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

Abstract

Deliberate drug poisoning leads to 1% of emergency department (ED) admissions. Even if most patients do not exhibit any significant complication, 5% need to be referred to an intensive care unit (ICU). Emergency physicians should distinguish between low-and high-acuity poisoned patients at an early stage to avoid excess morbidity. Our aim was to identify ICU transfer factors in deliberately self-poisoned patients without life-threatening symptoms on admission. We performed a 3-year retrospective observational study in a university hospital. Patients over 18 years of age with a diagnosis of deliberate drug poisoning were included. Clinical and toxicological data were analysed with univariate tests between groups (ED stay versus ICU transfer). Factors associated with ICU admission were then included in a logistic regression analysis. Two thousand five hundred and sixtyfive patients were included. 63.2% were women, and median age was 40 (28-49). 142 patients (5.5%) were transferred to ICU. Cardiac drugs [adjusted OR (aOR) = 19.81; 95% confidence interval (95% CI): 7.93-49.50], neuroleptics (aOR = 2.78; 95% CI: 1.55-4.97) and meprobamate (aOR = 2.71; 95% CI: 1.27-5.81) ingestions were significantly linked to ICU admission. A presumed toxic dose ingestion (aOR = 2.27; 95% CI: 1.28-4.02), number of ingested tablets (aOR = 1.01; 95% CI: 1.01-1.02 for each tablet) and delay between ingestion and ED arrival <2 hr (aOR = 2.85; 95%CI: 1.62-5.03) were also factors for ICU referral. The Glasgow Coma Scale was the only clinical feature associated with ICU admission (aOR = 1.57; 95% CI: 1.44-1.70 for each point loss). These results suggest that emergency physicians should pay particular attention to toxicological data on ED admission to distinguish between low-and high-acuity self-poisoned patients.Deliberate drug poisoning (DDP) is a major public health problem with more than 210,000 patients hospitalized in the United States in 2010 [1]. The annual incidence of DDP is around 2-6& in most western countries and DDP accounts for 1% of all emergency department (ED) visits [1][2][3][4]. One major problem concerning the ED management of such a high number of DDP patients is the respective proportion of lowand high-acuity patients. On the one hand, the vast majority of DDP patients attending the ED do not have any severe symptoms and do not require any specific intervention [5,6]. Inappropriate recognition of such patients lead to unnecessary laboratory testing and/or ward monitoring, and it finally contributes to overcrowding [7,8]. On the other hand, around 5% of DDP patients exhibit complications, with an increased mortality rate up to 10-20% [9,10]. Appropriate identification of severe DDP is therefore crucial to avoid delayed intensive treatments and increased in-hospital mortality [11][12][13][14].Emergency physicians cannot rely on strong and validated indicators for the assessment of DDP patients. Although severity factors for specific intoxications are usually well-known, few data exist about patients overdosed w...

Acute Poisonings Admitted to a Tertiary Level Intensive Care Unit in Northern India: Patient Profile and Outcomes

“…We found that severity of illness scores like the APACHE II [33] and SOFA scores were significantly useful in predicting increased mortality and the need for vasoactive drugs at admission to the ICU was predictive of poor outcomes. In a retrospective cohort study of 76 consecutive cases presenting with acute organophosphorus poisoning, serum acetylcholinesterase levels of less than 1000 the time elapsed after ingestion to presentation of greater than two hours, and SpO 2 (at room air) at presentation lesser than 85%, were found to predict need for mechanical ventilation.…”

Associations of Adverse Clinical Course and Ingested Substances among Patients with Deliberate Drug Poisoning: A Cohort Study from an Intensive Care Unit in Japan

“…For example, demographic characteristics (i.e., sex [17, 18] and age [18]), clinical characteristics (i.e., blood pressure [10, 19, 20], renal function [10], and level of consciousness [15, 19, 21]), and characteristics of the drugs ingested (dosage [20] and type [15]) are important contributing factors in adverse clinical courses among patients with drug poisoning. The dose and type of ingested drugs are particularly preventable factors associated with a severe adverse clinical course among patients with deliberate drug poisoning [22].…”

Factors that trigger emergency physicians to contact a poison centre: findings from a Swiss study

“…Compared with all hospital admissions, rates of poisoning-related admissions vary from 0.7% (Spain) to 1% (France) 1 2. If telephone consultations of EDs are considered, poisoning-related cases account for up to 10% of all consultations 3.…”