Toxicology Investigators Consortium (ToxIC)
In 2009, ACMT established the ACMT Toxicology Investigators Consortium, known as ToxIC. This network of medical toxicologists was constituted to promote multi-center research in Medical Toxicology and to enable the nationwide collection of important toxicological data from patients at the bedside. ACMT considered it incumbent to establish this network to systematically investigate these issues. As the specialty of medical toxicology has grown considerably in recent years, we now have medical toxicologists at most major medical centers, facilitating the undertaking of a nationwide toxicovigilance program.
At ToxIC's inception an electronic survey was sent to all ACMT members asking questions on bedside medical toxicology practice patterns. Of the 114 ACMT members who answered the survey, 95 (83% of respondents) reported that they had an inpatient medical toxicology practice. In some cases, 2 or more members from the same program (or site) responded to the survey. Taking into account duplicative responses from the same program, ToxIC identified at least 45 distinct sites that see inpatients at the bedside and record the number of patients that they see each year. ToxIC estimated that the aggregate numbers of patients seen in the past year by these centers exceeded 14,000. Individual site census varied from 10 to more than 1,000 per year. Most respondents expressed an interest in participating in a national research network and/or bedside based toxicovigilance system. Given this interest, work was commenced to develop a national registry.
Creation of the ToxIC Registry
During the Fall of 2009 a test version of the ToxIC Registry was developed. Starting on January 15, 2010 four medical toxicology sites (Bellevue Medical Center, New York, NY; Porter & Littleton Adventist Hospital, Denver, CO; University of Massachusetts, Worcester, MA; and University of Texas Southwestern, Dallas TX) began to jointly pilot the initial collection of Registry data. Collecting more than 150 cases in a 6 week period, on March 1, 2010 this collaboration was expanded to 7 additional sites to form the beta test phase of the Registry project. These additional sites were at Children's Hospital, Boston MA; Harrisburg Hospital, Harrisburg PA; Hartford Hospital, Hartford CN; Robert Wood Johnson Medical Center, New Brunswick NJ; St Mary's Hospital, Duluth MN; University of Illinois Hospital, Chicago IL; and University of Utah Hospital, Salt Lake City UT. On April 15, 2010 the final version of the Registry went live with full registry participation available to all practices in the ToxIC network.
ToxIC Registry 2010-2015
Since 2010 the ToxIC Registry has expanded to over 50 sites across the United States and a handful of other countries (see members site listing here). In addition, ToxIC includes the majority of active U.S. medical toxicology practices and accredited medical toxicology fellowship programs. Participating sites are expected to enter all cases in which a formal in- or out-patient consultation was conducted by a medical toxicologist. Through its fifth year in 2014, the ToxIC Registry has continued to grow in the total number of cases reported -- from 3,945 in 2010 to over 9,100 in 2014.
Also, several supplemental or sub-registries have been created within ToxIC to provide additional detailed data for specific research areas of interest. As of early-2015, seven sub-registries exist including those novel drugs of abuse, metal-on-metal hip implants, caustic induced injury, lipid resuscitation therapy, prescription opioids misuse, snake bites and a clinical poisoning severity score. In addition, two new registries Extracorporeal Therapies (ECT) and Sodium Bicarbonate Therapy were initiated in mid-2015 (see here).
In addition to seed funding support from ACMT, recent extramural funding for the Registry came from both governmental and industry sources in 2014. Government funding was provided via three National Institute of Health (NIH) grant sub awards (1-3), while industry funding was in the form of an unrestricted grant from BTG International Inc. (North America) utilized for support of the North American Snakebite Registry (4). As ToxIC matures, additional resources to support the registry infrastructure; operational requirements for data reporting and quality assurance; and, site training and support will continue.
1 NIH National Institute of Neurological Disorders and Stroke 3U01NS083452-01 (Bird, SB)
2 NIH National Institute on Drug Abuse 1R56DA38366 (Boyer, EW/Carlson RG)
3 NIH National Institute on Drug Abuse 1R01DA037317-01 (Manini, A)
4 BTG International Group companies at www.btgplc.com.