Archives of
TOXICOLOGY
Arch. Toxicol. 40, 125--129 (1978)
9 Springer-gerlag 1978
The Index Line as a New Aid in Cfinical and Forensic Toxicology M. v. Clarmann 1, G. Mathes 1, G. Solfrank 1, and E. Bystrich 2 Toxikologische Abteilung der II. Med. Klinik r. d. Isar der Technischen Universitiit M/inchen, Ismaninger StraBe 22, D-8000 Miinchen, Federal Republic of Germany 2 Deutsches Institut ffir Medizinische Dokumentation und Information D-5000 K6ln, Federal Republic of Germany
Abstract. On behalf of the German Federal Ministry for Research and Technology, we investigated the use of electronic data processing for clinical toxicological purposes. Initially, sufficient funds were available for a comprehensive approach to the problem and programs covering the following areas were established: 1. A casuistic data program; 2. an identification program for wild fruits; 3. a program for the identification of tablets by their shapes. Due to a subsequent lack of funds, it was necessary to develop a partial solution: this solution is what we call the Index Line. The Index Line -- limited data on poisonings -- should enable the user to receive information by telex from the German Institute for Medical Documentation and Information, i.e., information on "who has what, where". As a first step the continuous Index Line registration of all cases of poisoning recorded at the poison control centers in Munich, Freiburg, Hamburg, and Nfirnberg as well as at the State Institute for Food, Pharmaceutical and Forensic Chemistry in Berlin was founded in 1975. To participate in the program, complete instructions are necessary. Key words: Documentation -- Intoxication -- Electronic data processing. Zusammenfassung. Im Auftrag des Bundesministeriums fiir Forschung und Technologie wurde untersucht, wie in der klinischen Toxikologie die elektronische Datenverarbeitung nutzbringend angewendet werden kann. Zun/ichst sprathen die finanziellen M/Sglichkeiten fftir eine groBe L6sung, Teilprogramme wurden ausgef/ihrt: 1. Das Kasuistik-Speicherungsprogramm; 2. das Programm zur Erkennung wild wachsender Friichte; 3. das Programm zur Identifizierung fester Arzneiformen aufgrund ihrer /iul3eren Merkmale. Durch Mittelkiirzung ergab sich die Notwendigkeit, dem klinischen Toxikologen mit einer kleineren L6sung weiterzuhelfen, die von uns als ,Index-Line"
0340-5761/78/0040/0125/$ 01.00
126
M.v. Clarmann et al. bezeichnet wurde. Sie soil durch Abspeicherung von Vergiftungsf'~illen mit begrenztem Datenangebot erm6glichen, dab fiber Telex die dem System angeschlossenen Benutzer vom Deutschen Institut ffir Medizinische Dokumentation und Information Ausk/infte bekommen k6nnen ,,wer wo was hat". In einem ersten Schritt wurde die regelm/iBige Index-Line-Erfassung aller Vergiftungsf'~ille in den Giftnotrufzentralen M/inchen, Freiburg, Hamburg und N/irnberg sowie der Landesanstalt f'tir Lebensmittel-, Arzneimittel- und Gerichtliche Chemie in Berlin im Jahre 1975 begonnen. Details mfissen einer ausffihrlichen Arbeitsanleitung entnommen werden 1.
The purpose of the poison control center is to provide immediate and adequate information every time -- outside of the working day too. This requires the use of upto-date methods. On behalf of the Federal Ministry for Research and Technology three programs have been developed for the project "data storage in clinical toxicology", which together with the non toxicologic dialogue is currently in use. The programs are: (1) the casuistry storage program; (2) the recognition of wild fruits and berries; (3) a program for the identification of tablets by their shapes. Further development of the original, larger conception to prepare comprehensive toxin and metabolite data was not possible due to lack of funds. Therefore, we recommended the storage, in one computer, of at least some essential data from each case of poisoning. These specifications, to put briefly to one line, provide information about "who has what, where". Thus the idea of the Index Line was born. In 1974 it was discussed by different members of the "European Community of Poison Control Centers" in Ischia and also by coworkers of the National Poison Control Services working group of W H O in Lyon. The plan was presented to various experts, who modified it slightly. In cooperation with E. Bystrich, the program was stored at D I M D I -- German Institute for Medical Documentation and Information - and tested with our own cases in a trial run. The program is now available for information at D I M D I in Cologne from the same time-sharing computer Siemens System 4004-151 as ISIS (Index of Sequential Information System) and is completely compatible with the project "data storage in clinical toxicology". The aim of the Index Line is to provide, in the form of a short coded reference or index, a data base of available information, e.g., casuistry, statistical analyses, indications for treatment, literature references, etc. The information is centrally stored at D I M D I and is at all times available to all national and foreign poison control centers, clinics, toxicological laboratories, and institutes participating in the storage, for instance via the terminal of a connected poison control center. Thus a comprehensive toxicologic index will be created that can provide information about cases of acute poisoning, urgent analyses, and expert answers to the question "who has what, where". 1
The authors will send the complete Index Line Legend to interested persons upon demand
The Index Line as a New Aid in Clinical and Forensic Toxicology
127
At a meeting at D I M D I on June 18th, 1975, it was agreed that regular Index Line storage would begin for all poisoning cases from the poison control centers of Munich, Freiburg, Hamburg, Niirnberg, and from the State Institute for Food, Pharmaceutical and Forensic Chemistry in Berlin. Until literature is documented and the poison control centers are equipped with terminals, the Index Line can be transmitted via the public teletype network of the Federal Postal Administration (Bundespost). The mailing of appropriate lists or books of the Index Line has also proved useful. To guarantee clarity we use the following stamp on our medical records, on written records of telephone consultations, etc. Toxicologic information will be gathered at D I M D I (possibly via poison control center).
Indextine
[-rql ! I 111 it i I IFF1 FFFTA
qqq E]
In most cases it will suffice to look up the computer expressions available there. All information provided by poison control centers is, of course, free. Periodically we plan to mail printed lists: Monthly = a list of recently stored poisonnings from all centers and a list off all stored information for corrections. Quarterly = a complete list of all stored cases. Annually -- or, if required, statistical analyses. For technical reasons, the information must be maintained in the proper format. Therefore this Index Line has been divided into individual squares. Each line contains 50 characters always with one blank space. A key to the various squares follows.
Letter (;ode(first coded square) ~,C,E,F,I,K, M, P,R, _Ap_propriotenumber Source
.Current year
--~
Ind4x[ine
/ . / - -
[ll r q-I I I I IL_ I
I . . . . . . . . Oeqree of. [ I~. . . . { ..i . . . .
. . . . ~f ~"~L~I~/I/~/II 1 I--L\h ]~l [ _ ~ I ~i
Deqree of ___1-~ 1"9, X,
@
/
//
Number of pmsons/ 1-9, M, ~ / / Age of patient F,N,B,I,P,A.G,Z, 0
/
I
Key_
[ / ' " ! " Special features I/ 1= Oiagn.o,sficand . ~
3 Invesh attono| = intere~ "
/
Variable_contents frames
i)ther information 1 Death 2 = ToxicoL~Qnatyticatcorpse 3 = Other somatic i[tness (or other causesof death)
128
M.v. Clarmann et al.
Source of Information. In the two available squares, the source of the information is coded, e.g., M = poison control center Munich. The ten coded squares can be used individually by the person reporting the actual information by using letters or figures. 1. F r o m the first of the ten coded squares the nature of the information must be obvious to all other users of the Index Line. 2. The complete set of squares must enable the user of the information to find the information easily without further investigation. The first coded square must indicate, by letter, what type of information is included. For example: A = analysis, I = information, P -- own patient. The two next squares are destined for the current year. The name of the poison is recorded in the 20 poison squares. Practical directions for this procedure have been developed.
Unchangable Index Squares In the first square the degree of seriousness, in the second one the degree of security, in the third one, the number of poisons, and in the fourth one, the age of the patient are recorded in code. In the fifth square additional information can be added: cause of death, i.e., whether death was from a toxicologically analyzed cause or from a somatic disease. The four subsequent squares can be used alternatively. In the lastfield an unusual poisoning case with interesting characteristics can be recorded. The codes chosen for the Index Line are based on internationally accepted abbreviations. The Index Line maintains the necessary protection of data, because the patient remains completely anonymous. Nevertheless the use of the Index Line enables all participating centers and institutions not only to find their own cases quickly but also to get a fast answer to the question "who has what, where". With little effort, this system offers so many advantages that it should be used quickly and extensively even if it is not possible to obtain answers to all detailed questions directly from the computer. The Index Line is sure to remove some of the major difficulties of practical clinical-toxicological work, depending on the plurality of poisons, local isolation of the individual analyzers, and the complexity of the various scientific specialties and branches. The Index Line is written as shown below: -M.P -M.I -M.P -M.I -M.I
0834 0301 1170 0801 - 0302
75 75 75 75 75
9A E T H A N O L 9A D I P H E N I N 9A M A N I T A - P H A L L O I D E S 9C A L C I P O T - F - T A B L . 9N A G E L L A C K
.261A .241A .121P .011I .2311
0. 0. 0. 0. 0.
.0 .0 .0 .0 .0
The Index Line as a New Aid in Clinical and Forensic Toxicology -M.P 0406
- M . I 1901 -M.P 0394 --M.P 0558 --
75 75 75 75
9PRAZEPAM
9S I D O L I N - F L S G 9T O G A L - T A B L . 9T H A L L I U M
Received January 17, 1977
. 1 3 1 A 0.
.0 .011B 0 . - - - . 0 .293A 4.---.0 . 3 9 1 A 1. .0
129
TOXICOLOGY
Arch. Toxicol. 40, 125--129 (1978)
9 Springer-gerlag 1978
The Index Line as a New Aid in Cfinical and Forensic Toxicology M. v. Clarmann 1, G. Mathes 1, G. Solfrank 1, and E. Bystrich 2 Toxikologische Abteilung der II. Med. Klinik r. d. Isar der Technischen Universitiit M/inchen, Ismaninger StraBe 22, D-8000 Miinchen, Federal Republic of Germany 2 Deutsches Institut ffir Medizinische Dokumentation und Information D-5000 K6ln, Federal Republic of Germany
Abstract. On behalf of the German Federal Ministry for Research and Technology, we investigated the use of electronic data processing for clinical toxicological purposes. Initially, sufficient funds were available for a comprehensive approach to the problem and programs covering the following areas were established: 1. A casuistic data program; 2. an identification program for wild fruits; 3. a program for the identification of tablets by their shapes. Due to a subsequent lack of funds, it was necessary to develop a partial solution: this solution is what we call the Index Line. The Index Line -- limited data on poisonings -- should enable the user to receive information by telex from the German Institute for Medical Documentation and Information, i.e., information on "who has what, where". As a first step the continuous Index Line registration of all cases of poisoning recorded at the poison control centers in Munich, Freiburg, Hamburg, and Nfirnberg as well as at the State Institute for Food, Pharmaceutical and Forensic Chemistry in Berlin was founded in 1975. To participate in the program, complete instructions are necessary. Key words: Documentation -- Intoxication -- Electronic data processing. Zusammenfassung. Im Auftrag des Bundesministeriums fiir Forschung und Technologie wurde untersucht, wie in der klinischen Toxikologie die elektronische Datenverarbeitung nutzbringend angewendet werden kann. Zun/ichst sprathen die finanziellen M/Sglichkeiten fftir eine groBe L6sung, Teilprogramme wurden ausgef/ihrt: 1. Das Kasuistik-Speicherungsprogramm; 2. das Programm zur Erkennung wild wachsender Friichte; 3. das Programm zur Identifizierung fester Arzneiformen aufgrund ihrer /iul3eren Merkmale. Durch Mittelkiirzung ergab sich die Notwendigkeit, dem klinischen Toxikologen mit einer kleineren L6sung weiterzuhelfen, die von uns als ,Index-Line"
0340-5761/78/0040/0125/$ 01.00
126
M.v. Clarmann et al. bezeichnet wurde. Sie soil durch Abspeicherung von Vergiftungsf'~illen mit begrenztem Datenangebot erm6glichen, dab fiber Telex die dem System angeschlossenen Benutzer vom Deutschen Institut ffir Medizinische Dokumentation und Information Ausk/infte bekommen k6nnen ,,wer wo was hat". In einem ersten Schritt wurde die regelm/iBige Index-Line-Erfassung aller Vergiftungsf'~ille in den Giftnotrufzentralen M/inchen, Freiburg, Hamburg und N/irnberg sowie der Landesanstalt f'tir Lebensmittel-, Arzneimittel- und Gerichtliche Chemie in Berlin im Jahre 1975 begonnen. Details mfissen einer ausffihrlichen Arbeitsanleitung entnommen werden 1.
The purpose of the poison control center is to provide immediate and adequate information every time -- outside of the working day too. This requires the use of upto-date methods. On behalf of the Federal Ministry for Research and Technology three programs have been developed for the project "data storage in clinical toxicology", which together with the non toxicologic dialogue is currently in use. The programs are: (1) the casuistry storage program; (2) the recognition of wild fruits and berries; (3) a program for the identification of tablets by their shapes. Further development of the original, larger conception to prepare comprehensive toxin and metabolite data was not possible due to lack of funds. Therefore, we recommended the storage, in one computer, of at least some essential data from each case of poisoning. These specifications, to put briefly to one line, provide information about "who has what, where". Thus the idea of the Index Line was born. In 1974 it was discussed by different members of the "European Community of Poison Control Centers" in Ischia and also by coworkers of the National Poison Control Services working group of W H O in Lyon. The plan was presented to various experts, who modified it slightly. In cooperation with E. Bystrich, the program was stored at D I M D I -- German Institute for Medical Documentation and Information - and tested with our own cases in a trial run. The program is now available for information at D I M D I in Cologne from the same time-sharing computer Siemens System 4004-151 as ISIS (Index of Sequential Information System) and is completely compatible with the project "data storage in clinical toxicology". The aim of the Index Line is to provide, in the form of a short coded reference or index, a data base of available information, e.g., casuistry, statistical analyses, indications for treatment, literature references, etc. The information is centrally stored at D I M D I and is at all times available to all national and foreign poison control centers, clinics, toxicological laboratories, and institutes participating in the storage, for instance via the terminal of a connected poison control center. Thus a comprehensive toxicologic index will be created that can provide information about cases of acute poisoning, urgent analyses, and expert answers to the question "who has what, where". 1
The authors will send the complete Index Line Legend to interested persons upon demand
The Index Line as a New Aid in Clinical and Forensic Toxicology
127
At a meeting at D I M D I on June 18th, 1975, it was agreed that regular Index Line storage would begin for all poisoning cases from the poison control centers of Munich, Freiburg, Hamburg, Niirnberg, and from the State Institute for Food, Pharmaceutical and Forensic Chemistry in Berlin. Until literature is documented and the poison control centers are equipped with terminals, the Index Line can be transmitted via the public teletype network of the Federal Postal Administration (Bundespost). The mailing of appropriate lists or books of the Index Line has also proved useful. To guarantee clarity we use the following stamp on our medical records, on written records of telephone consultations, etc. Toxicologic information will be gathered at D I M D I (possibly via poison control center).
Indextine
[-rql ! I 111 it i I IFF1 FFFTA
qqq E]
In most cases it will suffice to look up the computer expressions available there. All information provided by poison control centers is, of course, free. Periodically we plan to mail printed lists: Monthly = a list of recently stored poisonnings from all centers and a list off all stored information for corrections. Quarterly = a complete list of all stored cases. Annually -- or, if required, statistical analyses. For technical reasons, the information must be maintained in the proper format. Therefore this Index Line has been divided into individual squares. Each line contains 50 characters always with one blank space. A key to the various squares follows.
Letter (;ode(first coded square) ~,C,E,F,I,K, M, P,R, _Ap_propriotenumber Source
.Current year
--~
Ind4x[ine
/ . / - -
[ll r q-I I I I IL_ I
I . . . . . . . . Oeqree of. [ I~. . . . { ..i . . . .
. . . . ~f ~"~L~I~/I/~/II 1 I--L\h ]~l [ _ ~ I ~i
Deqree of ___1-~ 1"9, X,
@
/
//
Number of pmsons/ 1-9, M, ~ / / Age of patient F,N,B,I,P,A.G,Z, 0
/
I
Key_
[ / ' " ! " Special features I/ 1= Oiagn.o,sficand . ~
3 Invesh attono| = intere~ "
/
Variable_contents frames
i)ther information 1 Death 2 = ToxicoL~Qnatyticatcorpse 3 = Other somatic i[tness (or other causesof death)
128
M.v. Clarmann et al.
Source of Information. In the two available squares, the source of the information is coded, e.g., M = poison control center Munich. The ten coded squares can be used individually by the person reporting the actual information by using letters or figures. 1. F r o m the first of the ten coded squares the nature of the information must be obvious to all other users of the Index Line. 2. The complete set of squares must enable the user of the information to find the information easily without further investigation. The first coded square must indicate, by letter, what type of information is included. For example: A = analysis, I = information, P -- own patient. The two next squares are destined for the current year. The name of the poison is recorded in the 20 poison squares. Practical directions for this procedure have been developed.
Unchangable Index Squares In the first square the degree of seriousness, in the second one the degree of security, in the third one, the number of poisons, and in the fourth one, the age of the patient are recorded in code. In the fifth square additional information can be added: cause of death, i.e., whether death was from a toxicologically analyzed cause or from a somatic disease. The four subsequent squares can be used alternatively. In the lastfield an unusual poisoning case with interesting characteristics can be recorded. The codes chosen for the Index Line are based on internationally accepted abbreviations. The Index Line maintains the necessary protection of data, because the patient remains completely anonymous. Nevertheless the use of the Index Line enables all participating centers and institutions not only to find their own cases quickly but also to get a fast answer to the question "who has what, where". With little effort, this system offers so many advantages that it should be used quickly and extensively even if it is not possible to obtain answers to all detailed questions directly from the computer. The Index Line is sure to remove some of the major difficulties of practical clinical-toxicological work, depending on the plurality of poisons, local isolation of the individual analyzers, and the complexity of the various scientific specialties and branches. The Index Line is written as shown below: -M.P -M.I -M.P -M.I -M.I
0834 0301 1170 0801 - 0302
75 75 75 75 75
9A E T H A N O L 9A D I P H E N I N 9A M A N I T A - P H A L L O I D E S 9C A L C I P O T - F - T A B L . 9N A G E L L A C K
.261A .241A .121P .011I .2311
0. 0. 0. 0. 0.
.0 .0 .0 .0 .0
The Index Line as a New Aid in Clinical and Forensic Toxicology -M.P 0406
- M . I 1901 -M.P 0394 --M.P 0558 --
75 75 75 75
9PRAZEPAM
9S I D O L I N - F L S G 9T O G A L - T A B L . 9T H A L L I U M
Received January 17, 1977
. 1 3 1 A 0.
.0 .011B 0 . - - - . 0 .293A 4.---.0 . 3 9 1 A 1. .0
129
