Patterns and epidemiology of acute poisoning in Ethiopia: systematic review of observational studies

Epidemiology, clinical characteristics, and associated cost of acute poisoning: a retrospective study

Introduction

Poisoning is a major public health issue and a leading cause of admission to the emergency department (ED). There is a paucity of data describing the epidemiology and cost of acute poisoning. Therefore, this study investigated the epidemiology, patterns, and associated costs of acute poisoning in emergency department of the largest tertiary care healthcare centre in Qatar.

Method

This study was a retrospective review of the health records of patients admitted to the ED due to poisoning between January 2015 and December 2019. Incidence, clinical characteristics, and costs associated with acute poisoning were assessed. Frequency and percentages were calculated for categorical variables and mean and SD for continuous variables. The relationship between sociodemographic characteristics and poisoning profile was assessed using the chi-square test. A micro-costing approach using the cost of each resource was applied for cost calculations.

Result

The incidence of acute poisoning was 178 cases per 100,000 patients. Females (56%) and children below 14 years (44.3%) accounted for the largest proportion. Most of the exposures were accidental involving therapeutic agents (64.2%). The mean length of hospital stay was found to be 1.84 ± 0.81 days, and most patients (76.6%) were discharged within the first 8 h. A statistically significant difference was found between age groups and type of toxin (χ2 = 23.3, p < 0.001), cause and route of exposure (χ2 = 42.2, p < 0.001), and length of hospital stay (χ2 = 113.16, p < 0.001). Admission to intensive care units had the highest cost expenditure (USD 326,008), while general wards accounted for the least (USD 57,709).

Conclusion

Unintentional poisoning by pharmacological agents is common in infants and children. This study will assist in the development of educational and preventive programmes to minimise exposure to toxic agents. Further studies are required to explore the impact of medical toxicology services, and post discharge monitoring of poisoning.

Clinico-epidemiological evaluation of pharmaceutical/non-pharmaceutical poisoning in a referral poisoning emergency in the Central part of Iran

The pattern of poisoning varies in different societies. In this study, we investigated the clinical-epidemiological features and outcomes of poisoned patients based on the substances involved, whether pharmaceutical or non- pharmaceutical toxins. This cross-sectional study involved a retrospective chart review of all poisoned patients who presented to the poisoning emergency hospital in the center of Iran between January 2015 and December 2019. We collected data on socio-demographics, the nature of the poisoning, and the outcomes. Backward stepwise binary regression analysis was conducted to predict the mortality. Throughout the study period, 5777 patients with acute poisoning met the inclusion criteria. Of these, 3524 cases (61%) were attributed to pharmaceutical, and 2253 cases (39%) were due to non-pharmaceutical poisoning. The majority of pharmaceutical poisonings (82.9%) were intentional, whereas non-pharmaceutical poisonings accounted for 46.2% of intentional exposures (P < 0.001). Patients with non-pharmaceutical poisoning were predominantly men, older in age, and had a history of addiction compared to those with pharmaceutical poisoning (P < 0.001). In binary logistic regression analysis, patients poisoned by non-pharmaceutical substances had a significantly higher risk of mortality [Odds ratio, 3.14; (95% CI 1.39-7.10); P = 0.006] compared to those poisoned by pharmaceutical substances (P < 0.001). The pattern of poisoning differs in terms of age and gender when comparing pharmaceutical to non-pharmaceutical poisoning. Patients poisoned by non-pharmaceutical may have a worse outcome compared to those poisoned by pharmaceutical substances.

Mortality of acute poisoning and its predictors in Ethiopia: A systematic review and meta-analysis

Introduction

Poison is defined as any chemical that has the potential to affect or harm human physiology due to its chemical activity. Poisoning is becoming a major preventable public health issue in many countries, including Ethiopia. There is a variation in acute poisoning mortality among the existing evidence in Ethiopia. This study aims to determine the pooled mortality rate from acute poisoning and its predictors in Ethiopia.

Methods

We searched available evidence of acute poisoning mortality in databases such as PubMed, Hinari, Cochrane, ScienceDirect, and other search engines. Using the Microsoft Excel data extraction form, three authors independently extracted all relevant data. The Higgins I2 test statistics were used to examine heterogeneity among included studies A random-effects model was used to analyze the pooled estimates and predictors in Stata MP version 17.

Results

We retrieved 2685 relevant records from different database sources, and after screening, 21 studies (17 published and 4 unpublished) were included. The pooled mortality rate for acute poisoning was 4.69(95 % CI: 3.69, 5.69 I2 = 94.7 %). The most common poisoning agents are organophosphate (29.9 %), household cleansing agents (17.5 %), and pharmaceuticals/medications (9.3 %). The majority of poisoning cases were intentional poisoning committed suicide. Poisoning cases in rural areas [RR: 3.98(95 % CI: 1.41, 11.25)] and delayed arrival times [RR: 2.90(95 % CI: 1.45, 5.84)] were identified predictors of mortality.

Conclusions

In this study, the pooled mortality from acute poisoning was 4.69 %. Poisoned cases from rural areas and delayed arrival times to the hospital were predictors of mortality. To prevent mortality, healthcare professionals should give special attention to rural residents and delayed arrival of poison cases. To control this avoidable death, poison control centers should be strengthened, and other preventive measures implemented at the national level.

Prediction the prognosis of the poisoned patients undergoing hemodialysis using machine learning algorithms

BACKGROUND

Hemodialysis is a life-saving treatment used to eliminate toxins and metabolites from the body during poisoning. Despite its effectiveness, there needs to be more research on this method precisely, with most studies focusing on specific poisoning. This study aims to bridge the existing knowledge gap by developing a machine-learning prediction model for forecasting the prognosis of the poisoned patient undergoing hemodialysis.

METHODS

Using a registry database from 2016 to 2022, this study conducted a retrospective cohort study at Loghman Hakim Hospital. First, the relief feature selection algorithm was used to identify the most important variables influencing the prognosis of poisoned patients undergoing hemodialysis. Second, four machine learning algorithms, including extreme gradient boosting (XGBoost), histgradient boosting (HGB), k-nearest neighbors (KNN), and adaptive boosting (AdaBoost), were trained to construct predictive models for predicting the prognosis of poisoned patients undergoing hemodialysis. Finally, the performance of paired feature selection and machine learning (ML) algorithm were evaluated to select the best models using five evaluation metrics including accuracy, sensitivity, specificity the area under the curve (AUC), and f1-score.

RESULT

The study comprised 980 patients in total. The experimental results showed that ten variables had a significant influence on prognosis outcomes including age, intubation, acidity (PH), previous medical history, bicarbonate (HCO3), Glasgow coma scale (GCS), intensive care unit (ICU) admission, acute kidney injury, and potassium. Out of the four models evaluated, the HGB classifier stood out with superior results on the test dataset. It achieved an impressive mean classification accuracy of 94.8%, a mean specificity of 93.5 a mean sensitivity of 94%, a mean F-score of 89.2%, and a mean receiver operating characteristic (ROC) of 92%.

CONCLUSION

ML-based predictive models can predict the prognosis of poisoned patients undergoing hemodialysis with high performance. The developed ML models demonstrate valuable potential for providing frontline clinicians with data-driven, evidence-based tools to guide time-sensitive prognosis evaluations and care decisions for poisoned patients in need of hemodialysis. Further large-scale multi-center studies are warranted to validate the efficacy of these models across diverse populations.

Patterns, Clinical Outcome, and Factors Associated with Poisoning Outcomes among Poisoned Patients in Northwest Ethiopia

Introduction

Poison is a substance that can hurt or cause dysfunction in the body due to its chemical action. Poisoning related to pesticides used in agriculture is a major public health issue in developing countries. However, there is a limited epidemiological data on poisoning in Ethiopia.

Objective

The aim of this study was to determine poisoning patterns, clinical outcome, and factors associated with poisoned patients in Northwest Ethiopia.

Methods

A cross-sectional study was conducted in July 2021 to include data of 1 year period. Data of all poisoned patients were collected using a standardized checklist from the registration book and patient medical records. The association between variables and outcomes was analyzed using a multivariable logistic regression model. A p-value of < 0.05 was considered to declare a statistically significant association.

Result

Over one-third of the poisoning cases (35.9%) were seen in the spring, according to a survey of 315 patient medical data. The majority of patients were in the age group of 21-30 years (44.1%). The most common form of poison consumed was organophosphate (OP), which accounts for 61.3% of all visits, and the least common was food poisoning, which accounts for 1.9%. About 82.5% of poisoning cases survived, while the remaining 17.5% were died. Time of arrival to the hospital ≥1 h (adjusted odds ratio (AOR) = 7.02; 95% confidence interval (CI): 1.16, 11.40), lack of oxygen support (AOR = 6.64; 95% CI: 3.56-6.78), and lack of adrenaline/dopamine medication (AOR = 3.57; 95% CI: 1.17-5.78) were all substantially linked with death of poisoned cases.

Conclusions

Three-fourth of poisoning cases survived, while the remaining one-fourth died. Ingestion of OPs is the most prevalent type of poisoning, and most cases are intentional. Delayed arrival ≥1 h, lack of oxygen support, and adrenaline/dopamine treatment were all linked to death. On-time arrival, oxygen assistance, and adrenaline/dopamine treatment in a healthcare setting are all recommended.

Outcome of Poisoning and Associated Factors Among Patients Admitted at Referral Hospitals in Northwest Ethiopia, 2022: A Multicenter Retrospective Study

Background

Poisonings are the most common reason for visiting emergency departments and hospitals globally. Poisoning-related mortalities increase instantly, and it is a principal public health problem in Ethiopia. Hence, understanding the treatment outcome and identifying the associated factors is necessary to reduce poisoning-related mortality.

Objective

To assess outcome of poisoning and associated factors among patients admitted to Referral Hospitals in Northwest Ethiopia, 2022.

Methods

An institutional-based retrospective cross-sectional study was conducted in Western Amhara referral hospitals from June 2019 to May 2022. A total of 400 medical charts were reviewed. A stratified sampling technique was used. The data were entered into Epi Info version 7.2.1.0 and exported to SPSS version 25.0 software for analysis. Multivariable binary logistic regression analysis was used to determine factors associated with the outcome of poisoning.

Results

The mortality rate of poisoning was 18% (95% CI: 14.4-22.1). Being rural dwellers (AOR=2.65, 95% CI: 1.07-6.63), being unconscious (AOR=4.86, 95% CI: 1.89-12.48), not treated in triage area (AOR=4.64, 95% CI: 1.608-13.407), transport by Bajaj (AOR=6.78, 95% CI: 1.86-24.73), spo2 <95% (AOR=4.42, 95% CI: 1.19-10.78), and stayed >48 hours in the hospital (AOR=0.08, 95% CI: 0.02-0.36) were significantly associated with a mortality of poisoning.

Conclusion

The mortality rate from poisoning was considerably high. Residence, level of consciousness, treatment at the triage area, mode of arrival, Spo2, and prolonged hospital stay were significantly associated. All stakeholders should focus on planning and improving care for patients with poisoning. Improving ambulance service in rural areas and providing treatment at the triage area for all patients are recommended.

A nomogram proposal for early prediction of intensive care unit admission in patients with acute antipsychotic poisoning

Background

Early identification of antipsychotic poisoned patients who may have a potential risk for intensive care unit (ICU) admission is crucial especially when resources are limited. Nomograms were previously used as a practical tool to predict prognosis and planning the treatment of some diseases including some poisoning conditions. However, they were not previously investigated in antipsychotic poisoning.

Aim

The current study aimed to construct a nomogram to predict the need for ICU admission in acute antipsychotic poisoning. Patients and methods: This 2-year study included 140 patients acutely intoxicated with antipsychotics and admitted at Tanta University Poison Control Centre throughout July 2019 to June 2021. Personal and toxicological data, findings of clinical examination and electrocardiography, as well as, results of laboratory investigations at time of admission were recorded. According to the outcome, patients were divided into ICU-admitted and ICU-not admitted groups.

Results

The results of this study provided a proposed nomogram that included five significant independent predictors for ICU admission in acute antipsychotic intoxications; the presence of seizures (OR: 31132.26[108.97-Inf]), corrected QT interval (OR: 1.04[1.01-1.09]), mean arterial blood pressure (OR: 0.83[0.70-0.92]), oxygen saturation (OR: 0.62[0.40 to 0.83)], and Glasgow Coma Scale (OR: 0.25 [0.06-0.56]).

Conclusion

It could be concluded that the developed nomogram is a promising tool for easy and rapid decision making to predict the need for ICU admission in acute antipsychotic poisoning.

Clinico-Epidemiological Profile and Short-Term Outcomes of Patients with Acute Poisoning Presenting to an Emergency of a Tertiary Care Center in Western Rajasthan

Background

This research aimed to evaluate the clinico-epidemiological profile and short-term outcomes of patients admitted to the emergency department of a tertiary hospital.

Materials and Methods

This prospective observational cross-sectional study was conducted between January 1, 2021, and June 30, 2022, in the Emergency Department of a tertiary hospital. Patients of either gender of any age attending the emergency department with acute poisoning were included. These cases were analyzed for their epidemiological profiles, poisoning characteristics, and various clinical variables influencing patient outcomes.

Results

Out of a total of 236 patients, 190 patients (80.5%) were aged more than 18 years. Comorbidities were present in 32 (13.5%) patients, and psychiatric illness was the most common comorbidity. The intention of poisoning was suicidal in 185 patients (78.4%) and accidental in 51 patients (21.6%). Organophosphate was the most common poisoning seen in 55 patients (23.3%), followed by drug ingestion seen in 44 patients (18.6%). Twenty-eight patients (11.8%) were transferred to the intensive care unit. Nineteen patients (8.1%) required mechanical ventilation. There were ten deaths (4.2%) in the study population. Aluminum phosphide poisoning was associated with the highest mortality rate, followed by organophosphate poisoning.

Conclusions

This study indicates that most poisoning cases involved young people, mainly males. Organophosphorus poisoning was one of the most common poisonings, followed by the ingestion of drugs in this part of the world. Aluminum phosphide had the highest fatality rate.

Prevalence of unfavorable outcome in acute poisoning and associated factors at the University of Gondar comprehensive specialized hospital, Gondar, Northwest Ethiopia: a hospital-based cross-sectional study

Background

Acute poisoning is a medical emergency in which the toxic effects occur almost immediately, usually within hours from the time of exposure, and can result from exposure to excessive doses of any chemical. It is the common cause of emergency admission, which may result in morbidity and mortality. There are a lot of factors that are associated with an increased magnitude of mortality and complication. Therefore, this study was carried out to assess the clinical characteristics of patients, unfavorable outcomes of acute poisoning, and associated factors to improve the quality of care, resource utilization, and decrease mortality.

Objective

This study aimed to assess the outcome and associated factors among acute poisoning patients at the University of Gondar Comprehensive Specialized Hospital, Gondar, Northwest Ethiopia (2021).

Methods

A prospective follow-up study was conducted from January 2021 to September 2021 at the University of Gondar Comprehensive Specialized Hospital, Gondar, Northwest Ethiopia. Data were collected using a comprehensively organized and pretested interviewer-administered questionnaire. The data were entered using EPI data version 4.6.0 statistical software and then exported to Stata 14 for analysis. The data were analyzed for descriptive statistics. Statistical analysis was performed using bivariate and multivariate logistic regression models to identify factors associated with the unfavorable outcome of acute poisoning. The result is presented in the form of tables, figures, and text using frequencies and summary statistics such as mean, SD, median, IQR, and percentage.

Result

A total of 233 patients were included in the study. The prevalence of unfavorable poisoning outcomes in acute poisoning was 17.6% (95% CI: 13.2, 23.1). In the multivariate logistic regression analysis, known chronic medical comorbidities [AOR: 3.846 (1.619, 9.574); value of p: 0.014] and hospital stay of less than 48 h [AOR: 6.57 (2.03, 21.273); value of p: 0.002] were found to be independent factors associated with unfavorable outcomes in acute poisoning.

Conclusion

The magnitude of unfavorable poisoning outcomes was high in patients with acute poisoning. Having known medical comorbid illness and short hospital stay of less than 48 h were found to be associated with unfavorable outcomes.

A Methodological Review of Drug-Related Toxicological Studies in Saudi Arabia

This study aimed to conduct a methodological review of drug-related toxicological studies in Saudi Arabia. A systematic review and a methodological analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Medline and Embase were searched for all types of studies reporting toxicological studies in the English language published until January 10, 2022. The search was conducted using both keywords and Medical Subject Headings (MeSH) terms. The methodological analysis of included studies was assessed using the Newcastle-Ottawa Scale. A total of 3,750 studies were extracted and screened. Of these, 30 observational studies (seven cohort studies and 23 cross-sectional studies) met the inclusion criteria. The methodological scores ranged from five to seven out of 10 possible points. Twelve studies had high quality, and 18 studies had moderate quality. Eight studies focused on adverse drug reactions, eight explored poisoning, four explored drug-related hospitalizations, nine explored drug-induced toxicity, and one explored drug overdose. This research project revealed that most of the drug-related toxicological studies conducted in Saudi Arabia were observational studies of moderate quality. Future studies should focus on the quality of the design and reporting.

Providing a Population Based Registry Model of Drug Poisoning in Iran

Background

The prevalence of drug poisoning is on the rise in Iran due to the increased public access to drugs. A national drug poisoning registry system is a suitable tool for better management, control, and prevention of drug poisoning.

Objectives

This study aimed to propose a national drug poisoning registry model for Iran.

Methods

This was an applied research conducted in two major phases. In the first phase, all sources pertaining to drug poisoning registries were reviewed, and a national drug poisoning registry model was proposed. In the second phase, this model was validated and finalized using a researcher-made questionnaire and through a two-stage Delphi technique.

Results

The focus of national drug poisoning activities and registry management reached the 100% consensus of experts at the Drug and Poison Information Center of the Food and Drug Organization (Ministry of Health and Medical Education). Goals, data sources, registry system structure, data set, standards, data exchange, registry features, and processes of the proposed model also achieved unanimous expert consensus.

Conclusions

Given the importance of a national drug poisoning registry in gathering, storing, analyzing, and reporting the data of patients, it is essential to provide a framework for evaluating and controlling drug poisoning and for generating valuable data for decision-making. The model proposed herein can offer the information infrastructure for designing and implementing such a system.

Acute poisoning in children in Ethiopia: a cross-sectional study

Acute poisoning is a global pediatric emergency problem. However, a wide variation in patterns of acute poisoning and associated factors across different geographical regions was stated. As a result, our research focused on the investigation of acute poisoning in children. An Institutional-based Retrospective study design was conducted at the University of Gondar comprehensive specialized hospital from October 2016 to October 2020. The analysis of the data was performed via SPSS Version 25. Furthermore, multiple logistic regression analysis was recruited. A P-value ≤ 0.05 was declared as statistically significant. Our study's prevalence of acute poisoning was 82/5489 (1.5%). 53 (64.6%) of patients were males. Of the total patients who had the diagnosis of poisoning, 54 (65.9%) came from rural areas. Venom was the most frequent offending agent (26.8%) and oral ingestion was the most common route of exposure (70.7%). Of the total patients who had the diagnosis of poisoning, 54 (65.9%) came from rural areas. Venom was the most frequent offending agent (26.8%), followed by insecticides (organophosphates) (21.5%). Accidental poisoning was the most common mode of poisoning more often than intentional (75.6-24.4%). The digestive tract (oral ingestion) (69.5%) was the commonest route of poisoning, followed by the cutaneous (skin bite) (24.4%). Death was three times more likely in the rural population than in urban residents [AOR 2.9 (1.21-13.7); P value 0.046]. Appropriate emergency care is the mainstay of the supportive management protocol for childhood poisoning.

Treatment outcome and associated factors among patients admitted with acute poisoning in a tertiary hospital in Eastern Ethiopia: A cross-sectional study

Introduction:

Acute poisoning causes morbidity and mortality worldwide. There is scarce of information on acute poisoning in the study area.

Objective:

To assess treatment outcome and the associated factors among patients admitted with acute poisoning at Hiwot Fana Comprehensive Specialized Hospital, Eastern Ethiopia.

Methods:

A cross-sectional study was conducted. All acutely poisoned patients who had been admitted at the emergency department of Hiwot Fana Comprehensive Specialized Hospital from 1 January 2016 to 31 December 2020 who fulfilled the inclusion criteria of the study were included. Data were collected by review of medical records. Poor treatment outcome of acute poisoning was defined as the acutely poisoned patient was died, or survived with disability. Multivariate logistic regression analysis was used to determine factors associated with the outcome of acute poisoning.

Result:

A total of 175 patient’s medical records were reviewed. Of these, 150 patient’s medical records had complete information and were included in the final analysis. The majority of participants 89 (59.3%) were in the age group of 19–37 years. More than half of the participants 86 (57.3%) were females. Organophosphate was the most poisoning agent encountered in 62 cases. Acetaminophen was the predominant drug poisoning agent encountered in 10 participants. Among 30 patients managed with antidote, 18 patients were treated with atropine for organophosphate poisoning. Of all the poisoning cases admitted during the study period, 16.7% died. Participants who were poisoned by themselves were 2.4 times more likely to have poor treatment outcomes than those who were poisoned accidentally: 2.44 (95% confidence interval: 1.10–5.42). The odd of having poor treatment outcome in participants who were poisoned by drugs was 2.13 more likely: 2.13 (95% confidence interval: 1.21–3.32).

Conclusion:

Organophosphate was the predominant cause of acute poisoning encountered in 62 cases. The modes of poisoning and drug poisoning were significant risk factors associated with poor treatment outcomes of acute poisoning.

Availability of Essential Antidotes and the Role of Community Pharmacists in the Management of Acute Poisoning: A Cross-Sectional Study in Ethiopia

Background

Morbidity and mortality related to acute poisoning is a major public health issue in both developing and developed countries. Community pharmacists have a crucial role in ensuring drug availability, increasing drug safety, counseling patients, overdose risk reduction and management, and provision of appropriate drug information. This study aimed to assess the availability of necessary antidotes in community pharmacies in Gondar and Bahir-Dar cities, Ethiopia, and the role of community pharmacists in the management of acute poisoning.

Methods

A cross-sectional survey was conducted in Gondar and Bahir-Dar cities. A self-administered, structured questionnaire was used for data collection and Statistical Package for Social Sciences (SPSS) version 24.0 was used for data analysis. Chi-square analysis was computed to identify the associated factors with a confidence interval of 95% and a P value less than .05 was used as a cut-point for statistical significance.

Results

Out of 101 community pharmacies invited to participate in the study, 80 of them completed the survey with a response rate of 79.2%. The overall mean antidote availability score was .59 (SD = .837), which falls within the definition of Poor availability. None of the pharmacies had kept all of the antidotes, and the maximum number of an antidote kept by a single pharmacy was 7 out of nineteen essential antidotes surveyed. The most commonly reported reason for the unavailability of essential antidotes was stock was not ordered (56.3%) followed by stock ordered but not delivered from suppliers (wholesalers) (20.0%). More than 3 fourth of the respondents (83.8%) had poor knowledge about the antidotes for the common poisonings.

Conclusion

There was a significantly very low availability of essential antidotes in the community pharmacies. Strategies should be implemented to improve pharmacist’s knowledge about antidotes, and management of poisoning emergencies through on-job training and provision of reference materials.

Acute Poisoning Cases Presented to the Addis Ababa Burn, Emergency, and Trauma Hospital Emergency Department, Addis Ababa, Ethiopia: A Cross-Sectional Study

Background

Acute poisoning is a common reason for visits to the emergency room and hospitalization across the world, as well as a possible cause of morbidity and death. This study aimed to assess acute poisonings at Addis Ababa Burn, Emergency, and Trauma (AaBET) Hospital. Methodology. A one-year cross-sectional study was conducted at AaBET Hospital from February 1, 2018, to January 31, 2019. Data were collected using a structured and pretested questionnaire by the Emergency Medicine and Critical Care residents from acutely poisoned patients' interviews and patient charts.

Results

Data were collected from 98 acute poisoning cases, and 52% were males and 48% were females. 85 (86.7%) were less than 45 years. 52 (55.1%) were unemployed, and 33 (33.7%) were farmers. 96 (98%) cases were due to intentional poisoning, and 96 (98%) had oral ingestion. Organophosphates poisoning (27.5%) was the commonest cause, followed by 26.5% of unknown poisons and 16.3% prescribed drugs. Sixty-six percent of the patients presented to the hospital after 2 hours of ingestion. The case fatalities were 10.2% of which 40% of the cases were due to 2,4-dichlorophenoxyacetic (2, 4-D) poisoning, followed by aluminum phosphide (20%).

Conclusion

This study showed farmers and the unemployed were more affected. The most common mode of poisoning was intentional poisoning, oral ingestion being the primary route. The common poisons used by the victims were organophosphates. 2, 4-D poisoning was the major cause of death.

An analysis of 1344 consecutive acute intoxication cases admitted to an academic emergency medicine department in Turkey

OBJECTIVE:

One of the major causes of emergency department (ED) visits is acute poisoning. Acute intoxications occur soon after either single or multiple exposures to toxic substances, and they started to be a more serious problem in developing countries. The objective of this study was to investigate the local patterns of acute intoxications, as well as clinical and sociodemographic characteristics of patients with acute poisoning, admitted to our hospital’s ED.

METHODS:

This single-center, retrospective study was conducted using medical records of consecutive patients admitted to the ED between January 2016 and December 2017.

RESULTS:

A total of 1344 patients were included in the statistical analysis. Of these, 673 (50.1%) were female. Mean (±SD) age was 32.2 (±12.0), ranging between 17 and 84 years. The highest number of poisoning cases was observed in summer, especially in July (10.0%) and August (11.8%), whereas lowest number of admissions related to poisoning occurred during winter in November (5.1%) and December (5.2%). Among admitted cases, many were suicide attempts (55.7%) followed by non-intentional (accidental) ingestion of non-pharmaceutical (n=553, 41.2%) and pharmaceutical agents (n=42, 3.1%). Single agents were the most common cause of acute intoxications (63.2%) rather than multidrug intoxications. Most frequently observed causes of poisonings were recreational substances (30.0%) and agents exposed by inhalation (13.2%). INR, lactate, and pH levels at admission were significant predictors of 7-day mortality without a significant paired difference between each other. The AUCs for each were 0.89 (SE 0.04; p<0.0001), 0.84 (SE 0.10; p=0.0007), and 0.79 (SE 0.11; p=0.0102), respectively.

CONCLUSION:

We conclude that recreational substances and medicinal drug intoxications were the leading cause of acute poisonings in our region, occurring mostly during the summer.

Minimum Data Set for a Poisoning Registry: A Systematic Review

Poisoning, as a well-known medical condition, puts everyone at risk. As a data management tool, a registry plays an important role in monitoring the poisoned patients. Having a poisoning minimum data set is a major requirement for creating a poisoning registry. Therefore, the present systematic review was conducted in 2019 to identify the minimum data set for a poisoning registry. Searches were performed in four scientific databases, i.e., PubMed, Scopus, Web of Science, and Embase. The keywords used in the searches included minimum data set, "poison", and "registry". Two researchers independently evaluated the titles, abstracts, and texts of the papers. The data were collected from the related papers. Ultimately, the minimum data set was identified for the poisoning registry. Data elements extracted from the sources were classified into two general categories: administrative data and clinical data. Ninety-eight data elements in the administrative data category were subdivided into three sections: general data, admission data, and discharge data. One-hundred and thirty-one data elements in the clinical data category were subdivided into five sections: clinical observation data, clinical assessment data, past medical history data, diagnosis data, and treatment plan data. The minimum data set is a prerequisite for creating and using a poisoning registry and data system. It is suggested to evaluate and use the poisoning minimum data set in accordance with the national laws, needs, and standards based on the opinion of the local experts.

Toxicoepidemiology of poisoning exhibited in Indian population from 2010 to 2020: a systematic review and meta-analysis

OBJECTIVE

To determine the prevalence of pesticide, corrosive, drugs, venom and miscellaneous poisoning in India.

SETTING

Systematic literature search was done in PubMed Central, Cochrane and Google Scholar databases for studies that satisfied the inclusion criteria. Systematic review and meta-analyses of all observational studies published in the English language from January 2010 to May 2020 were included in this review.

PARTICIPANTS

Patients exposed to poisoning reported to hospitals were included.

PRIMARY AND SECONDARY OUTCOME MEASURES

The prevalence of pesticide poisoning was analysed. The prevalence of poisoning due to corrosives, venom, drugs and miscellaneous agents, along with subgroup analysis based on age and region, was also determined. The percentage of persons with poisoning along with 95% CI was analysed.

RESULTS

Pooled analysis of studies revealed that pesticides were the main cause of poisoning in adults, with an incidence of 63% (95% CI 63% to 64%), while miscellaneous agents were the main cause of poisoning in children, with an incidence of 45.0% (95% CI 43.1% to 46.9%), among those presenting to hospitals. Pesticide poisoning was the most prevalent in North India (79.1%, 95% CI 78.4% to 79.9%), followed by South (65.9%, 95% CI 65.3% to 66.6%), Central (59.2%, 95% CI 57.9% to 60.4%), West (53.1%, 95% CI 51.9% to 54.2%), North East (46.9%, 95% CI 41.5% to 52.4%) and East (38.5%, 95% CI 37.3% to 39.7%). The second most common cause of poisoning was miscellaneous agents (18%, 95% CI 18% to 19%), followed by drugs (10%, 95% CI 10% to 10%), venoms (6%, 95% CI 6% to 6%) and corrosives (2%, 95% CI 1% to 2%).

CONCLUSIONS

Pesticide poisoning is the most common type of poisoning in adults, while miscellaneous agents remain the main cause of poisoning in children.

PROSPERO REGISTRATION NUMBER

CRD42020199427.

The Disclosure Dilemma: Willingness to Disclose a Positive HIV Status Among Individuals Preparing for HIV Testing During Antenatal Care in Tanzania

HIV status disclosure can reduce transmission risks and improve care engagement. Individuals may have strong feelings about HIV disclosure even prior to diagnosis. We assessed willingness to disclose a positive HIV status among pregnant women and their male partners awaiting routine HIV testing during antenatal care in Tanzania (n = 939). Logistic regression models were used to examine factors associated with willingness to disclose to one's inner circle (partner/family member) and outer circle (friend/neighbor) in the event of an HIV diagnosis. Almost all (93%) were willing to disclose to at least one person; participants were more willing to disclose to their inner circle (91%) vs outer circle (52%). Individuals with some form of employment, more stigmatizing attitudes of social distancing of PLWH, greater anticipated HIV stigma, more perceived social support, and prior contact with someone living with HIV were more likely to disclose to their inner circles. Individuals who were older, male, and who had higher levels of perceived social support were more willing to disclose to their outer circle. These findings increase the understanding of the intra- and interpersonal factors that influence HIV disclosure decisions. Tailored pre- and post- HIV test counseling are needed to facilitate social support and overcome barriers to disclosure if they test positive for HIV.

Prevalence, Predictors and Treatment Outcome of Acute Poisoning in Western Ethiopia

Background

Acute poisoning is a common reason for visiting the emergency department (ED) worldwide. However, little is known about this issue in the western part of Ethiopia. This study was carried out to determine the prevalence, predictors, and treatment outcome of acute poisoning at the ED of western Ethiopia.

Patients and Methods

A hospital record-based retrospective study design was conducted on all patients admitted to the ED of the two hospitals between 01 January 2018 to 17 March 2019. Socio-demographic, clinical presentation, medication history, poisoning characteristics, time to hospital arrival, treatment given, and outcome of treatment were collected. All collected data were analyzed using SPSS Version 20. Backward multiple logistic regression analysis at p-value ≤0.05 tested the predictor for treatment outcome.

Results

The prevalence of acute poisoning was 134/7883 (1.7%) per ED admissions. The mean ±SD age of the study participants was 23.90±10.606 with female to male ratio of 1:1.06. The most vulnerable patients to poisoning were individuals in the age range of 18 to 29 years 68/134 (50.7%) for both genders. Moreover, the most common poisoning agent was organophosphate 72/134 (53.7%). Besides, intentional poisoning was the most common 103/134 (76.9%) manner of poisoning with family disharmony 37/103 (35.9%) as the common reason. The case fatality rate of acute poisoning in the two hospitals was 2/134 (1.5%). The mean ±SD length of hospital stay was 1.86 ±0.943. The independent predictors of poor treatment outcome of acute poisoning were age ≥35 years [p-value= 0.049], female gender [p-value= 0.027], and hospital stay of >48 hours [p-value= 0.035].

Conclusion

The prevalence of acute poisoning in western Ethiopia is higher than the ever-reported data in Ethiopia. Thus, stakeholders should have to pay more attention to prevention and control strategies and appropriate handling of agrochemical substances to minimize their negative effects on this productive age group.

Development a national minimum data set for poisoning registry in Iran

OBJECTIVES

In the developing countries with high mortality rates, poisoning is considered to be one of the most common causes of admission to emergency wards. Given the importance of registering data on poisoned patients, it is very important to have a complete poisoning Minimum Data Set (MDS). Therefore, the purpose of this study was to determine an MDS for poisoning registry in Iran.

METHODS

This applied and cross-sectional study was conducted through of Delphi technique in the poisoning ward of Imam Reza Hospital (northeastern Iran) in 2019. Literature reviews were initially carried out on such databases as PubMed, Web of Sciences, Scopus, and Embase. Then, Google search was done to retrieve poisoning forms and poisoning registry websites. Also, we considered International Classification of Diseases, 10th Revision coding guidelines of poisoning. Then, a questionnaire containing data elements of poisoning was developed.

RESULTS

In total, 558 data elements were developed during two rounds of Delphi technique. The MDS was divided into 10 categories including patient and communication data, encounter data, diagnostic data and medical history, exposure data, clinical data, treatment data, complications, paraclinical tests, biobank, and discharge data.

CONCLUSIONS

Establishing an MDS as the first and most important step towards implementing poisoning registry can be the standard basis for collecting poisoned patient data. The data registered in the poisoning registry can be used for planning, policy-making, prevention, and control purposes.