Occupational Illness: Case Detection by Poison Control Surveillance

doi:10.1059/0003-4819-111-3-238

Occupational Illness: Case Detection by Poison Control Surveillance

Paul D. Blanc, MD, MSPH;
David Rempel, MD, MPH;
Neil Maizlish, PhD, MPH;
Patricia Hiatt, BS; and
Kent R. Olson, MD

Abstract

Study Objective: To evaluate the usefulness of poison control center detection in occupational illness surveillance.

Design: Case series of all occupationally related exposures referred for poison control center consultation over 6 months. Follow-up structured interviews were done of exposed persons and health care providers. Cases were traced under established occupational illness reporting programs.

Setting: A regional poison control center.

Patients: Consecutive sample of 461 symptomatic occupational exposure cases. After exclusions and losses to follow-up, interview of 301 patients and the treating physician, physician's assistant, or nurse practitioner for the 223 of the patients under direct medical care.

Measurements and Main Results: One hundred and fifty-five persons (61%; CI, 55% to 67%) had systemic or respiratory illness; 109 (36%; CI, 31% to 41%) had eye or skin conditions. Work practices were associated with exposures more often than technical failure; 118 persons (39%; CI, 33% to 45%) reported lack of respirators or other appropriate personal protective equipment. For 223 persons who received direct medical care, only five treating health care providers (2%; CI, 0.2% to 4%) reported occupational specialization, although occupational care was a regular practice activity for 128 of the health care providers (57%; CI, 51% to 63%). Sixty-seven cases (22%; CI, 17% to 27%) were detected by the Doctor's First Report surveillance program; 97 cases (32%; CI, 27% to 37%) comprised the maximal detection estimated for Occupational Safety and Health Administration surveillance.

Conclusions: Poison control center detection provides a useful surveillance measure for occupational illness. The proportion of case detection failures by established surveillance programs suggests that the incidence of occupational illness in the United States, which is calculated from these incomplete programs, may be three to five times greater than previously estimated.

Article and Author Information

From the University of California at San Francisco, San Francisco Bay Area Regional Poison Control Center, San Francisco, California, and the Occupational Health Surveillance and Evaluation Program, California State Department of Health Services, Berkeley, California. For current author addresses, see end of text.
Grant Support: Supported in part by the Occupational Health Surveillance and Evaluation Program, California State Department of Health Services and by a grant from the Robert Wood Johnson Foundation.
Requests for Reprints: Paul D. Blanc, MD, Division of Occupational and Environmental Medicine, University of California, San Francisco, 350 Parnassus, Suite 609, San Francisco, CA 94117-9024.
Current Author Addresses: Dr. Blanc: Division of Occupational and Environmental Medicine, University of California, San Francisco, 350 Parnassus, Suite 609, San Francisco, CA 94117-9024.
Drs. Rempel and Maizlish: State of California Department of Health Services, 2151 Berkeley Way, Room 504, Berkeley, CA 94704.
Ms. Hiatt and Dr. Olson: San Francisco Regional Poison Control Center, 1001 Potrero Avenue, Building 30, Room 3216, San Francisco, CA 94110.