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 ra tes for acute, unintentional acetaminophen-only, poisoning and acute, unint entional adult formulation iron poisoning. Methods: Managers of US poison c enters were interviewed by telephone to determine their center's triage thr eshold value (mg/kg) for acute iron and acute acetaminophen poisoning in 19 97. Triage threshold values and healthcare facility, referral rates were fi t to a univariate logistic regression model for acetaminophen and iron usin g maximum likelihood estimation. Results: Triage threshold values ranged fr om 120-201 mg/kg (acetaminophen) and 16-61 mg/kg (iron). Referral rates ran ged 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 v ariation. Their influence appears to be substance dependent. These data sug gest that efforts to determine and utilize the highest, safe, triage thresh old value could substantially decrease healthcare costs for poisonings as l ong as patient medical outcomes are not compromised.