Posters IV - The American Academy of Clinical Toxicology

(age>=18). Using artificial neural networks, decision tree induction, and logistic regression, we
induced multiple possible predictive models of adherence for the three age groups using: only
NPDS data elements, and combined NPDS data elements/narrative text. We validated models
using one year of reserved data. We calculated non-parametric area under the receiver operating
characteristic curve (AROC) for model comparison. Results: AROC values for predictive models
based on NPDS data elements ranged from 0.64-0.71. AROC values for predictive models based
on both NPDS data elements and narrative text ranged from 0.53-0.73. For 11 of 14 models, the
inclusion of narrative text resulted in increased performance. The mean difference in AROC =
0.02. Conclusions: Coded representations of narrative text improved the performance of
predictive models of caller adherence to PCC referral to EDs. The NPDS data elements
accurately described key caller and exposure characteristics, and so the narrative text may reflect
additional PCC staff concerns and impressions resulting from the communication process. In
clinical decision support applications, PCCs should consider the modest improvement in
predictive modeling realized with additional natural language processing in the context of clinical
implications and increased processing times necessary to include narrative text in computerized
decision support tools.
264
Exotic Venomous Snakebite Drill
Rittirak Othong 1 , Sophia Sheikh 1 , Nahar D Alruwaili 1 , Rachel Gorodetsky 2 , Brent W Morgan 1 , Brad
Lock 3 , Ziad N Kazzi 1
1 Emory University, Atlanta GA 2 Georgia Poison Center, Atlanta GA 3 Zoo Atlanta, Atlanta GA USA
Background: The National Poison Data System has reported 41-93 patients/year exposed to exotic
venomous snakes from 2005 to 2009. According to the Association of Zoos and Aquariums'
recommendation, institutions housing venomous animals should have protocols in place for appropriate
and timely transport of envenomated individuals to hospitals. The objective of this study was to use a
functional exercise to evaluate the existing exotic snakebite protocol (ESP) that is used by our local zoo.
Methods: Prior to the exercise, all involved parties were contacted, including the poison center (PC), zoo,
emergency medical services (EMS), receiving hospital emergency department (ED) and pharmacy. A
checklist of all required actions in the ESP was created and used during the exercise. The exercise was
divided into 4 phases that were evaluated by independent observers: zoo, EMS, PC, and hospital ED. The
zoo component was further divided into 3 action lists (victim, assistant, and zoo dispatch). After the drill,
we held a debriefing session and generated an after action report that was submitted to the zoo, PC, and
hospital administrations. Results: We found that the ESP contained procedures for zoo personnel that
were easy to follow, but the procedures for hospital personnel lacked details regarding signs and
symptoms expected from each species; indications, dosing, reconstituting and forms (liquid vs. powder) of
each antivenin (AV). Zoo personnel performed almost all required actions (93%-victim, 100%-assistant,
93%-zoo dispatch). EMS and ED personnel completed 90% and 78% of the listed tasks while
PC personnel completed 25% of the tasks. Additionally, we discovered that pharmacy was not included in
the ESP, even though reconstituting and dosing the exotic AV consumed time (22 minutes). Finally, we
encountered problems communicating the ESP to the ED and pharmacy due to the PC phone system
problem. Despite the identified shortcomings, the time from simulated envenomation to AV
administration was under an hour. Conclusions: This drill identified several potential issues that led us to
revise our protocol by adding signs and symptoms expected from each species; indications, dosing and
reconstituting of each AV; and a pharmacy section. We also identified suboptimal PC response in the