C Kavalci, G Kavalci, P Durukan
discharge, emergency department, poisoning
C Kavalci, G Kavalci, P Durukan. Poisoning Cases In Trakya Uiversity Hospital, Turkey. The Internet Journal of Toxicology. 2008 Volume 6 Number 2.
Introduction: Poisonings are important causes of emergency department visits. It is especially very common in youth and women. In this study we aimed to define clinical and demographic features of poisoning cases admitted to our hospital.
Intoxication is the disruption of functions of a living organism by any agent 1 . Toxic substances have been used for centuries for suicide and/or homicide purposes. Intoxications have been one of the important public health challenges dating back to ancient times. The annual incidence varies 0.02% to 9.3% in developing countries. A significant portion of emergency department admissions are constituted by intoxication cases and can lead to serious results depending upon the agent and the admission time to hospital 23 . The prevalence is 0.4% according to data of the State Statistics Institute 4 . Intoxication cases exhibit regional differences in terms of demographic characteristics, intoxication fashion and agents to be exposed. Intoxication can occur not only due to the voluntary intake of agent but also accidentally or during a treatment. While intoxication can be accidental in children, it can occur as a result of suicidal intention. The aim of this study is to identify the clinical and demographic characteristics of intoxication cases admitted to the Trakya University Hospital emergency department.
Material and Methods
Patients admitted to Trakya University Hospital between the dates of January 2008 and January 2009 were evaluated retrospectively. Characteristics such as age and gender of the patients, weather conditions and the time the intoxication occurred, admission time and mode of transport, intoxication agents, routes, of contact with the substance, interventions done at the emergency department, and the results (discharge, forwarding, hospitalization, death etc) were recorded to the prepared form. Data were assessed with the SPSS 15.0 software package and expressed. Chi-squared (χ 2 ), Mann-Whitney U and Student t-test were used in statistical analysis and
During the study period, a total of 20,715 patients were admitted to emergency service and, 2. 2% of them were admitted due to intoxication. While 39.6% (n=182) of the intoxication patients came directly to the emergency department, the other 60.4 % of them (n=278) were forwarded to the emergency department. 40% of the patients (n=184) were male, 60% (n=276) of them were female, giving a female/male ratio of 1.5. Mean admission time to the hospital after intoxication was 231.8±169.1 minutes. 229.6±150.6 minutes in males and 233.4±180.6 in females respectively. Statistically no significant difference was found between the admission times in terms of gender (X2 =21.9, p>0.05). Mean age of the patients was 25.6±11.5 years (Male: 34.3±14.9 years, Female: 27.9±12.8 years) with no statistically significant difference was found between the two (X2 =21.9, p>0.05). The distribution of patients in terms of age groups and gender is shown in table 1. A statistically significant difference was found between age groups in terms of gender (X2 =22.7 p<0.001*).
When intoxication events were examined in terms of seasons, it was seen that 30.7% of the patients were admitted in spring, 31.1% of them were admitted in summer, 22% of them were admitted in autumn and 16.3 % of them were admitted in winter. A statistically significant difference was found between the seasons and the intoxication events (
A statistically significant difference was found between toxic substance intakes in terms of gender (X2 =74.02, p<0.001). It was seen that while intoxications in female were usually for suicidal purposes, they were for pleasure or accidental in males. The most frequent intoxication causes are drugs (75.7%, n=348), alcohol (14.8%, n=68) and carbon monoxide (CO) (5.4%, n=25). Other intoxication causes are summarized in table 3.
There was a statistically significant difference between either gender in drug, narcotic, organophosphate and alcohol intoxication (
The most frequent drugs leading to intoxication were antidepressants (33.2%). The distribution of drugs causing intoxication in terms of gender is summarized in table-4. There was a statistically significant difference between genders in antidepressant and analgesic drugs.
Table-4: Drugs causing most frequently to intoxication in terms of gender
62.2 % of the patients (n=286) were intoxicated by a single agent, 24.3% of them were intoxicated by two agents (n=112), 13.3% of them (n=62) were intoxicated by three or more agents (Graphic-1). 95.7% of the patients (n=440) took the agent by oral route, 4.1% of them (n=19) took the agent by inhalation, 0.2% of them (n=1) took the agent by dermal route (Graphic-2).
The vital signs of the patients were as follows: mean systolic blood pressure was 117.3±18.7 mmHg, diastolic blood pressure was 74.7±10.7 mmHg, and pulses were 88.1±15.2 beats/ minute. While gastric lavage was performed on 10.4% of the patients (n=48), 44.8% of them (n=206) were treated with active charcoal and an antidote was given to 6.5% of them (n=30). 77.8% of the patients were discharged from the hospital where as 0.2% of them were forwarded, 21.3% of them were hospitalized and 0.7% of them were terminal.
Intoxications are important health problems leading to mortality and morbidity when they are not treated in time. Suicide is the second most common cause of death among the adolescent and young adults 5 . In the studies done, very different data were obtained about the rate of intoxication. Different rates changing from 0.7-5% 246789 . Our result is also consistent with the literature (2.2%).
In the literature, it has been reported that intoxication cases are seen more commonly in the younger age group and in females 461011 . In our study F/M ratio is 1.5 and the rate is 46.3% in the 16 to 25 age group which found consistent with literature. We suggest that economic and social problems such as unemployment, marriage etc are affecting this age group more commonly, and so increase the rate.
In the reported studies, it was detected that the majority of the patients admitted to hospital in two hours 12 . In our study, this time was found as four hours. We think that this one-hour extension is caused by the insufficient headways of the mass transportation means providing the arrival to our hospital.
In literature, it has been reported that intoxication cases are more seen in the spring and winter 13 . In our study we drawn the conclusion about that intoxication events were more frequent in spring and summer. We think that it may be due to climate and geographic differences.
It was reported that the intoxications due to suicidal purposes were more common than the accidental intoxications 246121415 . Our results are consistent with the literature. Drugs were reported as the most frequent intoxication agents 24791213 , as it is in our study. We think that banned drug sales without prescription may reduce the intoxication cases. We found in our study that CO and alcohol as the agents of intoxication. We suggest that CO intoxications will diminish by the use of LPG. In the drug of choice for intoxication cases, it was reported the analgesic drugs 468 are the most common agents, some other authors reported that psychoactive drugs 21416 are the most common agents. We also found antidepressant drugs as the most frequent agents. We suggest that restriction in the prescription of the antidepressant drugs is effective in this conclusion.
The ratio of intoxication by a single agent was reported as 62% by Pekdemir 14 . 65% of our patients were intoxicated by a single agent. Gastrointestinal route was reported as the most frequent exposure route 2614 . Our results are also consistent with the literature.
Activated charcoal has an important role in the treatment of the intoxications. Pekdemir 13 reported that he gave active charcoal to 64.4% of the patients. Similarly, we gave active charcoal 44.8% of the patients.
It was seen that most of the patients were discharged from the emergency department after 8-hour observation period. Our results showed parallelism with these results. Most of the patients were discharged from the emergency department after this observation period. Various hospitalization rates were reported in the literature. Pekdemir 14 reported that 25.3% of the patients were hospitalization. Our results are consistent with the literature.
The mortality rates were reported as 0-5.8% in the literature 41417 . In accordance with the literature we had a mortality rate of 0.7%. The early interventions in the intoxication cases decrease the mortality.
Intoxications are still important health problems. We saw with this study that intoxications are seen mostly in summer months, in 16-25 age group, in women, oral route, and with single agent. Immediate and proper treatment of these cases will decrease the mortality.