1
|
Roversi M, Martini M, Musolino A, Pisani M, Zampini G, Genuini L, Bottari G, Di Nardo M, Stoppa F, Marano M. Drug self-poisoning in adolescents: A report of 267 cases. Toxicol Rep 2023; 10:680-685. [PMID: 37304378 PMCID: PMC10247951 DOI: 10.1016/j.toxrep.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/17/2023] [Accepted: 05/28/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction The current study aims at describing a sample of adolescents admitted to a tertiary referral pediatric hospital for drug self-poisoning and to identify variables that could explain and predict a higher severity of intoxication. Methods We retrospectively reviewed the cases of drug self-poisoning in adolescents admitted to the Bambino Gesù Children's Hospital between January 2014 and June 2022 requiring consultation by the local Pediatric Poison Control Center (PPCC). We reported the type and class of drug ingested and correlated the clinical characteristics of the patients with their Poison Severity Score. Results The data of 267 patients were reported. Most patients were female (85.8 %), with a median age of 15.8 years at presentation. Half of the patients were symptomatic at admission (44.2 %), and most had at least one psychiatric comorbidity (71.1 %). Most patients were hospitalized (79.6 %), 16.6 % of cases required antidote administration and a minority required intensive care. Most patients received a PSS score of 0 (59.6 %). The most frequently ingested drug was acetaminophen (28.1 %) followed by ibuprofen (10.1 %) and aripiprazole (10.1 %). Antipsychotics as a class were the most abused drugs (33.1 %). The correlation of clinical variables with the PSS showed that older and male patients were more prone to be severely intoxicated. Conclusions This single-center study identifies the most commonly ingested drugs in a large sample of adolescents with voluntary drug self-poisoning, also showing that older and male patients are more susceptible to severe intoxication.
Collapse
Affiliation(s)
- Marco Roversi
- Clinical Trial Area, Development and Implementation of Drugs, Vaccines, and Medical Devices for pediatric use, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | - Matteo Martini
- Pediatric Poison Control Centre, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Antonio Musolino
- Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | - Mara Pisani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giorgio Zampini
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Leonardo Genuini
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Gabriella Bottari
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Francesca Stoppa
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Marco Marano
- Pediatric Poison Control Centre, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| |
Collapse
|
2
|
Jensen TL, Tejlbo Frost M, Dalhoff K, Studsgaard Petersen T. Repeated poisonings in Denmark - a nationwide study. Clin Toxicol (Phila) 2023; 61:392-399. [PMID: 37171194 DOI: 10.1080/15563650.2023.2205006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Poisonings contribute significantly to morbidity and mortality of patients. Some patients have numerous contacts to a poison information center, indicating repeated poisoning exposures. Information on the involved substances is necessary to explore methods to prevent self-harm and reduce mortality. The objective of this study was to characterize the patient population with repeated poison exposures in Denmark and identify the substances involved. METHODS This study was a retrospective cohort study of enquiries to the nationwide Danish Poison Information Centre and the Danish National Patient Registry. The databases were used to identify patients with more than five individual poisoning episodes within a 12-month-period between 1 January 2013, and 31 December 2017. RESULTS One hundred and thirty-seven patients and 995 patients met the inclusion criteria in the Danish Poison Information Centre and the Danish National Patient Registry, respectively. The majority were women (82.5% and 66.3% for the Danish Poison Information Centre and the Danish National Patient Registry cohorts, respectively). The mean age was 24.7 and 29.5 years. Psychiatric comorbidities were frequent with 74.5% and 67.0% suffering from personality disorders and 70.1% and 54.5% from affective disorders in the Danish Poison Information Centre and the Danish National Patient Registry cohorts, respectively. One thousand seven hundred and fifty-two poisoning episodes were identified in the Danish Poison Information Centre database, and the most common types of substance were 'pharmaceuticals' (1,420 episodes). The most common medications ingested were quetiapine, paracetamol and cyclizine. Median number of contacts to the Danish Poison Information Centre was 10. Patients with one or more poisoning episodes involving cyclizine had on average 11.4 poisoning episodes involving cyclizine. In the Danish National Patient Registry cohort 80.9% were alive after 10 years compared to 97.7% in the background population. CONCLUSION AND IMPLICATIONS Most poisonings were intentional and occurred among younger women. Psychiatric comorbidity was frequent. Most often, pharmaceuticals were the toxic substance, mainly quetiapine, paracetamol and cyclizine. Changing the status of cyclizine from over the counter to prescription only medication, and implementing stricter rules for prescribing quetiapine, could limit future poisoning incidences.
Collapse
Affiliation(s)
- Thomas Leth Jensen
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Matilde Tejlbo Frost
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Kim Dalhoff
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tonny Studsgaard Petersen
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
3
|
Rezar R, Jung C, Mamandipoor B, Seelmaier C, Felder TK, Lichtenauer M, Wernly S, Zwaag SM, De Lange DW, Wernly B, Osmani V. Management of intoxicated patients – a descriptive outcome analysis of 4,267 ICU patients. BMC Emerg Med 2022; 22:38. [PMID: 35279068 PMCID: PMC8917674 DOI: 10.1186/s12873-022-00602-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Intoxications are common in intensive care units (ICUs). The number of causative substances is large, mortality usually low. This retrospective cohort study aims to characterize differences of intoxicated compared to general ICU patients, point out variations according to causative agents, as well as to highlight differences between survivors and non-survivors among intoxicated individuals in a large-scale multi-center analysis.
Methods
A total of 105,998 general ICU patients and 4,267 individuals with the admission diagnoses “overdose” and “drug toxicity” from the years 2014 and 2015 where included from the eICU Collaborative Research Database. In addition to comparing these groups with respect to baseline characteristics, intensive care measures and outcome parameters, differences between survivors and non-survivors from the intoxication group, as well as the individual groups of causative substances were investigated.
Results
Intoxicated patients were younger (median 41 vs. 66 years; p<0.001), more often female (55 vs. 45%; p<0.001), and normal weighted (36% vs. 30%; p<0.001), whereas more obese individuals where observed in the other group (37 vs. 31%; p<0.001). Intoxicated individuals had a significantly lower mortality compared to general ICU patients (1% vs. 10%; aOR 0.07 95%CI 0.05-0.11; p<0.001), a finding which persisted after multivariable adjustment (aOR 0.17 95%CI 0.12-0.24; p<0.001) and persisted in all subgroups. Markers of disease severity (SOFA-score: 3 (1-5) vs. 4 (2-6) pts.; p<0.001) and frequency of vasopressor use (5 vs. 15%; p<0.001) where lower, whereas rates of mechanical ventilation where higher (24 vs. 26%; p<0.001) in intoxicated individuals. There were no differences with regard to renal replacement therapy in the first three days (3 vs. 4%; p=0.26). In sensitivity analysis (interactions for age, sex, ethnicity, hospital category, maximum initial lactate, mechanical ventilation, and vasopressor use), a trend towards lower mortality in intoxicated patients persisted in all subgroups.
Conclusion
This large-scale retrospective analysis indicates a significantly lower mortality of intoxicated individuals compared to general ICU patients.
Collapse
|
4
|
Alghafees MA, Abdulmonen A, Eid M, Alhussin GI, Alosaimi MQ, Alduhaimi GS, Albogami MT, Alhelail M. Poisoning-related emergency department visits: the experience of a Saudi high-volume toxicology center. Ann Saudi Med 2022; 42:36-44. [PMID: 35112588 PMCID: PMC8812162 DOI: 10.5144/0256-4947.2022.36] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Acute poisoning is a major contributing factor to mortality and morbidity. There is a lack of research on the epidemiology of acute poisoning risk factors in Saudi Arabia. OBJECTIVES Descriptive overview of poisoning cases at a tertiary care center. DESIGN Descriptive, medical record review. SETTINGS Tertiary care center in Riyadh. PATIENTS AND METHODS From the electronic medical record system, we collected demographic information, medical history, and the poisoning history on all emergency department visits diagnosed as acute poisoning from January 2016 to January 2021. Patients were classed as children (<18 years old) or adults, and further classified by body mass index. MAIN OUTCOME MEASURES Intensive care unit (ICU) admission, organ transplantation, and mortality were classified as poor outcomes. SAMPLE SIZE 492 adults and 1013 children (<18 years old) were identified. RESULTS The most frequent agent in poisoning for both groups was acetaminophen (n=52, 10.57% and n=100, 9.87%, respectively). The ICU admission rate was 6.7% and 4.8%, and the mortality rate 0.8% and 0.3%, respectively. The accidental poisoning rate was 57.7% among adults (n=284) and 67.6% among children (n=658). The suicide intention rate was 11.2% (n=55) and 7.4% (n=75) among adults and children, respectively. The management for both populations was nonspecific, involving observation, supportive measures, and symptomatic treatment. CONCLUSION Although the ICU admission rates were consistent with reported data, the mortality rate was marginally lower. The pediatric predominance in the population implies a lack of caregiver education in the region regarding the safe storage of drugs and household products, as well as the use of child-resistant packaging. The high rate of accidental poisoning in both age groups should prompt further investment to promote public health education on the rational use and safe storage of toxic agents and self-protection. The high suicide intention rate needs to be investigated to develop multidisciplinary risk prevention strategies. LIMITATIONS Single center, retrospective, small population size. CONFLICT OF INTEREST None.
Collapse
Affiliation(s)
| | - Abdullah Abdulmonen
- From the Department of Emergency Medicine, King Abdulaziz Medical City.,From the Department of Medicine, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mahmoud Eid
- From the Department of Emergency Medicine, King Abdulaziz Medical City.,From the Department of Medicine, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | | | | | - Ghadah Saad Alduhaimi
- From the College of Medicine, King Saud bin Abdulaziz University for Health Sciences
| | | | - Mohammed Alhelail
- From the Department of Emergency Medicine, King Abdulaziz Medical City.,From the Department of Medicine, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| |
Collapse
|
5
|
A Farrar R, B Justus A, A Masurkar V, M Garrett P. Unexpected survival after deliberate phosphine gas poisoning: An Australian experience of extracorporeal membrane oxygenation rescue in this setting. Anaesth Intensive Care 2021; 50:250-254. [PMID: 34871510 DOI: 10.1177/0310057x211047603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Phosphine poisoning is responsible for hundreds of thousands of deaths per year in countries where access to this pesticide is unrestricted. Metal phosphides release phosphine gas on contact with moisture, and ingestion of these tablets most often results in death despite intensive support. A 36-year-old woman presented to a regional hospital after ingesting multiple aluminium phosphide pesticide tablets and rapidly developed severe cardiogenic shock. In this case, serendipitous access to an untested Extracorporeal Membrane Oxygenation (ECMO) service of a regional hospital effected a successful rescue and prevented the predicted death. We discuss the toxicology, management and the evidence for and against using ECMO in this acute poisoning.
Collapse
Affiliation(s)
- Ross A Farrar
- Intensive Care Unit, 523457Sunshine Coast University Hospital, Sunshine Coast University Hospital, Queensland, Australia
| | - Angelo B Justus
- Intensive Care Unit, 523457Sunshine Coast University Hospital, Sunshine Coast University Hospital, Queensland, Australia
| | - Vikram A Masurkar
- Intensive Care Unit, 523457Sunshine Coast University Hospital, Sunshine Coast University Hospital, Queensland, Australia.,Griffith University, Sunshine Coast, Queensland, Australia
| | - Peter M Garrett
- Intensive Care Unit, 523457Sunshine Coast University Hospital, Sunshine Coast University Hospital, Queensland, Australia.,Griffith University, Sunshine Coast, Queensland, Australia
| |
Collapse
|
6
|
Maiden MJ, Trisno R, Finnis ME, Norrish CM, Mulvey A, Nasr-Esfahani S, Orford NR, Moylan S. Long-term outcomes of patients admitted to an intensive care unit with intentional self-harm. Anaesth Intensive Care 2021; 49:173-182. [PMID: 33853393 DOI: 10.1177/0310057x20978987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Self-harm is one of the most common reasons for admission to an intensive care unit (ICU). While most patients with self-harm survive the ICU admission, little is known about their outcomes after hospital discharge. We conducted a retrospective cohort study of patients in the Barwon region in Victoria admitted to the ICU with self-harm (between 1998 and 2018) who survived to hospital discharge. The primary objective was to determine mortality after hospital discharge, and secondarily estimate relative survival, years of potential life lost, cause of death and factors associated with death. Over the 20-year study period, there were 710 patients in the cohort. The median patient age was 37 years (interquartile range (IQR) 26-48 years). A total of 406 (57%) were female, and 527 (74%) had a prior psychiatric diagnosis. The incidence of ICU admission increased over time (incidence rate ratio 1.05; 95% confidence interval (CI) 1.03-1.06 per annum). There were 105 (15%) patients who died after hospital discharge. Relative survival decreased each year after discharge, with the greatest decrement during the first 12 months. At ten years, relative survival was 0.85 (95% CI 0.81-0.88). The median years of potential life lost was 35 (IQR 22-45). Cause of death was self-harm in 27%, possible self-harm in 32% and medical disease in 41%. The only factors associated with mortality were male sex, older age and re-admission to ICU with self-harm. Further population studies are required to confirm these findings, and to understand what interventions may improve long-term survival in this relatively young group of critically ill patients.
Collapse
Affiliation(s)
- Matthew J Maiden
- Intensive Care Unit, Barwon Health, Geelong, Australia.,Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia.,Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia
| | - Roth Trisno
- Mental Health, Drugs and Alcohol Service, Barwon Health, Geelong, Australia.,School of Medicine, Deakin University, Waurn Ponds, Australia
| | - Mark E Finnis
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia.,Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia.,Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Anne Mulvey
- Intensive Care Unit, Barwon Health, Geelong, Australia
| | | | - Neil R Orford
- Intensive Care Unit, Barwon Health, Geelong, Australia.,School of Medicine, Deakin University, Waurn Ponds, Australia.,Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Steven Moylan
- Mental Health, Drugs and Alcohol Service, Barwon Health, Geelong, Australia.,School of Medicine, Deakin University, Waurn Ponds, Australia
| |
Collapse
|
7
|
Ahlström B, Larsson IM, Strandberg G, Lipcsey M. A nationwide study of the long-term prevalence of dementia and its risk factors in the Swedish intensive care cohort. Crit Care 2020; 24:548. [PMID: 32887659 PMCID: PMC7472680 DOI: 10.1186/s13054-020-03203-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/26/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Developing dementia is feared by many for its detrimental effects on cognition and independence. Experimental and clinical evidence suggests that sepsis is a risk factor for the later development of dementia. We aimed to investigate whether intensive care-treated sepsis is an independent risk factor for a later diagnosis of dementia in a large cohort of intensive care unit (ICU) patients. METHODS We identified adult patients admitted to an ICU in 2005 to 2015 and who survived without a dementia diagnosis 1 year after intensive care admission using the Swedish Intensive Care Registry, collecting data from all Swedish general ICUs. Comorbidity, the diagnosis of dementia and mortality, was retrieved from the Swedish National Patient Registry, the Swedish Dementia Registry, and the Cause of Death Registry. Sepsis during intensive care served as a covariate in an extended Cox model together with age, sex, and variables describing comorbidities and acute disease severity. RESULTS One year after ICU admission 210,334 patients were alive and without a diagnosis of dementia; of these, 16,115 (7.7%) had a diagnosis of sepsis during intensive care. The median age of the cohort was 61 years (interquartile range, IQR 43-72). The patients were followed for up to 11 years (median 3.9 years, IQR 1.7-6.6). During the follow-up, 6312 (3%) patients were diagnosed with dementia. Dementia was more common in individuals diagnosed with sepsis during their ICU stay (log-rank p < 0.001), however diagnosis of sepsis during critical care was not an independent risk factor for a later dementia diagnosis in an extended Cox model: hazard ratio (HR) 1.01 (95% confidence interval 0.91-1.11, p = 0.873). Renal replacement therapy and ventilator therapy during the ICU stay were protective. High age was a strong risk factor for later dementia, as was increasing severity of acute illness, although to a lesser extent. However, the severity of comorbidities and the length of ICU and hospital stay were not independent risk factors in the model. CONCLUSION Although dementia is more common among patients treated with sepsis in the ICU, sepsis was not an independent risk factor for later dementia in the Swedish national critical care cohort. TRIAL REGISTRATION This study was registered a priori with the Australian and New Zeeland Clinical Trials Registry (registration no. ACTRN12618000533291 ).
Collapse
Affiliation(s)
- Björn Ahlström
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
- Region Dalarna, Centre of Clinical Research Dalarna, Nissers väg 3, Falu lasarett, Falun, 79182, Sweden.
| | - Ing-Marie Larsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Gunnar Strandberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Miklos Lipcsey
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Hedenstierna Laboratory, CIRRUS, Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| |
Collapse
|