2018 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 36th Annual Report
2018 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 36th Annual Report
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DOI：
10.1080/15563650.2019.1677022
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发表时间：
2019-11-12
影响因子：
3.3
通讯作者：
Ryan, Mark L.
中科院分区：
文献类型：
--
作者：
Gummin, David D.;Mowry, James B.;Ryan, Mark L.
简介：这是美国毒物控制中心协会（AAPCC）国家毒物数据系统（NPDS）的第36次年度报告。截至2018年1月1日，全国55个中毒中心（PC）自动将病例数据上传到NPDS。上传间隔为7.72 [6.90，12.0]（中位数[25%，75%]）分钟，创建了一个接近实时的国家暴露和信息数据库和监测系统。方法：采用NPDS中的具体指标，对病例资料进行分析.方法与往年相似。在引入变更的情况下，确定了差异。由医学和临床毒理学家评审小组使用1-6的顺序量表评价具有死亡医学结局的病例，以评估暴露的相对致死率（RCF）。结果如下：2018年，NPDS记录了2，530，238次封闭接触：2，099，751次人类暴露，57，017次动物暴露，368，025次信息请求，5，346次人类确认未暴露，99次动物确认未暴露。美国PC在2018年也进行了2，621，242次后续呼叫。与2017年相比，总接触率下降了2.96%，而卫生保健机构（HCF）的人类接触病例几乎保持稳定，略有下降0.261%。所有信息请求减少了15.5%，药物识别（药物ID）请求减少了30.2%，人体暴露病例减少了0.729%。自2008年以来，人类暴露于不太严重的后果每年下降2.33%，而自2000年以来，具有更严重后果（中度、严重或死亡）的暴露每年增加4.45%。与前一年一样，所有人类接触最频繁的前5种物质类别是镇痛药（10.8%）、家用清洁物质（7.28%）、化妆品/个人护理产品（6.53%）、镇静剂/催眠药/抗精神病药（5.53%）和抗抑郁药（5.22%）。对于结局更严重的病例，镇静剂/催眠药/抗精神病药暴露是增加最快的类别，在过去18年中增加了1，828例/年（9.21%/年）。在过去的10年里（对于结局最严重的病例），抗抑郁药暴露量增加最快，每年增加1，887例（7.02%）。5岁及以下儿童最常见的前5种接触是化妆品/个人护理产品（12.1%）、家用清洁剂（10.7%）、镇痛剂（9.04%）、异物/玩具/杂项（6.87%）和局部制剂（4.69%）。药物识别请求占所有信息请求的18.2%。NPDS记录了3，111例导致死亡的人类暴露;其中2，582例（83.0%）被判定为相关（RCF为1-无疑负责，2-可能负责或3-贡献）。结论：这些数据支持PC专业知识的持续价值，并需要专门的医疗毒理学信息来管理更严重的暴露。在美国，无意和有意接触仍然是发病率和死亡率的重要原因。NPDS的近实时状态代表了收集和监测美国暴露病例和信息请求的国家公共卫生资源。NPDS的持续使命是提供一个全国性的基础设施，用于监测所有类型的照射（例如，异物、传染病、有毒物质、化学制剂或商业产品），以及重大公共卫生事件的识别和跟踪。NPDS是近实时监测国家和全球公共卫生的示范系统。
Introduction: This is the 36(th) Annual Report of the American Association of Poison Control Centers' (AAPCC) National Poison Data System (NPDS). As of 1 January, 2018, 55 of the nation's poison centers (PCs) uploaded case data automatically to NPDS. The upload interval was 7.72 [6.90, 12.0] (median [25%, 75%]) minutes, creating a near real-time national exposure and information database and surveillance system. Methods: We analyzed the case data tabulating specific indices from NPDS. The methodology was similar to that of previous years. Where changes were introduced, the differences are identified. Cases with medical outcomes of death were evaluated by a team of medical and clinical toxicologist reviewers using an ordinal scale of 1-6 to assess the Relative Contribution to Fatality (RCF) of the exposure. Results: In 2018, 2,530,238 closed encounters were logged by NPDS: 2,099,751 human exposures, 57,017 animal exposures, 368,025 information requests, 5,346 human confirmed nonexposures, and 99 animal confirmed nonexposures. United States PCs also made 2,621,242 follow-up calls in 2018. Total encounters showed a 2.96% decline from 2017, while health care facility (HCF) human exposure cases remained nearly steady with a slight decrease of 0.261%. All information requests decreased by 15.5%, medication identification (Drug ID) requests decreased by 30.2%, and human exposure cases decreased by 0.729%. Human exposures with less serious outcomes have decreased 2.33% per year since 2008, while those with more serious outcomes (moderate, major or death) have increased 4.45% per year since 2000. Consistent with the previous year, the top 5 substance classes most frequently involved in all human exposures were analgesics (10.8%), household cleaning substances (7.28%), cosmetics/personal care products (6.53%), sedatives/hypnotics/antipsychotics (5.53%), and antidepressants (5.22%). For cases with more serious outcomes, sedative/hypnotics/antipsychotics exposures were the class that increased most rapidly, by 1,828 cases/year (9.21%/year) over the past 18 years. Over just the past 10 years (for cases with the most serious outcomes) antidepressant exposures increased most rapidly, by 1,887 cases/year (7.02%/year). The top 5 most common exposures in children age 5 years or less were cosmetics/personal care products (12.1%), household cleaning substances (10.7%), analgesics (9.04%), foreign bodies/toys/miscellaneous (6.87%), and topical preparations (4.69%). Drug identification requests comprised 18.2% of all information requests. NPDS documented 3,111 human exposures resulting in death; 2,582 (83.0%) of these were judged as related (RCF of 1-Undoubtedly responsible, 2-Probably responsible, or 3-Contributory). Conclusions: These data support the continued value of PC expertise and need for specialized medical toxicology information to manage more serious exposures. Unintentional and intentional exposures continue to be a significant cause of morbidity and mortality in the US. The near real-time status of NPDS represents a national public health resource to collect and monitor US exposure cases and information requests. The continuing mission of NPDS is to provide a nationwide infrastructure for surveillance for all types of exposures (e.g., foreign body, infectious, venomous, chemical agent, or commercial product), and the identification and tracking of significant public health events. NPDS is a model system for the near real-time surveillance of national and global public health.