A retrospective descriptive study of the characteristics of deliberate self-poisoning patients with single or repeat presentations to an Australian emergency medicine network in a one year period

Abstract

BackgroundA proportion of deliberate self-poisoning (DSP) patients present repeatedly to the emergency department (ED). Understanding the characteristics of frequent DSP patients and their presentation is a first step to implementing interventions that are designed to prevent repeated self-poisoning.MethodsAll DSP presentations to three networked Australian ED’s were retrospectively identified from the ED electronic medical record and hospital scanned medical records for 2011. Demographics, types of drugs ingested, emergency department length of stay and disposition for the repeat DSP presenters were extracted and compared to those who presented once with DSP in a one year period. Logistic regression was used to analyse repeat versus single DSP data.ResultsThe study determined 755 single presenters and 93 repeat DSP presenters. The repeat presenters contributed to 321 DSP presentations. They were more likely to be unemployed (61.0% versus 39.9%, p = 0.008) and have a psychiatric illness compared to single presenters (36.6% versus 15.5%, p < 0.001). Repeat presenters were less likely to receive a toxicology consultation (11.5% versus 27.3%, p < 0.001) and were more likely to abscond from the ED (7.5% versus 3.4%, p = 0.004). Repeat presenters were more likely to ingest paracetamol and antipsychotics than single presenters. The defined daily dose for the most common antipsychotic ingested, quetiapine, was less in the repeat presenter group (median 1.9 [IQR: 1.3-3.5]) compared with the single presenter group (4 [1.4-9.5]), (OR 0.85, 95% CI 0.74-0.99).ConclusionPatients who present repeatedly to the ED with DSP have pre-existing disadvantages, with increased likelihood of being unemployed and having a mental illness. These patients are also more likely to have health service inequities given the greater likelihood to abscond from the ED and lower likelihood of receiving toxicology consultation for their DSP. Early recognition of repeat DSP patients in the ED may facilitate the development of individualised care plans with the aim to reduce repeat episodes of self-poisoning and subsequent risk of successful suicide.

Paracetamol poisoning in adolescents in an Australian setting: Not quite adults

“…In a larger cohort of adult overdose patients taking a wide range of medications, women represented 65% of patients presenting with DSP to our hospital network. 2,5 With paracetamol, this percentage was considerably higher in both adults and adolescents in the current study.…”

“…Although DSP is generally weighted towards the female sex as a form of intentional self‐harm, we found that adolescents ingesting paracetamol were even more likely to be women. In a larger cohort of adult overdose patients taking a wide range of medications, women represented 65% of patients presenting with DSP to our hospital network . With paracetamol, this percentage was considerably higher in both adults and adolescents in the current study.…”

Mortality and repeated poisoning after self-discharge during treatment for acute poisoning by substances of abuse: a prospective observational cohort study

“…In a Canadian study of hospitalised patients using illicit drugs, unstable employment, incarceration, daily heroin injection and younger age were associated with leaving against medical advice [27]. An Australian study of patients with deliberate self-poisoning found absconding patients more likely to have a mental illness and to be unemployed [28]. Among trauma patients in California, readmissions were more likely to be for psychiatric reasons following discharge against medical advice compared to regular discharge [3].…”

Self-Inflicted Gunshot Wound as a Consideration in the Patient Selection Process for Facial Transplantation

“…The association between mental illness and suicide, as well as repeat attempts, 28,29,30,31,32,33 has led to concern that recipients with self-inflicted injuries may have difficulty withstanding the rigors of the FT procedure and subsequent long-term treatment, particularly with regard to adherence. Inability to adhere to the post-transplant regimen can lead to adverse outcomes, including rejection and graft failure.…”