The Toxicology Investigators Consortium 2023 Annual Report

Abstract

Since 2010, the American College of Medical Toxicology (ACMT) Toxicology Investigators Consortium (ToxIC) has maintained the ToxIC Core Registry, a national case registry of in-hospital and clinic patient consultations submitted by medical toxicology physicians. Deidentified patient data entered into the registry includes patient demographics, reason for medical toxicology evaluation, exposure agents, clinical signs and symptoms, treatments and antidotes administered, and mortality. This fourteenth annual report provides data from 7392 patients entered into the Core Registry in 2023 by 36 participating sites comprising 61 distinct healthcare facilities, bringing the total case count to 102331 between 2010 and 2023. Ethanol was the most commonly reported exposure agent class (24.4%), followed by opioids (22.7%), non-opioid analgesics (16.7%), and antidepressants (11.7%). For the first time since the registry's initiation, in 2023, ethanol was the leading agent of exposure. There were 98 fatalities (case fatality rate of 1.3%). Additional descriptive analyses in this annual report were conducted to describe the reasons for medical toxicology consultation by age in 2023, and yearly trends for opioid and psychoactive exposures, physostigmine and rivastigmine treatments, and acetaminophen exposures treated with fomepizole.

Keywords: Epidemiology; Medical Toxicology; Overdose; Poisoning; Surveillance.

Fig. 1

Core Registry data collection elements

Fig. 2

Percentage of medical toxicology consults with opioid and psychoactive exposures by year

Fig. 3

Percentage of medical toxicology consults with anticholinergic exposures receiving physostigmine or rivastigmine treatment by year

Fig. 4

Percentage of medical toxicology consults with acetaminophen exposures receiving fomepizole treatment by year