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A quarter of admitted poisoned patients have a mild poisoning and require no treatment: An observational study

      Highlights

      • Using admission rates of poisoned patients as an outcome measure is of limited use.
      • 23% of admitted poisoned patients had a mild poisoning and required no treatment.
      • There is a potential for improvement of admission strategies for poisoned patients.

      Abstract

      Background

      Poisoned patients are frequently admitted following Emergency Department (ED) presentation, while the necessity of such admissions is hardly investigated. We determined the proportion and characteristics of poisoned patients who were admitted, but in retrospect had an uneventful admission.

      Methods

      For this observational cohort study, all patients presented to the ED of a Dutch University Hospital with various poisonings during a 1.5-year period (January 2015–July 2016) were included. The uneventfulness of admissions, defined as patients with a low Poisoning Severity Score (PSS) who received no treatment, was determined in retrospect.

      Results

      We included 417 patients who visited the ED for poisoning. 247 Patients were admitted: 30% to a general ward, 58% to a MCU, and 12% to the ICU. The poisoning severity scores of the admitted patients were none to mild in 38%, moderate to severe in 59%, and fatal in 2%. Upon admission, 60% of the patients received treatment. In retrospect, 77% of the admitted patients had a moderate, severe or fatal poisoning and/or required treatment. However, 23% of the admitted patients had a mild poisoning and required no treatment. This group involved younger patients (median age of 23 versus 42 years) and a higher proportion of patients reporting exposure to only one substance (65% versus 51%).

      Conclusions

      The majority of poisoned patients presented to the ED was admitted, while in retrospect, a quarter of these admissions were uneventful. Predictive parameters should be sought to identify patients who can be sent home safely.

      Keywords

      Abbreviations:

      CO (Carbon monoxide), ED (Emergency Department), ER (Extended Release), GHB (Gamma-Hydroxybutyric acid), ICU (Intensive Care Unit), LOS (Length of stay), MCU (Medium Care Unit), MDMA (3,4-Methylenedioxymethamphetamine), PSS (Poisoning Severity Score), SNRI (Serotonin Norepinephrine Reuptake Inhibitor), SSRI (Selective Serotonin Reuptake Inhibitor), TCA (Tricyclic Antidepressant), THC (∆-9-Tetrahydrocannabinol)
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