General characteristics of hospitalized patients after deliberate self-poisoning and risk factors for intensive care admission

Abstract 

Background

Deliberate self-poisoning (DSP) is recognized as a major health problem worldwide with significant morbidity. After DSP, a substantial number of patients require intensive care unit (ICU) care, but little is known about how these patients differ from patients admitted to a general medical ward.

Methods

From January 2001 to December 2002, all adult patients admitted to Soroka University Hospital after DSP were identified by ICD-9 coded diagnoses. Demographic data, previous psychiatric illness, laboratory tests, medication used in the DSP, presenting syndromes, treatment, and time elapsed after ingestion until emergency department presentation were obtained retrospectively from the patients' charts.

Results

Out of a total of 217 patients, 34 (15.7%) were admitted to the ICU. Their mean age was 35.9 years and 65.4% of the patients were female. In multivariate analysis, the risk factors for ICU admission were suicide attempt with an antihypertensive medication (OR=12.2, 95% CI 2.3–65.8), coma on presentation (OR=15.8, 95% CI 4.9–50.7), and arrival at the emergency department less than 2 h after ingestion as compared to arrival after 2 h (OR=8.4, 95% CI 2.6–26.7). Previous psychiatric disease had no impact on ICU admission, and a recurrent attempt was protective of ICU admission.

Conclusions

We have shown that ingestion of antihypertensive medication, coma upon presentation, and emergency department admission less than 2 h after ingestion are predictive of ICU admission after a deliberate overdose with medication. These variables may help emergency department physicians to identify high-risk patients more quickly and, thereby, to improve patient care.

Keywords: Deliberate self-poisoning, Intensive care, Emergency care