Background: Acetaminophen (APAP) toxicity is a diagnosis with a time-dependent intervention. Signs and symptoms of toxicity rarely manifest until after the window of maximally effective treatment. Diagnosis often relies solely on serum APAP concentration ([APAP]) assays, which are not universally available. In a 2009 survey of hospitals in 3 Midwestern states, only 50.6% (126/249) had access to real-time [APAP] assays. Little is known regarding Poison Center recommendations to providers without access to real-time APAP assays; less is known regarding perceived liability when recommending send-out [APAP] assays. Methods: A survey sent to the American Association of Poison Control Centers Managing Directors ’ listserv querying practices and opinions regarding APAP testing in undifferentiated overdose (OD) patients when a) intentional OD is suspected and b) intentional OD is suspected and [APAP] is a send-out test. Respondents described practices and perceived liability
regarding testing and empiric treatment of APAP toxicity in both cases.
Results: 41 responses resulted (by region):
16 (39.02%) Midwest
5 (12.20%) Northeast
13 (31.71%) South
7 (17.07%) West
40/41 respondents recommend [APAP] on undifferentiated OD patients; 33/41 recommend [APAP] when that test is a send-out (p 0.0156, 2-sided Sign test, Table 1). 3/41 respondents recommend empiric treatment of APAP toxicity without immediately available [APAP]. With a high index of suspicion or suggestive history, 10/41 would recommend empiric treatment. Nearly 22% perceive some degree of liability when recommending send-out [APAP] on undifferentiated intentional OD patients. Conclusions: Most respondents in this survey recommend [APAP] in undifferentiated intentional ODs; fewer recommend send-out assays. Management of potential APAP toxicity in the absence of real-time [APAP] testing is not uniform and largely depends on clinical history. Recommending “send-out” [APAP] assays carries at least some perceived legal risk.