On-Line Poison Information in the United States

Background: The first United States poison center (PC) opened in Chicago, IL in 1953. A standardized poison information system for PCs did not exist. In 1974, Micromedex (Thomson Healthcare, Denver, CO, USA) launched Poisindex registered a microfiche based system for poison centers. The system consists of continuously updated pharmaceutical and non-pharmaceutical product index and medical toxicological managements targeted to the active product ingredients. Now CD-ROM and internet based, all 61 US PCs use this system which interfaces directly with their local computer data entry software and provides a common upload to the US National Poison Data System (NPDS). Uploads of cases from poison centers occur continuously and allow for near real-time surveillance with alerts sent to a 24 hour monitoring team. Because of the detailed coding, data can also be examined for any combination of time period, location, region, or product. The AAPCC database (NPDS) documents over 2.4 million exposures and over 1.5 million information calls annually as published in the AAPCC Annual Report. Objective: Characterize the features of the US on-line poison information system. Methods: PCs respond daily to a variety of questions from the public and health care professionals. Poisindex registered lists over 350,000 pharmaceutical and non-pharmaceutical products. All are identified by a unique product identification number and are categorized into one of 922 American Association of Poison Control Centers (AAPCC) generic codes. Product information is obtained directly from the manufacturers using either the Material Safety Data Sheet (MSDS) in the case of non-pharmaceutical products or the Package Insert (PI) for drugs. Product information includes: active ingredients, excipients, form, packaging, company contact information and in some cases inert ingredients. Product information also includes US EPA regulatory numbers, NDC codes, and Chemical Abstract Service (CAS) numbers. This data allows for the precise linking of one or more clinical toxicology managements to each product. Toxicology managements are written by in-house medical and clinical toxicologists with review by external toxicologists. This process insures accurate up-to date information. With the advent of the personal computer, the data system was transitioned to a CD-ROM format. In the last several years, the system has transitioned to the internet. This allows for weekly system updates. Managements and products can