Physostigmine: A Survey of Clinician Knowledge

1Washington University School of Medicine in St. Louis, St. Louis, MO
2University of Texas Southwestern, Dallas, TX
3Parkland Health and Hospital System, Dallas, TX
4Indiana University School of Medicine, Indianapolis, IN

Meeting: Hospital Medicine 2014, March 24-27, Las Vegas, Nev.

Abstract number: 15


Physostigmine is used to treat anticholinergic toxicity and education on its use is relevant for physician training. In fact, the American Boards of Pediatrics and Emergency Medicine specifically list toxicology or poisoning on their content outline for certification examination. Despite this, physician knowledge of physostigmine remains variable. Here we present preliminary results of a multicenter survey evaluating attending physician knowledge on the role of physostigmine in toxicology.


A survey was created and tested on a group of physicians for completion time and clarity. The survey was then reformatted and piloted among a different physician group. After obtaining local Institutional Review Board approval, all potential survey participants received a printed survey and/or an e‐mail containing a link to an electronic version. Physicians completing the final survey did not participate in survey development or pilot. No identifiable information was collected and responses remained confidential. Responses to printed surveys were individually entered into SurveyMonkey by three research team members. SurveyMonkey filtering was used to interpret responses.


The chart compares selected survey responses from Adult and Pediatric Hospitalists as well as Emergency Medicine (EM) Attendings. When compared to Adult and Pediatric Hospitalists, more EM attendings reported rotating on a toxicology service during training (62%) and more reported previously administering physostigmine (51%). Additionally, more EM attendings reported feeling comfortable administering physostigmine without toxicology input (44%). However, the ability to correctly identify indications and contraindications for physostigmine use varied between all three survey groups. Interestingly, more Adult Hospitalists were able to correctly identify indications and contraindications for physostigmine use when compared to Pediatric Hospitalists.


There is significant variability amongst Pediatric and Adult Hospitalists and EM attendings in terms of their comfort and previous experience with physostigmine, as well as their ability to correctly recognize indications and contraindications to its use. These results help to identify a potential educational need. Future programs should be designed to educate on the appropriate use of physostigmine.

Adult Hospitalists Pediatric Hospitalists Emergency Medicine Attendings
n=19 n=18 n=47
Rotated on a toxicology service Yes 0 0 62%
Administered physostigmine Yes 16% 17% 51%
Comfortable administering physostigmine without toxicology input Yes 11% 0 44%
Glaucoma Yes 35% 6% 26%
Anticholinergic toxicity Yes 84% 65% 95%
Asthma Yes 44% 13% 56%
Intestinal obstruction Yes 56% 7% 52%
Urogenital obstruction Yes 56% 27% 50%
Tricyclic antidepressants Yes 28% 12% 37%

To cite this abstract:

Plasencia A, Schwarz E, Velez L, Ordonez J, Wang D, Young A, Hail S, Kao L, Kleinschmidt K. Physostigmine: A Survey of Clinician Knowledge. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 15. Journal of Hospital Medicine. 2014; 9 (suppl 2). Accessed March 28, 2020.

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