Do poison center triage guidelines affect healthcare facility referrals?

Background: The purpose of this study, was to determine the extent to which poison center triage guidelines influence healthcare facility, referral rates for acute, unintentional acetaminophen-only, poisoning and acute, unintentional adult formulation iron poisoning. Methods: Managers of US poison centers were interviewed by telephone to determine their center's triage threshold value (mg/kg) for acute iron and acute acetaminophen poisoning in 1997. Triage threshold values and healthcare facility, referral rates were fit to a univariate logistic regression model for acetaminophen and iron using maximum likelihood estimation. Results: Triage threshold values ranged from 120-201 mg/kg (acetaminophen) and 16-61 mg/kg (iron). Referral rates ranged from 3.1% to 24% (acetaminophen) and 3.7% to 46.7% (iron). There was a statistically significant inverse relationship between the triage value and the referral rate for acetaminophen (p < 0.001) and iron (p = 0.0013). The model explained 31.7% of the referral variation for acetaminophen but only 4.1% of the variation for iron. Conclusion: There is great variability, in poison center triage values and referral rates for iron and acetaminophen poisoning. Guidelines can account for a meaningful proportion of referral variation. Their influence appears to be substance dependent. These data suggest that efforts to determine and utilize the highest, safe, triage threshold value could substantially decrease healthcare costs for poisonings as long as patient medical outcomes are not compromised.