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Salem W, Abdulrouf P, Thomas B, Elkassem W, Abushanab D, Rahman Khan H, Hanssens Y, Singh R, Zaki HA, Azad AM, Al Hail M, Mohammed S. Epidemiology, clinical characteristics, and associated cost of acute poisoning: a retrospective study. J Pharm Policy Pract 2024; 17:2325513. [PMID: 38741897 PMCID: PMC11089918 DOI: 10.1080/20523211.2024.2325513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Abstract
Introduction Poisoning is a major public health issue and a leading cause of admission to the emergency department (ED). There is a paucity of data describing the epidemiology and cost of acute poisoning. Therefore, this study investigated the epidemiology, patterns, and associated costs of acute poisoning in emergency department of the largest tertiary care healthcare centre in Qatar. Method This study was a retrospective review of the health records of patients admitted to the ED due to poisoning between January 2015 and December 2019. Incidence, clinical characteristics, and costs associated with acute poisoning were assessed. Frequency and percentages were calculated for categorical variables and mean and SD for continuous variables. The relationship between sociodemographic characteristics and poisoning profile was assessed using the chi-square test. A micro-costing approach using the cost of each resource was applied for cost calculations. Result The incidence of acute poisoning was 178 cases per 100,000 patients. Females (56%) and children below 14 years (44.3%) accounted for the largest proportion. Most of the exposures were accidental involving therapeutic agents (64.2%). The mean length of hospital stay was found to be 1.84 ± 0.81 days, and most patients (76.6%) were discharged within the first 8 h. A statistically significant difference was found between age groups and type of toxin (χ2 = 23.3, p < 0.001), cause and route of exposure (χ2 = 42.2, p < 0.001), and length of hospital stay (χ2 = 113.16, p < 0.001). Admission to intensive care units had the highest cost expenditure (USD 326,008), while general wards accounted for the least (USD 57,709). Conclusion Unintentional poisoning by pharmacological agents is common in infants and children. This study will assist in the development of educational and preventive programmes to minimise exposure to toxic agents. Further studies are required to explore the impact of medical toxicology services, and post discharge monitoring of poisoning.
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Affiliation(s)
- Waleed Salem
- Medical Toxicology, Trauma & Emergency Center, Hamad Medical Corporation, Doha, Qatar
| | - Pallivalappila Abdulrouf
- Drug and Poison Information Center, Pharmacy Executive Director’s Office, Hamad Medical Corporation, Doha, Qatar
| | - Binny Thomas
- Drug and Poison Information Center, Pharmacy Executive Director’s Office, Hamad Medical Corporation, Doha, Qatar
| | - Wessam Elkassem
- Drug and Poison Information Center, Pharmacy Executive Director’s Office, Hamad Medical Corporation, Doha, Qatar
| | - Dina Abushanab
- Drug and Poison Information Center, Pharmacy Executive Director’s Office, Hamad Medical Corporation, Doha, Qatar
| | - Haseebur Rahman Khan
- Drug and Poison Information Center, Pharmacy Executive Director’s Office, Hamad Medical Corporation, Doha, Qatar
| | - Yolande Hanssens
- Drug and Poison Information Center, Pharmacy Executive Director’s Office, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- Department of Biostatistics, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hany A. Zaki
- Medical Toxicology, Trauma & Emergency Center, Hamad Medical Corporation, Doha, Qatar
| | - Aftab Mohammed Azad
- Medical Toxicology, Corporate Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Moza Al Hail
- Drug and Poison Information Center, Pharmacy Executive Director’s Office, Hamad Medical Corporation, Doha, Qatar
| | - Shaban Mohammed
- Drug and Poison Information Center, Pharmacy Executive Director’s Office, Hamad Medical Corporation, Doha, Qatar
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Oktay MA, Derinöz Güleryüz O, Akyüz Oktay S, Akca Caglar A. Mental health emergency admissions in the paediatric emergency department. J Paediatr Child Health 2023; 59:1061-1066. [PMID: 37326444 DOI: 10.1111/jpc.16455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/26/2023] [Accepted: 06/02/2023] [Indexed: 06/17/2023]
Abstract
AIM To evaluate the demographic characteristics, diagnoses and length of stay of mental health emergency attendance to the paediatric emergency department (ED), to determine the burdens these patients brought to the paediatric ED and to the national economy by examining hospital costs. METHODS This retrospective observational study was conducted in a tertiary hospital's paediatric ED in Turkey. Data were obtained from the electronic medical record system from January 2018 to January 2020. RESULTS A total of 142 admissions were included of whom 60% were female. The mean age was 15.2 ± 1.8 years, 50% of cases were suicide attempts and 19% were alcohol intoxications. The majority (85.9%) of patients were discharged from the emergency observation unit. Among the diagnostic groups, the mean age was higher in patients with a history of substance abuse. There was a female predominance among patients who were admitted due to suicide attempts. Among the diagnostic groups, the duration of hospital stay and cost of hospitalization were higher in patients who were followed up with a diagnosis of suicide attempt. CONCLUSIONS Mental health problems are frequent in the paediatric ED. We determined that the most common cause of attendance in paediatric emergencies was suicide attempts, and the length of hospital stay and hospital cost were higher in this diagnostic group. Although further research is necessary to determine national trends in paediatric mental health problems in the paediatric ED, screening strategies and early detection and interventions in primary healthcare may allow more effective care for childhood mental health problems.
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Affiliation(s)
- Mehmet A Oktay
- Department of Child Health and Diseases, Kara Mustafa Pasa State Hospıtal, Amasya, Turkey
| | | | - Selin Akyüz Oktay
- Department of Child Health and Diseases, Suluova State Hospıtal, Amasya, Turkey
| | - Ayla Akca Caglar
- Pediatric Emergency Department, Gazi University Faculty of Medicine, Ankara, Turkey
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Daei M, Abbasi G, Khalili H, Heidari Z. Direct oral anticoagulants toxicity in children: an overview and practical guide. Expert Opin Drug Saf 2022; 21:1183-1192. [PMID: 35924671 DOI: 10.1080/14740338.2022.2110236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION By increasing use of direct oral anticoagulants (DOACs) in adults and children, gradual increase in the number of intentional or unintentional DOAC poisonings among children is suspected in the near future. Hence, clinicians and pharmacists need to be familiar with the clinical features and management of DOAC-toxicity among pediatric population. AREAS COVERED This article provides an overview and practical guide to DOAC-toxicity in pediatrics according to the available clinical evidence. EXPERT OPINION Based on limited available data, accidental pediatric ingestion of DOACs can be managed by supportive care in most cases. However, serious toxicity may occur following massive overdose, in presence of underlying disorders (renal or hepatic dysfunction) and concurrent anticoagulant therapy. Activated charcoal is recommended for known recent ingestion of DOACs (within 2-4 hours) to reduce the gastrointestinal absorption. Supportive interventions including local hemostatic measures and volume resuscitation are the cornerstone of management of bleeding. Vitamin K and fresh frozen plasma are ineffective for DOAC reversal and thus are not recommended. Currently, safety and efficacy data regarding the use of specific reversal agents (including idarucizumab and andexanet alfa) and 3-factor or 4-factor prothrombin complex concentrate (PCC) or activated PCC (aPCC) among children with DOAC-associated bleeding are lacking.
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Affiliation(s)
- Maryam Daei
- Faculty of Pharmacy, Alborz University of Medical Sciences, Alborz, Iran
| | - Golnaz Abbasi
- Faculty of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Khalili
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Zinat Heidari
- Department of Clinical Pharmacy, Faculty of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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