Acute intoxications: Differences in management between six Dutch hospitals

Abstract

Context . Acute intoxications are frequently seen in Dutch hospitals. Based on single-centre studies and the fact that there are no clear guidelines, we hypothesised that hospital admission of acute intoxications may vary. Furthermore, decontamination treatment of poisonings may differ between hospitals, as earlier studies showed that adherence to international guidelines concerning decontamination may be poor. Objective . We aim to identify possible variations in Dutch hospital admission and decontamination treatment of patients with acute intoxications. Materials and methods . Data on acute intoxications was retrospectively collected from patient records from the emergency departments of six Dutch hospitals. All patients older than 14 years who presented between 1 January 2008 and 31 December 2008 were included in the study. Results . The percentage of suicide attempts differed signifi cantly between the hospitals (25 -73%, p Ͻ 0.0001) as equally the percentage of intoxications with drugs of abuse (18 -61%, p Ͻ 0.0001). Marked differences in admission rates were found (27 -78%, p Ͻ 0.0001) and these differences remained even when intoxications because of suicide attempts and drugs of abuse were analysed separately (admission rate of 52 -87%, p Ͻ 0.0001 and 8 -71%, p Ͻ 0.0001 respectively). Reported consultation with the National Poisons Information Centre differed between hospitals (range 0% to 80 -100%). No statistical differences were found between hospitals for the use of activated charcoal (16.1 -42.5%, p = 0.037). Gastric lavage was used infrequently in all hospitals. (6.6 -16.7%, p = 0.614). Discussion and conclusion . The admission rate of patients with an acute intoxication varies considerably, especially in the case of intoxications with drugs of abuse. Consultations with the National Poisons Information Centre differed between the six hospitals. Rates of decontamination did not vary, which may indicate adherence to guidelines by the American Academy of Clinical Toxicology, European Association of Poisons Centres and Clinical Toxicologists. National guidelines or admission algorithms may reduce variations in poisoning management and make the care for these patients more effi cient.

Characteristics and costs in adults with acute poisoning admitted to the emergency department of a university hospital in Belgium

“…The mean age average of 37 years in our study was within the range of most studies (33-40y) [3,4,10,11,14,17,18,32] although some studies found a lower mean age (range 23-28y) [2,5,12].…”

“…In the Netherlands, Duineveld et al [4] analysed acute intoxications in six hospitals. They reported the use of ethanol whether or not in combination with other drugs in 318/1,183 patients.…”

“…In cases of drugs of abuse (DOA), ethanol was involved in 73.5%, of which 60.7% mono-intoxications and 39.3% in combination with (illicit) drugs. In the 735/1.183 suicide attempts in the study of Duineveld et al [4], seven cases of mono-intoxications with ethanol with the intention of self-harm were recorded. It is not clear if ethanol was involved in other cases of intentional self-harm which may to some extent explain the low percentage of cases with ethanol involved.…”

Deliberate Drug Poisoning with Slight Symptoms on Admission: Are there Predictive Factors for Intensive Care Unit Referral? A three‐year Retrospective Study

“…However, these severity scores are not relevant in ED daily practice because they underestimate DDP mortality, they usually predict outcome 24 hr after admission and they rely on complex algorithms and biological data [17][18][19]. This lack of validated severity score leads to significant variations in the management of poisoned patients and to potential inappropriate use of medical resources [20]. The purpose of this study was therefore to identify simple factors associated with intensive care unit (ICU) admission that could help physicians in the triage of DDP patients without obvious life-threatening symptoms on ED admission.…”

HyperCKemia and rhabdomyolysis in the neuroleptic malignant and serotonin syndromes: A literature review

“…In addition, there is a higher use of antipsychotics in men compared to women, and men are known also to adhere to medication more consistently [25]. Also, in a study on acute intoxications in six Dutch hospitals, intoxications due to substance abuse was more frequently seen in men (66.0%) [26].…”