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)To read this article in full you will need to make a payment
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References
- 2017 annual report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 35th annual report.Clin Toxicol (Phila). 2018; https://doi.org/10.1080/15563650.2018.1533727
- 2011: national estimates of drug-related emergency department visits.in: HHS publication no. (SMA) 13–4760, DAWN series D −39. Substance Abuse and Mental Health Services Administration, Rockville, MD2013https://www.samhsa.gov/data/sites/default/files/DAWN2k11ED/DAWN2k11ED/DAWN2k11ED.pdfDate accessed: October 12, 2017
- Outcomes and costs of poisoned patients admitted to an adult emergency Department of a Spanish Tertiary Hospital: evaluation through a Toxicovigilance Program.PLoS One. 2016; 11e0152876
- Trends in emergency department resource utilization for poisoning-related visits, 2003–2011.J Med Toxicol. 2016; 12: 248-254
- Impact of an emergency short stay unit on emergency department performance of poisoned patients.Am J Emerg Med. 2017; 35: 764-768
- Triage vital signs predict in-hospital mortality among emergency department patients with acute poisoning: a case control study.BMC Health Serv Res. 2012; 12: 262-269
- Deliberate self-poisoning: characteristics of patients and impact on the emergency department of a large university hospital.Emerg Med J. 2013; 30: e9
- Acute intoxications: differences in management between six Dutch hospitals.Clin Tox (Phila). 2012; 50: 120-128
- Service provision and outcome for deliberate self-poisoning in adults--results from a six Centre descriptive study.Soc Psychiatry Psychiatr Epidemiol. 2003; 38: 390-395
- A prospective study on acute poisonings presenting to the Emergency Department at Landspitali University Hospital in Iceland 2012.Laeknabladid. 2017; 103: 275-280
- Characteristics and determinants of adult patients with acute poisoning attending the accident and emergency department of a teaching hospital in Qatar.Hum Exp Toxicol. 2013; 32: 921-929
- Acute poison exposure in the emergency department: a 2-year study in a university hospital.J Med Assoc Thai. 2010; 93: S41-S49
- Deliberate drug poisonings admitted to an emergency department in Paris area - a descriptive study and assessment of risk factors for intensive care admission.Eur Rev Med Pharmacol Sci. 2016; 20: 1174-1179
- Acute intoxication patients presenting to an emergency department in the Netherlands: admit or not? Prospective testing of two algorithms.Emerg Med J. 2012; 29: 467-472
- Clinical parameters that predict the need for medium or intensive care admission in intentional drug overdose patients: a retrospective cohort study.J Crit Care. 2017; 37: 156-161
- Poisoning severity score. Grading of acute poisoning.J Toxicol Clin Toxicol. 1998; 36: 205-213
- Should we be using the poisoning severity score?.J Med Toxicol. 2017; 13: 135-145
- The poisoning severity score: if it did not exist we would have to invent it.J Med Toxicol. 2017; 13: 131-134
- Annual report 2017.https://www.umcutrecht.nl/getmedia/164598fc-fd76-4f7a-9de0-5b7024d701ec/UMC-Utrecht-Jaardocument-2017-V10-7.pdf.aspxDate: 2018Date accessed: August 13, 2018
- Consensus methods for medical and health services research.BMJ. 1995; 311: 376-380
- https://www.heart.org/en/health-topics/high-blood-pressure/the-facts-about-high-blood-pressureDate: 2019Date accessed: April 11, 2019
- Compendium Kindergeneeskunde - Diagnostiek en Behandeling.4th ed. Bohn Stafleu van Loghum, Houten2011
- Thermometry in paediatric practice.Arch Dis Child. 2006; 91: 351-356
- Respiratory assessment.Nurs Stand. 2008; 22: 41-43
- The measurement of observer agreement for categorical data.Biometrics. 1977; 33: 159-174
- Pharmacokinetic considerations in clinical toxicology: clinical applications.Clin Pharmacokinet. 2007; 46: 897-939
- A meta-analysis of the reliability of the history in suspected poisoning.J Emerg Med. 2015; 48 (Jun): 679-684
- Use of a 23-hour emergency department observation unit for the management of patients with toxic exposures.Emerg Med J. 2017; 34: 755-760
- Deliberate self-poisoning: characteristics of patients and impact on the emergency department of a large university hospital.Emerg Med J. 2013; 30: e9
- Features and prognostic factors for elderly with acute poisoning in the emergency department.J Chin Med Assoc. 2010; 73: 78-87
- The need for ICU admission in intoxicated patients: a prediction model.Clin Toxicol (Phila). 2017; 55: 4-11
- Severity scores and their associated factors among orally poisoned toddlers: a cross sectional single poison center study.BMC Pharmacol Toxicol. 2016; 17
- Predicting the clinical course in intentional drug overdose. Implications for use of the intensive care unit.Arch Intern Med. 1987; 147: 133-137
- Reliability of the Glasgow Coma Scale for the emergency department evaluation of poisoned patients.Hum Exp Toxicol. 2004; 23: 197-200
- Glasgow coma scale and its components on admission: are they valuable prognostic tools in acute mixed drug poisoning?.Crit Care Res Pract. 2011; 952956
- Utilization of observation units for the care of poisoned patients: trends from the toxicology investigators consortium case registry.J Med Toxicol. 2016; 12: 111-120
- Observation unit experience for pediatric poison exposures.J Med Toxicol. 2009; 5: 15-19
- Utilization of a pediatric observation unit for toxicologic ingestions.Pediatr Emerg Care. 2012; 28: 1169-1172
- The pediatric hybrid observation unit: an analysis of 6477 consecutive patient encounters.Pediatr. 2005; 115: e535-e542
Article info
Publication history
Published online: May 18, 2019
Accepted:
May 13,
2019
Received in revised form:
April 13,
2019
Received:
January 29,
2019
Identification
Copyright
© 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
