Impact of case exposures on physician behavior responses in childhood poisoning: quality and cost implications.

OBJECTIVES: When measuring physicians' competencies, there is no consensus as to what would constitute an optimum exposure in unintentional pediatric poisoning. In the absence of universal protocols and poison centers' support, the behavior responses of the physicians can vary depending on their exposure to cases. We sought to determine if there was a correlation between the case exposure and physicians' behavior choices that could affect quality and cost of care. METHODS: A cross-sectional study was conducted in 2010, and a self-reporting survey questionnaire was given to the physicians in the pediatric emergency departments and primary care centers in the city of Al Ain. The physicians' responses were plotted against (a) the number of cases the physicians have had managed in the preceding 12 months and (b) the number of years the physicians have had been in practice RESULTS: One hundred seven physicians partook in the survey. We found that the physicians who had managed more than 2 cases of childhood poisoning in the preceding year chose significantly more positive behavior responses when compared with those who had managed 2 cases or less. There was no significant difference when the responses were measured against the physicians' number of years of practice. CONCLUSIONS: Physicians' practice effectiveness may improve if they manage at least 3 cases of childhood poisoning in a year. Physicians training modules could be developed for those physicians who do not get the optimum exposure necessary in improving physicians' behaviors associated with effective quality and cost efficiency.

Role of a poison center in reducing unintentional childhood ingestion by targeting pre-event risk factors.

OBJECTIVES: Unintentional poisoning is a frequent presentation in the pediatric emergency care settings. We sought to determine the current incidence of unintentional poison ingestions in children who present to the emergency care in the city of Al Ain in United Arab Emirates, to create a profile of the products ingested, and to compare our data with a previous study conducted before the inception of a poison and drug information center. METHODS: We reviewed all cases of unintentional poisoning in children 10 years or younger, who presented at 2 tertiary level emergency care centers during January-December 2010. Two hundred cases met our inclusion criteria. Data on demographics, type and amount of noxious substance ingested, time of presentation, and outcomes were collected. Annual incidence was estimated, and data were compared with the previous study. RESULTS: The annual incidence of unintentional poisoning in the UAE is 2.35 per 1000 children 10 years or younger. The incidence is decreasing, especially for household chemical ingestions. The incidence is twice as high among native Emirati children compared with expatriate children. There was an increase in cosmetics- and synthetic hormone-related poisonings, as well as in the involvement of younger infants. CONCLUSIONS: The incidence of unintentional pediatric poisoning in the UAE is decreasing particularly in household chemical ingestions. Targeted health promotion campaigns by the poison center may have led to this drop. The sociological, environmental, and cultural factors that might be contributing to the greater use of emergency care in native children should be investigated.