Intentional poisoning among elderly people-residents of a large urban agglomeration in Poland

Repeated hospital admission for intentional poisonings among older adults - a Swedish national register-based study

BACKGROUND

Poisoning injuries is an increasing concern among older people, and so is the repetition of intentional poisonings. To date, few studies have documented the pattern and individual risk factors for repeated poisonings. This national study aims to shed light on the burden, pattern, and health-related risk factors of repeated intentional poisoning leading to hospitalization or death among older Swedish adults (50 years and older), with a focus on the year following a first event.

METHODS

We conducted a nationwide register-based cohort study of people aged 50-100, hospitalized for intentional poisoning (ICD10: X60-69) during 2006-2016 (n = 15,219) and re-hospitalized by poisoning of any intent within a year (n = 1710), i.e., up to the end of 2017. We considered in turn, the distribution of the second poisoning in 30-day intervals stratified by intent; poisoning lethality within a month and a year; and the sex-specific association between health conditions and being re-hospitalized for intentional poisoning within one year as compared to being hospitalized only once using logistic regression (odds ratios (OR) with 95% confidence intervals (95% CI)).

RESULTS

Following an intentional poisoning, re-hospitalization within a year was predominantly for a new intentional poisoning (89.7%) and occurred most typically within a month (median 4 days). Death within 30 days occurred in similar proportion for the first and second poisoning (2.3% vs. 2.1% respectively). Among both men and women, comorbidity of psychiatric illness was strongly associated with re-hospitalization for intentional poisoning (adjusted ORs = 1.70; 95% CI = 1.45-2.01 and 1.89 (95% CI = 1.60-2.19) respectively).

CONCLUSION

Most re-hospitalizations within a year after intentional poisoning are also for intentional poisoning and occur most typically within days. Re-hospitalization is associated with several conditions that are characteristic of poor mental health and there are more similarities than differences between men and women in that respect.

Evaluation of factors related to overdose in patients with impaired consciousness who are transported by emergency medical services: an age-specific research

Background

Drug overdose accounts for most of the admissions to the emergency department. Prescription drugs, most of which are psychotropic medications, are often misused for drug overdose. The purpose of this study was to investigate the association between overdose in patients transported with disorders of consciousness and psychotropic medications administered prior to transport, so as to enable quick differentiation of drug overdose patients from patients with disorders of consciousness.

Methods

We evaluated 222 patients transported to the Advanced Critical Care Center of Teikyo University Hospital due to disorders of consciousness. The patients were categorized into two groups: overdose group (n = 128) and control group with other disorders of consciousness (n = 94). Logistic regression models were used to assess the association between disorders of consciousness due to drug overdose and psychotropic drugs prescribed before emergency transportation based on sex and age.

Results

According to multivariate logistic regression analysis, only female sex (odds ratio [OR] 4.54, 95% confidence interval [CI] 2.43–8.05, P < 0.0001) was associated with overall overdose. Results from the univariate logistic regression analysis showed that in the group of patients aged 40–50 years, female sex (OR 4.36, 95% CI; 1.54–12.4, P = 0.006) and the use of psychotropic drugs (OR 5.05, 95% CI; 1.75–14.6, P = 0.003), benzodiazepines (OR 4.64, 95% CI; 1.61–13.4, P < 0.05), antidepressants (OR 11.4, 95% CI; 2.35–55.8, P = 0.003), and anticonvulsants (OR 4.46, 95% CI; 1.11–17.9, P = 0.035) were associated with overdose. According to multivariate logistic regression analysis, female sex (OR 4.44, 95% CI; 1.37–14.3, P = 0.013) and antidepressants (OR 7.95, 95% CI; 1.21–52.1, P = 0.031) were associated with overdose patients aged 40–50 years.

Conclusions

As a reference in distinguishing overdose in women in their 40s and 50s who present with impaired consciousness, attention may need to be paid to the type of psychotropic drug used, especially antidepressants.

Intentional or unintentional drug poisoning in elderly people: retrospective observational study in a tertiary care hospital in Japan

Aim

Intentional or unintentional acute drug poisoning occurs even in elderly people, but little is known about the factors influencing the intention to poisoning. A retrospective study was undertaken to describe the characteristics of acute drug poisoning in elderly people according to whether the poisoning was intentional or unintentional and the responsible agents.

Methods

The study was carried out in a single tertiary hospital in Japan. A total of 145 patients aged ≥65 years who were transferred by an ambulance service and were diagnosed with acute drug poisoning were included. Medical records were used to collect information on the intention behind poisoning and the responsible agents. Patients were divided into two groups according to whether they experienced intentional or unintentional poisoning and were further classified according to the responsible agent. Multivariable logistic regression models were used to estimate the association between hospitalization for acute drug poisoning and the use of benzodiazepine receptor agonists (BzRAs).

Results

Poisoning was unintentional in 102 (70.3%) patients and intentional in 43 (29.7%) patients. In total, 65 (44.8%) patients required hospitalization. Among patients in the unintentional poisoning group, those using non‐BzRAs were more likely to be hospitalized than those using BzRAs (odds ratio, 6.64; 95% confidence interval, 2.56–17.22). The length of hospital stay was significantly longer in the unintentional poisoning group than in the intentional poisoning group (13.9 vs. 6.2 days; P = 0.013).

Conclusions

The proportion of unintentional poisoning in the elderly is high, and particularly with respect to poisoning with non‐BzRAs, the hospitalization rates are high.

Poisonings in Poland reported to the Polish National Health Fund in the years 2009-2011

BACKGROUND

Poisonings constitute a significant medical, social and economic problem worldwide. In Poland there is no nationwide registry of poisonings, which results in a lack of accurate epidemiological data. Few publications dealing with the problem are based on data obtained from toxicology units and therefore do not include information about cases treated at emergency departments and other non-toxicology units.

METHODS

We analyzed all admissions due to poisonings reported to the Polish National Health Fund by all hospital units in Poland in the 2009-2011 period. Diagnoses were encoded according to the ICD-10 classification.

RESULTS

A total of 254,425 admissions were reported, 85,398 in 2009, 85,230 in 2010 and 83,797 in 2011. The male to female ratios were 1.88, 1.75 and 1.80 respectively. The most frequent causes of admissions were poisonings with ethanol (n = 121,874; 47.9%), carbon monoxide (n = 17,179; 6.8%) and benzodiazepines (n = 10,340; 4.1%). Alcohols were the reason for 104,680 admissions in men (63.2%) and 22,612 admissions in women (25.5%; p < 0.01). Poisonings with pharmaceuticals and other drugs were reported in 34,616 men (20.9%) and 45,238 women (51%; p < 0.01). There were 1680 cases of fatal poisonings in the analyzed period. The hospital mortality due to poisonings increased from 1.1% in 2009 to 1.5% in 2011 (p < 0.01). The mortality in general Intensive Care Units increased from 14.4% in 2009 to 22.3% in 2011 (p < 0.01). The etiology of fatal poisonings was highly dependent on the type of hospital unit.

CONCLUSIONS

The overall number of admissions due to poisonings decreased slightly during the study period, but they remained a significant cause of morbidity and mortality. Alcohols were the main cause of admissions in the analyzed period. Alcohol intoxications were more frequent in men while poisonings with pharmaceuticals were more frequent in women. Carbon monoxide exposures were a significant cause of morbidity and mortality in the studied period in Poland. A national poison information and toxicovigilance system should be created in Poland, ideally allowing for near real-time monitoring of cases of poisonings.