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PublicHealthOntario.ca
Assessing the utility of Ontario Poison Centre
data for public health surveillance
Presentation objectives:
• Describe how poison centre data has informed public health
practice.
• Describe how Ontario Poison Centre exposure data could be used to
support evidence-based public health practice in Ontario.
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What is the Ontario Poison Centre?
www.publichealthontario.ca
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OPC Data - What We Collect
• Caller info: name, relation to patient, phone number, postal
code or city, hospital (if applicable)
• Patient info: name, age, weight, physical status including
symptoms, relevant lab results, outcome, patient and hospital
flow
• Substance or product info: name, ingredients, concentration,
• Scenario info: site of exposure, time since exposure, reason,
route of exposure
www.publichealthontario.ca
OPC Data - What We Don’t Collect
• Provincial Health card Numbers
• MRNs
• Patient’s address
• Specific product codes (e.g. DIN numbers)
www.publichealthontario.ca
How does Poison Centre Data
Inform Public Health?
www.publichealthontario.ca
United States: National Poisoning Data System
• Established in 1985. Data is uploaded every 4-10 minutes
• Includes 99.8% of all exposure calls reported in the US
• Real time automated analysis and alerting based on (i) call volume, (ii)
clinical effects, and (iii) case/exposure definitions
• Purpose:
1. Identify early indicators for chemical exposures at multiple sites;
2. Identify emerging problems with newly introduced products;
3. Identify illnesses resulting from chemical exposures; and
4. Monitor the frequency of reports involving abused substances.
• Detected 22 events of public health significance in 2009
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Example 1: Exposure Surveillance
• Understanding the true burden of
disease
• US National framework for surveillance
of carbon monoxide (CO) poisoning
• Poison centre data:
• Type of call: Exposure
• Substance: CO
• Clinical effect: Minor, moderate or major
• 6,832 calls / year
Iqbal S, Clower JH, King M, Bell J, Yip FY. National carbon monoxide poisoning surveillance
www.publichealthontario.ca framework and recent estimates. Public Health Rep. 2012 Sep-Oct;127(5):486-96. 8
Example 2: Outbreak Surveillance
• November 2008 - Salmonella outbreak detected by PulseNet
across 12 states
• January 2009 - Source confirmed as peanut butter
• January-February 2009 - NPDS daily surveillance began
• 1,998 calls potentially related to the outbreak
• Both information (28%) and exposure (72%) calls
• 1,028 exposure calls with a clinical effect (mostly mild)
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Example 4: Prioritizing Risk & Allocating Resources
• Florida Environmental Public Health
Tracking & Florida Poison Information
Control Network
• Rates of self-reported pesticide
exposure (per 100,000):
1. Pesticide exposure
2. Pesticide exposure with a health
effect
3. Pesticide exposure with a health
effect treated in a healthcare facility
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Improved understanding of population
exposure to health hazards over space & time
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Project background
• Collaborative project between:
• Environmental & Occupational Health team at Public Health Ontario (PHO)
• Ontario Poison Centre (OPC) at the Hospital for Sick Children
• Pilot for Environmental Health Tracking project (PHO)
• Project objectives:
1. Assess the utility of OPC exposure records for public health surveillance
and practice, and
2. Identify changes that would enhance the usefulness of the data for public
health practice, research and education.
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Data Extract
Date Elements: Restrictions:
• Age • Location: Ontario
• Gender
• Call type: Exposure
• Caller site
• Substance: (see below)
• Exposure site
• Reason • Date of exposure: (see below)
• Substance and subcategory
Substance Time period
• Route of exposure
Carbon Monoxide 2009-2013 (5y)
• Outcome
Lead 2009-2013 (5y)
• City
Mercury 2009-2013 (5y)
• Forward sortation area
Pesticides 2012-2013 (2y)
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Data Cleaning
Decision rules for:
• Duplicate records
• Identifying true duplicates
• Limited by nature of extract (2 relevant exposures/routes)
• Missing data
• Recoding / harmonizing data
• Clusters (group exposed vs. individual exposure)
• Data validation using electronic charts
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Exposures by Year & Month
Number of Exposures
Carbon Monoxide
1,504 (301 per year)
Lead
256 (51 per year)
Mercury
190 (38 per year)
Pesticides
2,952 (1,476 per year)
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Exposures by Gender & Age Group
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Exposures by Caller Site
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Exposures by Site
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Calls by Rural/Urban
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Exposures by Route
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Exposures by Route
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Exposures by Outcome
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Pesticide Exposures
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Key Findings
• Unique data source for supporting public health practice
• Not otherwise available!
• Lessons learned from secondary use of novel data source
• Open text fields
• Fairly small data extract
• Data trends are consistent with US data
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Next Steps
• National Poison Prevention Week:
March 20-26
• Public awareness campaign
• http://www.ontariopoisoncentre.ca
• Joint PHO-CCO Report
• Conference Presentations
• The Ontario Public Health
Convention 2016 (TOPHC)
• Public Health 2016 (CPHA)
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Thank you!
Acknowledgements:
• OPC: Anna Leah Desembrana, Dino
Bernabeo, Margaret Thompson
• PHO: Stanley Ing, Nicole Somers, JinHee
Kim, Ray Copes
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