A Retrospective Study of Acute Poisoning Cases and Their Management at Emergency Department of Dessie Referral Hospital, Northeast Ethiopia

Poisoning cases and their management in Amhara National Regional State, Ethiopia: Hospital-based prospective study

BACKGROUND

Poisoning is a significant public health problem globally. Ethiopia is a low-income country undergoing technological and social change that may increase access to drugs and chemicals, potentially increasing the incidence of poisoning. This study describes the epidemiology of hospital admissions due to poisoning in a region of Ethiopia.

METHODS

An institution based prospective observational study was employed, as a study design, in selected hospitals of the region from January to December 2018.

RESULTS

Of 442 poisoning cases, 78 (17.6%) died. Almost all poisoning cases were intentional self-poisonings. The most frequent poisonings were organophosphate compounds, 145 (32.8%), and metal phosphides (majorly aluminum phosphide), 115 (26.0%). The ingested poison was most frequently accessed from the patients' homes, 243 (55.0%), followed by purchases from local shops, 159 (36%). The median duration of admission was 24 hours. Of all the cases, 23 (5.2%) were admitted to intensive care units (ICU) requiring mechanical ventilation. Most of the cases admitted to the ICU were aluminum phosphide-poisoned patients. The majority of deaths (43 of 78) were due to metal phosphides. From the multivariate logistic regression analysis, altered level of consciousness on hospital arrival, metal phosphide poisoning, and no laboratory result as a part of the diagnosis process or investigation of the extent of toxicity were found to be significantly associated with the likelihood of poor treatment outcome.

CONCLUSION

The majority of the poisoning cases were females. The most common reasons for the intent of self-poisoning were dispute-related, mainly family disharmonies, followed by psychiatric conditions. The poisoning agents were mostly obtained from households. Organophosphate compounds and metal phosphides were the first and the second most frequently encountered poisoning agents, respectively, and it was noted that the later ones were responsible for most of the fatal cases. Of the pharmacologic interventions, atropine was the only agent regarded as an antidote. The most commonly employed agent for supportive treatment was cimetidine followed by maintenance fluids, while gastric lavage was the only GI decontamination method used among others. The fatality rate of poisoning in this study was found to be much higher than in other similar studies. Impaired consciousness upon hospital arrival, metal phosphide poisoning, and no involvement of laboratory investigation were found to significantly associate with the likelihood of death. Generally, the results dictate the need for the design and implementation of strategies to create awareness, prevent, and manage poisoning incidences in the community.

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.

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.

Uncovering the Hidden Burden of Pharmaceutical Poisoning in High-Income and Low-Middle-Income Countries: A Scoping Review

Pharmaceutical poisoning is a significant global public health concern, causing approximately 190,000 deaths annually. This scoping review aims to comprehensively map the available literature on pharmaceutical poisoning and compare patterns between high-income countries (HICs) and low-middle-income countries (LMICs). A systematic search was performed across the following databases: Embase, PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and CINAHL. Studies included were from 1 January 2011 to 31 December 2020, in English, with full text available. Seventy-nine articles were included in the study; 21 were from LMICs and 58 were from HICs. Toxic exposure was largely intentional (77%) in LMICs and accidental (68%) in HICs. Drugs acting on the nervous system were responsible for 95% of toxicities worldwide with analgesics accounting for the largest subtherapeutic group in both LMICs (40%) and HICs (58%). Notable statistics were that HICs accounted for 99% of opioid overdoses, and LMICs accounted for 19% of anti-epileptic-induced toxicities. Overall, the medical outcomes due to poisonings were generally worse in LMICs. The review provides possible interventions to target specific geographic locations, based on the trends identified, to reduce the burden worldwide. Many gaps within the literature were recognised, calling for more robust analytical research.

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.

Trends and profiles of acute poisoning cases: a retrospective analysis

Acute poisoning is a significant public health concern. This retrospective study investigates trends in acute poisoning cases and explores the clinical and sociodemographic profiles associated with this condition. Medical data from 859 hospitalized patients diagnosed with acute poisoning between January 2017 and December 2022 were comprehensively analyzed. The descriptive statistical analysis revealed that 360 patients had underlying diseases, with depression being the most prevalent among them. Furthermore, urban areas accounted for 87.2% of the acute poisoning cases, indicating a higher incidence compared to rural areas. The substances implicated in acute poisoning incidents varied, with drugs of abuse being the most common (53.2%), followed by pesticides (22.2%), carbon monoxide (11.8%), and alcohol (5.4%). Suicide attempt/suicide emerged as the leading cause of acute poisoning incidents, accounting for 75.9% of cases, while poisoning accidents predominantly occurred within the home setting. Through chi-square tests, it was determined that risk factors for suicide attempt/suicide included female gender and underlying medical conditions. Temporal analysis showed that the total number of acute poisoning cases increased from 2017 to 2019 and decreased from 2019 to 2022. Notably, suicide-related cases exhibited an upward trend, with suicide attempt/suicide accounting for over 80% of all acute poisoning cases after 2020. This study contributes valuable insights into the trends, profiles, and risk factors associated with acute poisoning cases.

Study of pattern and outcome of acute poisoning cases at tertiary care hospital in North India

Introduction

The WHO 2021 data estimate that 2 million lives and 53 million disability-adjusted life-years were lost in 2019 due to exposures to selected chemicals. It is important to know the pattern and outcome of acute poisoning cases for proper planning, prevention and management. Knowing the pattern will also help in designing training modules for primary care physicians to make them aware about newer poisons and their management. Awareness regarding newer poisons consumed is necessary for early identification, initial management and timely referral to higher centres by primary care physicians. This study was performed to see the pattern and outcome of acute poisoning cases in North Indian population and various factors related to outcome.

Materials and Methods

This study was conducted in department of medicine of a teaching institute in North India after approval by the Institutional Review Board. Patients admitted in the department during the study and fulfilling the inclusion criteria were enrolled in the study after obtaining consent.

Results

A total of 417 patients with poisoning were recruited in the study. Out of 417 patients, majority were males (59.5%). Maximum number of patients were in the age group of 21-30 years (33.8%), and rural population (79.9%) was found to be more affected. Most of the patients were students and private employees. Most common types of poisoning were snakebite (n = 109, 26.1%), organophosphate (n = 49, 11.8%) and aluminium phosphide (n = 39, 9.3%). Out of 417 patients, 349 (83.69%) improved, while 68 (16.3%) expired. Requirement of ventilatory support was most commonly associated with aluminium phosphide poisoning (30.12%) followed by organophosphate poisoning (24.1%).

Conclusion

Poisoning was more common in young males and more prevalent in rural population. Pesticides and snakebite were major causes of poisoning. Among suicidal cases, family conflict (problem/altercation with family members/marital discord) was main reason for the consumption of poison. There is need for creation of poison information centre along with separate toxicological units in tertiary care hospitals.

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.

Comparative Study of Demographic and Toxico-Clinical Factors of Patients with Acute Poisoning Admitted to General Intensive Care Unit versus Specific Intensive Care Unit for Poisoning Cases

Background

There is no dedicated specific intensive care unit (ICU) for poisoning cases due to the small number of poisoned patients in some poisoning centers and patients may hospitalized in the general ICU. In this study, we compared the outcome of hospitalization in poisoning and general ICU, in matched patients to demographical and toxico-clinical factors.

Materials and Methods

This historical cohort study was conducted from September 2020 to January 2022 in the general and poisoning ICUs of Khorshid Hospital affiliated to the University of Medical Sciences, Isfahan, Iran. Patient characteristics, clinical, and toxicological information as well as the therapeutic measures and outcome were collected from hospital medical records and analyzed.

Results

Totally, 178 (60.1% male and 39.9% female) patients met inclusion criteria. Medicines (56.2%) and opioids (25.3%) followed by pesticides (14%) were the most common substances. Suicide was the type of exposure in 78.7% of the cases. Most patients suffered from lung (19.1%) and kidney (15.2%) injuries. The mortality rate was 23.6%. The median length of hospital stay (P-value < 0.001) and duration of ventilator usage was higher (P-value < 0.001) in general ICU compared to specific ICU for poisoning cases. No significant difference with respect to demographic, toxico-clinical variables and mortality rate was found between the two groups.

Conclusion

Among poisoned patients admitted to ICU, reported mortality rate was relatively high. Patients who hospitalized in the specific ICU for poisoning cases have lower length of hospital stay and duration of mechanical ventilation compared to general ICU.

Epidemiology of poisoning in Syria (1999 through 2020)

INTRODUCTION

Acute poisoning is a significant international public health issue and one of the leading causes of death in the emergency department (ED). In the absence of any previous reports describing the poisoning profile in Syria, we present this study to assess the epidemiological and clinical characteristics of poisoning over 21 years.

METHODS

We collected the data retrospectively from the Syrian Poisons Information Centre (SPIC) from January 1999 until December 2020. The data included patients who had accidental or non-accidental exposure to poisons, either by drugs, medicaments, and biological substances or substances chiefly nonmedicinal sources such as soaps and detergents, corrosive substances, pesticides, and other miscellaneous products.

RESULTS

We collected the data of 120,972 poisoned patients, of whom 52.6% were females, and 47.4% were males. Aleppo governorate reported the highest number of poisoned cases (28.6%), followed by Damascus governorate (19.9%). The highest poisoning rates were recorded in 2020, 2014, and 2010. Pharmaceutical (37.0%) and animal (33.8%) sources were the most common causative agents. The oral route was the route of poisoning in 58.3% of patients, and 33.4% through the skin. The most common poison was scorpion stings 19.5% while the most common cause of death was organophosphates 15.7%.

DISCUSSION

The differences in socioeconomic status, cultural habits, and agricultural and industrial activities between countries have led to a state of fluctuation regarding the most common poisoning agents.

CONCLUSION

Damascus and Aleppo, the two major governorates in Syria, had the highest poisoning cases. Oral administration of pharmaceutical agents was responsible for most of the poisoning cases. The most common individual poison was the scorpion poison, while the top killer was organophosphates.

Trends and Outcomes of Acute Poisoning in Felege Hiwot Comprehensive Specialized Hospital Medical Intensive Care Units: Retrospective Study

Background

Acute poisoning with agrochemicals, medicines and different environmental exposures continues to be a global health problems. However, with our search for reports about acute poisoning, there was no data regarding a change in trends and outcomes of acute poisoning in Ethiopia and its districts.

Objective

This study was to determine the burden of poison-related health hazards, identify poisoning substances, and clinical outcomes of poisoning cases admitted to Felege Hiwot Comprehensive Specialized Hospital- Medical intensive care unit (FHCSH-MICU), Bahir Dar, Ethiopia.

Methods

A retrospective hospital-based study was conducted using patient data archived from March 2019 to February 2020 at FHCSH-MICU. Collected data were analyzed using Statistical Package for Social Sciences (SPSS) software version 26 and descriptive statistics such as measures of central tendency and proportions were computed. The results were reported as text narrations, figures and tables.

Results

A total 121 poisoned patients were identified from the patient registration log books. Among the total FHCSH-MICU cases registered, acute poisoning accounted for 17.0%. Of 121 poison cases, 118 (98.3%) were due to suicide attempts with the female to male ratio being 1.5:1. The majority, 65 (54.0%), of cases were in the range of 21-30 years age. Nearly two-thirds, 75 (62.0%), of the poisoning cases died, accounting for 21.6% of all deaths in the FHCSH-MICU. The most common poisoning substance was aluminum phosphide, 92 (76%).

Conclusion and Recommendations

Aluminum phosphide became the leading poisoning substance in the study area. Nearly two-thirds of the poisoning cases died. Hence, aluminum phosphide must be placed in secured and inaccessible places and it should be replaced by less poisonous rodenticides. Health education and awareness creation about this lethal toxin are strongly advisable.

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.

Poisoning-related emergency department visits: the experience of a Saudi high-volume toxicology center

BACKGROUND

Acute poisoning is a major contributing factor to mortality and morbidity. There is a lack of research on the epidemiology of acute poisoning risk factors in Saudi Arabia.

OBJECTIVES

Descriptive overview of poisoning cases at a tertiary care center.

DESIGN

Descriptive, medical record review.

SETTINGS

Tertiary care center in Riyadh.

PATIENTS AND METHODS

From the electronic medical record system, we collected demographic information, medical history, and the poisoning history on all emergency department visits diagnosed as acute poisoning from January 2016 to January 2021. Patients were classed as children (<18 years old) or adults, and further classified by body mass index.

MAIN OUTCOME MEASURES

Intensive care unit (ICU) admission, organ transplantation, and mortality were classified as poor outcomes.

SAMPLE SIZE

492 adults and 1013 children (<18 years old) were identified.

RESULTS

The most frequent agent in poisoning for both groups was acetaminophen (n=52, 10.57% and n=100, 9.87%, respectively). The ICU admission rate was 6.7% and 4.8%, and the mortality rate 0.8% and 0.3%, respectively. The accidental poisoning rate was 57.7% among adults (n=284) and 67.6% among children (n=658). The suicide intention rate was 11.2% (n=55) and 7.4% (n=75) among adults and children, respectively. The management for both populations was nonspecific, involving observation, supportive measures, and symptomatic treatment.

CONCLUSION

Although the ICU admission rates were consistent with reported data, the mortality rate was marginally lower. The pediatric predominance in the population implies a lack of caregiver education in the region regarding the safe storage of drugs and household products, as well as the use of child-resistant packaging. The high rate of accidental poisoning in both age groups should prompt further investment to promote public health education on the rational use and safe storage of toxic agents and self-protection. The high suicide intention rate needs to be investigated to develop multidisciplinary risk prevention strategies.

LIMITATIONS

Single center, retrospective, small population size.

CONFLICT OF INTEREST

None.

Probabilistic model to predict the outcome in acute suicidal chemical poisoning cases from age and gender of patient and type of chemical poison consumed

Background: Acute chemical poisoning is a significant global health problem. Chemical poisons include agrochemical, household and industrial poison subtypes. The present study used a probabilistic model based on age, gender and type of poison consumed by the patient to predict the outcome in acute suicidal poisoning cases. Material and methods: A prospective observational study was conducted at emergency department of SMS Hospital, Jaipur, India, from January 2019 to February 2020. Patients over 15 years of age with poisoning severity score 2 or above were included in the study. Probabilistic model was used to predict the outcome measured in terms of cure, death and left against medical advice (LAMA) using Minitab 14. Results: Poisoning cases were 0.32 % of all emergency presentations. Out of them, 857 (59.6 %) had consumed chemical poison. Their mean age was 32 years and men to women ratio was 1.22. Agrochemical subtype was most common followed by household and industrial poisoning. Analysis by Probabilistic model showed that person between 30-60 years is more likely to be cured and chances of death and LAMA are highest in age group 60-75. Gender-wise, men have higher possibility for recovery. Besides, a person has highest chances of recovery in case of household poisons; death is most common in industrial poisons and LAMA in agrochemical poisons. Conclusion: The study concluded that in poisoning, patients' basic information like age, gender, type of poison consumed can be used to identify high death probability and LAMA risk patients. It will assist in designing and monitoring the most effective strategies for them.