Occupational illness: case detection by poison control surveillance

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.