CLINICAL TOXICOLOGY https://doi.org/10.1080/15563650.2018.1533727 NPDS REPORT 2017 2017 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 35th Annual Report David D. Gummin MDa,b, James B. Mowry PharmDc, Daniel A. Spyker PhD, MDd,e, Daniel E. Brooks MDf, Krista M. Osterthaler MPHg and William Banner MD, PhDh aWisconsin Poison Center, Milwaukee, WI, USA; bDepartment of Emergency Medicine, Section of Medical Toxicology, Medical College of Wisconsin, Milwaukee, WI, USA; cIndiana Poison Center, Indiana University Health, Indianapolis, IN, USA; dDepartment of Emergency Medicine, Oregon Poison Center, Oregon Health & Science University, Portland, OR, USA; eDepartment of Biopharmaceutical Sciences, University of California, San Francisco, CA, USA; fDepartment of Medical Toxicology, Banner University Medical Center - Phoenix, Phoenix, AZ, USA; gAmerican Association of Poison Control Centers, Alexandria, VA, USA; hOklahoma Center for Poison and Drug Information, University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA Table of contents Introduction .........................................................................................................1 The NPDS products database........................................................................................ 5 Methods . .........................................................................................................5 Characterization of participating poison centers and population served .................................................. 5 Encounter management – specialized poison exposure emergency providers ............................................. 5 NPDS – near real-time data capture ................................................................................. 6 Annual report case inclusion criteria ................................................................................. 6 Statistical methods ................................................................................................. 7 NPDS surveillance .................................................................................................. 9 Emerging trends .................................................................................................. 10 Fatality case review and abstract selection .......................................................................... 11 Pediatric fatality case review ....................................................................................... 12 Results . ........................................................................................................12 Informational contacts with poison centers .......................................................................... 12 Exposure cases logged at poison centers ............................................................................ 14 Age and gender distributions ....................................................................................... 15 Caller site and exposure site ....................................................................................... 17 Exposures in pregnancy............................................................................................ 17 Chronicity ........................................................................................................ 17 Reason for exposure............................................................................................... 17 Scenarios ......................................................................................................17 Reason by age..................................................................................................18 Route of exposure................................................................................................. 18 Clinical effects .................................................................................................... 18 Case management site ............................................................................................ 18 Medical outcome ................................................................................................. 19 Decontamination procedures and specific antidotes .................................................................. 20 Top substances in human exposures ................................................................................ 21 Changes over time ................................................................................................ 21 Emerging trends – drugs of abuse .................................................................................. 21 Distribution of suicides ............................................................................................ 22 Plant exposures ................................................................................................... 22 Deaths and exposure-related fatalities............................................................................... 22 All fatalities – all ages ...........................................................................................22 Pediatric fatalities – age 5 years ................................................................................25 Pediatric fatalities – ages 6–12 years ..............................................................................25 Adolescent fatalities – ages 13–19 years ...........................................................................25 CONTACT David Gummin [email protected] American Association of Poison Control Centers, 515 King Street, Suite 510, Alexandria, VA 22314, USA ß 2018 American Association of Poison Control Centers 2 D. D. GUMMIN ET AL. Pregnancy and fatalities .........................................................................................26 AAPCC surveillance results ......................................................................................... 26 Discussion . ........................................................................................................26 Summary . ........................................................................................................28 Disclaimer . ........................................................................................................28 Declaration of interest . ..............................................................................................28 References . ........................................................................................................28 Appendix A: Acknowledgments . ....................................................................................31 Poison centers (PCs) ............................................................................................... 29 AAPCC fatality review team ........................................................................................ 31 AAPCC NPDS steering committee ................................................................................... 31 AAPCC micromedex joint coding group .............................................................................. 31 AAPCC rapid coding team ......................................................................................... 31 AAPCC surveillance team .......................................................................................... 31 Regional poison center fatality awards .............................................................................. 31 Appendix B: Data definitions . ....................................................................................33 Reason for exposure............................................................................................... 32 Medical outcome ................................................................................................. 32 Relative contribution to fatality (RCF) ............................................................................... 33 Appendix C: Abstracts of selected cases . .............................................................................43 Selection of abstracts for publication ................................................................................ 33 Abstracts ......................................................................................................... 33 Abbreviations & Normal Ranges .................................................................................... 43 APPENDIX D – Table 21. Listing of fatal nonpharmaceutical and pharmaceutical exposures . .......................46 APPENDIX E – Table 22(A) & Table 22(B), Demographic profile of SINGLE SUBSTANCE exposure cases by generic category Nonpharmaceuticals (Table 22(A))...172 Pharmaceuticals (Table 22(B))...188 . ..........................................172 List of Figures and Tables Figure 1. Human exposure cases, information contacts and animal exposure cases by day since 1 January 2000 . .......9 Figure 2. All drug identification and law enforcement drug identification contacts by day since 1 January 2000 . .......9 Figure 3. Health care facility (HCF) exposure cases and hcf information contacts by day since 1 January 2000 . .......9 Figure 4. Substance categories with the greatest rate of exposure increase since 1 January 2000 for more severe outcomes (Top 4) . ..............................................................................................10 Figure 5. Change in encounters by outcome from Year 2000 . ..................................................24 Figure 6. Deaths over time in the United States related