and annual incidence/rate per 100,000 population, substances used and outcome by patient age and demographics. Results: There were 1,677,435 cases of suicide attempt by self-poisoning among individuals 10-25 years old reported to US PCCs from 2000 to 2018. There were 410,940 self-poisoning cases (24.5%) with a serious medical outcome, and the proportion of exposures that resulted in a serious medical outcome increased with increasing age group. For the age groups of 10-12, 13-15 and 16-18 years of age, there was a significant increase after 2011, which was influenced primarily by females. The substance groups with the greatest number of serious medical outcomes were OTC analgesics, antidepressants, antihistamines and antipsychotics. ADHD medications were common in the younger age groups of 10-15 years, while the sedative/hypnotics occurred more commonly in the older age groups. The groups with the greatest increase in serious medical outcomes after 2011 were antidepressants, OTC analgesics, antihistamines and ADHD medications. Opiates were less commonly involved (7.4%) in cases with serious medical outcomes and decreased significantly in the 19-25 yearold age groups after 2012. States with a lower population per square mile had a greater number of reported cases with serious medical outcomes. There was a significant decrease in the number of cases in the age groups of 10-18 years during the traditional non-school months of June-August compared with September-May. This seasonal trend occurred among cases with all outcomes and among cases with serious medical outcomes. This decrease did not occur in the age group of 19-21 years, and there was an increase during summer months in the age group 22-25 years. Conclusions: The substances used during self-poisoning varies by age group but appears to include substances available to that age group, with a significant increase after 2011, increased rates in more rural states, and a seasonal variation of increased rates during school months among adolescents but not among young adults. Two of the top substances, OTC analgesics and antihistamines, in all age groups, comprising more than a third of all substances used, are widely available over-the-counter with no restrictions regarding access. Of additional concern, ADHD medications had the highest risk of a serious medical outcome.

Research paper thumbnail of Prevalence and Clinical Characteristics of Unintentional Ingestion of Marijuana in Children Younger Than 6 Years in States With and Without Legalized Marijuana Laws

Pediatric Emergency Care

Objective: The aim of this studywas to examine the relationship between state marijuana legalizat... more Objective: The aim of this studywas to examine the relationship between state marijuana legalization and the rates of unintentional ingestions of marijuana in children younger than 6 years. Methods: This was a retrospective review of all marijuana ingestions in the National Poison Data System in children younger than 6 years between January 1, 2000, and July 31, 2017. Data analysis from NPDS included, age, sex, state and year of occurrence, clinical effects, therapies, health care facility utilization, and medical outcome. Population of children younger than 6 years was obtained from the US Census Bureau. Public records search provided state legal status of marijuana and year of state marijuana legalization. Results: From 2000 through 2008, there was no significant change in the annual number or rate of ingestions of marijuana in children younger than 6 years across the United States. Following 2009, there was mean annual increase of 27% per year, rising to 742 ingestions per year or 2.98 ingestions per 100,000 population, respectively, in 2017. More than 70% of all cases occurred in states with legalized marijuana. Of all pediatric patients, 54.6% received some form of hospital-based care, of which 7.5% required critical care. Pediatric patients experienced awide range of symptoms from drowsiness and confusion, to seizures and coma. Medical treatments ranged from hydration therapy to sedation and intubation. Poison centers safely managed 23.4% of these pediatric cases by phone, without the need for hospital evaluation. Conclusion: There was a strong association between the legalization of marijuana and ingestions of marijuana by children younger than 6 years.

Research paper thumbnail of Opioid drug poisonings in Ohio adolescents and young adults, 2002-2014

Clinical toxicology (Philadelphia, Pa.), 2018

Opioids represent a drug class that adolescents and young adults intentionally misuse and abuse. ... more Opioids represent a drug class that adolescents and young adults intentionally misuse and abuse. When taken on their own or with other substances in this manner, opioids pose an increased risk of overdose and potential death. To determine trends of opioid drug poisonings among adolescents and young adults in Ohio from 2002 to 2014 using Poison Control Center (PCC) data. Data were obtained from Ohio PCCs from 2002 to 2014 for opioid drug poisonings amongst 10-29 year olds. Trends were evaluated with Poisson regression. Ohio counties with higher opioid drug poisoning rates were identified using age-adjusted resident population estimates. Chi-square tests were conducted to compare these county rates to the Ohio rate. Both unintentional and intentional Ohio PCC opioid drug poisonings peaked in 2009, and there were significant declines through 2014. Almost 40% of intentional opioid drug poisonings were for young adults aged 18-24 years. Suspected suicide poisonings were 64.9% female, mis...

Research paper thumbnail of Ocular Exposures Reported to United States Poison Control Centers

Ophthalmic epidemiology, Jan 21, 2018

To investigate the epidemiology of ocular exposures reported to poison control centers in the Uni... more To investigate the epidemiology of ocular exposures reported to poison control centers in the United States. A retrospective analysis of ocular exposures from 2000 to 2016 was conducted using National Poison Data System data. United States poison control centers received 1,436,683 reports of ocular exposures during 2000-2016, averaging 7,043 exposures per month. The annual frequency of ocular exposures declined significantly by 37.2% from 2006 to 2016. The ocular exposure rate per 10,000 US residents was highest among children < 6 years of age (10.7), particularly among 2-year-olds (20.5), and was lowest among adults ≥ 20 years of age (1.9). The majority of the exposures resulted in minor effects (51.4%). Among exposed individuals, 23.0% were treated and released and 0.3% were admitted to a healthcare facility. Household cleaning products (22.2%), cosmetics/personal care products (15.7%), and pesticides (7.4%) were the most common substance categories associated with exposures, b...

Research paper thumbnail of E-Cigarette and Liquid Nicotine Exposures Among Young Children

Pediatrics, 2018

To investigate exposures to liquid nicotine (including electronic cigarette devices and liquids) ... more To investigate exposures to liquid nicotine (including electronic cigarette devices and liquids) among children <6 years old in the United States and evaluate the impact of legislation requiring child-resistant packaging for liquid nicotine containers. Liquid nicotine exposure data from the National Poison Data System for January 2012 through April 2017 were analyzed. There were 8269 liquid nicotine exposures among children <6 years old reported to US poison control centers during the study period. Most (92.5%) children were exposed through ingestion and 83.9% were children <3 years old. Among children exposed to liquid nicotine, 35.1% were treated and released from a health care facility, and 1.4% were admitted. The annual exposure rate per 100 000 children increased by 1398.2% from 0.7 in 2012 to 10.4 in 2015, and subsequently decreased by 19.8% from 2015 to 8.3 in 2016. Among states without a preexisting law requiring child-resistant packaging for liquid nicotine contain...

Research paper thumbnail of Antidepressant and antipsychotic medication errors reported to United States poison control centers

Pharmacoepidemiology and drug safety, Jan 8, 2018

To investigate unintentional therapeutic medication errors associated with antidepressant and ant... more To investigate unintentional therapeutic medication errors associated with antidepressant and antipsychotic medications in the United States and expand current knowledge on the types of errors commonly associated with these medications. A retrospective analysis of non-health care facility unintentional therapeutic errors associated with antidepressant and antipsychotic medications was conducted using data from the National Poison Data System. From 2000 to 2012, poison control centers received 207 670 calls reporting unintentional therapeutic errors associated with antidepressant or antipsychotic medications that occurred outside of a health care facility, averaging 15 975 errors annually. The rate of antidepressant-related errors increased by 50.6% from 2000 to 2004, decreased by 6.5% from 2004 to 2006, and then increased 13.0% from 2006 to 2012. The rate of errors related to antipsychotic medications increased by 99.7% from 2000 to 2004 and then increased by 8.8% from 2004 to 2012....