Emergency Medicine Thu 02 May 2019 Profile of acute poisioning cases and their outcome in emergency department
Researcher : Mathew Roshan
Research Guide : Praveen Aggarwal
Institution Name : All India Institute of Medical Sciences New Delhi
Co-Researchers

Abstract

Background:Acute poisoning is one of the serious cause of morbidity and mortality in patients coming to the Emergency department. For an emergency physician it possesses a challenge in form resuscitative measures, identification of the pathogen, prompt initiation of the antidote and medico-legal aspects associated to them.
Aim and Objectives:To describe the socio-demographic profile of acute poisoning cases coming in emergency and to identify factors associated with outcomes in acute poisoning cases presenting in Emergency department of AIIMS
Patients and methods: Our is a prospective observational study which includes data collected from July 2016 to march 2018, which included 200 patients of acute poisoning from toxic agents and snake bite. Socio-demographic profile, with the presenting signs and symptoms were taken for all the patients. They were followed up for their complete course of hospital stay. Univariate and step wise multivariable logistic regression analysis was carried out to find the independent predictor of poor outcome using unadjusted and adjusted odds ratio with 95% CI. A p value less than 0.05 was considered significant.
Results: A total of 200 cases (184 poisoning from toxic agents and 16 snake bite cases). Males were more than females (114/86). Sixty percent patients were between age group 15-30 years. Eighty five percent patients were resident of Delhi. Eighteen percent were illiterate (n=36) and 53% (n =106) were unemployed. There were 115 suicidal cases, 68 cases of accidental ingestion and 17 cases of homicidal poisoning. Forty percent received primary treatment in other healthcare facilities. The major types of poisoning included corrosives (26.5%), drugs (13.5%), rodenticides (10.5%), organophosphates/carbamates (10%). In 30 (15%) cases, the agents could not be identified by the patients of their relatives. Of the 16 snake bite cases, 8 were vasculotoxic, 5 neurotoxic and 3 could not be differentiated into any specific class. Out of the 19 cases in children, 15 (79%) cases were below the age of five years. Most common agent implicated in children was hydrocarbon followed by pyretheroids. Median time (IQR) for point of first medical contact after exposure for patient coming directly to AIIMS and those going to other hospitals was 60 (51.25-120) minutes. Median length of stay (IQR) in the emergency was 14 (6-22.8) hours. One hundred and two (51%) patients were discharged from emergency itself after primary treatment and observation. 72 (36%) required admission for further workup and treatment. On applying multivariate regression of significant co-variates derived from uni-variate analysis, organophosphate poisoning {OR 10.6 (2.9-37.8) p = 0.001}, snake bite cases {14.4 (3.1-65.7) p = 0.001}and primary management received in other health care facilities {OR 2.8(1.4-5.3) p = 0.001} were independent factors that significantly had effect on disposition from emergency i.e they had poor outcome
Conclusion: In our study we found predominant use of corrosives as agents for poisoning, which demonstrated a change in trend from previous similar studies were pesticides were commonly used. The ease of access in urban households and more regulated sale of pesticides may be the reason for this change. With increasing rates of suicidal ingestions because of depression and work related stress, there is need for creating more awareness and help groups so that people come out in open with their problems.

DOI: 1556811384   Year of publication: 2018

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