Characteristics and costs in adults with acute poisoning admitted to the emergency department of a university hospital in Belgium


Autoři: Anne-Marie K. Descamps aff001;  Dominique M. Vandijck aff002;  Walter A. Buylaert aff004;  Martine A. Mostin aff001;  Peter De Paepe aff004
Působiště autorů: Antigifcentrum/Centre Antipoisons, Brussels, Belgium aff001;  Department of Public Health of Ghent University, Ghent, Belgium aff002;  Department of Medicine and Health Sciences of Hasselt University, Diepenbeek, Belgium aff003;  Department of Emergency Medicine of Ghent University Hospital, Ghent, Belgium aff004
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223479

Souhrn

Objective

The aims of this study were to assess the characteristics of all acute poisoning admissions among adult emergency department (ED) patients, to identify factors associated with admission and to calculate direct medical cost.

Methods

Data of 2017 (1st January to 31st December) were collected and analyzed retrospectively using patients’ medical records and hospital invoices. Factors associated with type of hospitalization were identified using appropriate statistics.

Results

A total of 1,214 hospital admissions were included, accounting for 3.6% of all ED admissions. Men (62.2%) and the age group 21–40 years (43.0%) accounted for the largest proportion. Substances most commonly involved were ethanol (52.9%), benzodiazepines (9.7%), cocaine (4.9%), cannabis (4.6%), antidepressants (4.6%) and psychostimulants (4.6%). A total of 4,561 treatment acts were recorded, most commonly monitoring of vital signs (63.6%) and medication and/or intravenous drip administration (62.9%). Patients were discharged home after having received care in the emergency department (ED-amb) in 54.5% of admissions, were admitted to the emergency-department-24-hours-observation unit (ED-24h) or were hospitalized (Hosp) in 24.6% and 20.9% of admissions, respectively. Factors found to be associated with hospitalization type were age, hour of admission, victim location, degree of severity, use of antidotes, involvement of antidepressants, antipsychotics, psychostimulants, benzodiazepines and ethanol. Total cost was €1,512,346 with an average of €1,287 per admission.

Conclusion

Poisonings entail a considerable percentage of patients admitted to an ED and financial burden. In particular, ethanol poisonings account for the largest proportion of all ED admissions. Comparison of our figures with other data is hampered by the heterogeneity in inclusion criteria. Availability of a uniform template would facilitate comparison and allow better monitoring policies for prevention and cost reduction.

Klíčová slova:

Antidepressants – Critical care and emergency medicine – Ethanol – Hospitals – Insurance – Poisoning – Self harm – Psychostimulants


Zdroje

1. Poisoning Prevention and management. [cited 2018 Jul 29]. WHO, http://www.who.int/ipcs/poisons/en/.

2. Akkas M, Coskun F, Ulu N, Sivri B. An epidemiological evaluation of 1098 acute poisoning cases from Turkey. Vet Hum Toxicol. 2004; 46(4): 213–215. 15303399

3. Burillo-Putze G, Munne P, Duenas A, Pinillos M, Naveiro J, Cobo j, et al. National multicentre study of acute intoxication in emergency departments of Spain. Eur J Emerg Med. 2003; 10(2): 101–104. doi: 10.1097/01.mej.0000072640.95490.5f 12789064

4. Duineveld C, Vroegop M, Schouren L, Hoedemaekers A, Schouten J, Moret-Hartman M, et al.Acute intoxications: differences in management between six Dutch hospitals. Clin Toxicol (Phila). 2012; 50(2): 120–128. doi: 10.3109/15563650.2011.649092 22273671

5. Guloglu C, Kara I. Acute poisoning cases admitted to a university hospital emergency department in Diyarbakir, Turkey. Hum Exp Toxicol. 2005; 24(2): 49–54. doi: 10.1191/0960327105ht499oa 15850278

6. Kristinsson J, Palsson R, Gudjonsdottir G, Blondal M, Gudmundsson S, Snook C. Acute poisonings in Iceland: a prospective nationwide study. Clin Toxicol (Phila). 2008; 46(2): 126–132. doi: 10.1080/15563650701438268 18259960

7. Majori S, Ricci G, Capretta F, Loss R, Baldovin T, Cigolini D, et al. The impact of acute intoxications in a toxicological unit care in north east Italy. J Prev Med Hyg. 2012; 53(1): 8–13. 22803313

8. McCaig L, Burt C. Poisoning-related visits to emergency departments in the United States, 1993–1996. J Toxicol Clin Toxicol. 1999; 37(7): 817–826. doi: 10.1081/clt-100102460 10630264

9. Satar S, Seydaoglu G, Akpinar A, Sebe A, Karakoc E, Gumusay U, et al. Trends in acute adult poisoning in a ten-year period in Turkey: factors affecting the hazardous outcome. Bratisl Lek Listy. 2009; 110(7): 404–411. 19711826

10. Kaya E, Yilmaz A, Saritas A, Colakoglu S, Baltaci D, Kandis H, et al. Acute intoxication cases admitted to the emergency department of a university hospital. World J Emerg Med. 2015; 6(1): 54–59. doi: 10.5847/wjem.j.1920-8642.2015.01.010 25802568

11. Jang H, Choi S, Yoon Y, Moon S, Hong Y, Lee S. Comparative analysis of acute toxic poisoning in 2003 and 2011: analysis of 3 academic hospitals. J Korean Med Sci. 2013; 28(10): 1424–1430. doi: 10.3346/jkms.2013.28.10.1424 24133344

12. Zöhre E, Ayrik C, Bozkurt S, Kose A, Narci H, Cevik I, et al. Retrospective analysis of poisoning cases admitted to the emergency medicine. Arch Iran Med. 2015; 18(2): 117–122. doi: 015182/AIM.0011 25644801

13. Heyerdahl F, Bjornas M, Hovda K, Skog K, Opdahl A, Wium C, et al. Acute poisonings treated in hospitals in Oslo: a one-year prospective study (II): clinical outcome. Clin Toxicol (Phila). 2008; 46(1): 42–49. doi: 10.1080/15563650701210048 18167036

14. Hovda K, Bjornas M, Skog K, Opdahl A, Drottning P, Ekeberg O, et al. Acute poisonings treated in hospitals in Oslo: a one-year prospective study (I): pattern of poisoning. Clin Toxicol (Phila). 2008; 46(1): 35–41. doi: 10.1080/15563650601185969 18167035

15. Lamminpaa A, Riihimaki V, Vilska J. Hospitalizations due to poisonings in Finland. J Clin Epidemiol. 1993; 46(1): 47–55. doi: 10.1016/0895-4356(93)90008-o 8433113

16. Lipnik-Stangelj M. Hospitalizations due to poisonings in Slovenia—epidemiological aspects. Wien Klin Wochenschr. 2010; 122 Suppl 2: 54–58.

17. Lund C, Drottning P, Stiksrud B, Vahabi J, Lyngra M, Ekeberg I, et al. A one-year observational study of all hospitalized acute poisonings in Oslo: complications, treatment and sequelae. Scand J Trauma Resusc Emerg Med. 2012; 20–49.

18. Muňoz R, Borobia A, Quintana M, Martinez A, Ramirez R, Muňoz M, et al. Outcomes and costs of poisoned patients admitted to an adult emergency department of a Spanish tertiary hospital: Evaluation through a toxicovigilance program. PLoS One. 2016; 11(4): e0152876. doi: 10.1371/journal.pone.0152876 27100460

19. Verelst S, Moonen P, Desruelles D, Gillet J. Emergency department visits due to alcohol intoxication: characteristics of patients and impact on the emergency room. Alcohol and Alcoholism. 2012; 47(4): 433–438. doi: 10.1093/alcalc/ags035 22493048

20. Hendrix L, Verelst S, Desruelles D, Gillet J. Deliberate self-poisoning: characteristics of patients and impact on the emergency department of a large university hospital. Emerg Med J. 2013; 30(1): 1–5. doi: 10.1136/emermed-2011-201033 22328636

21. Xiang Y, Zhao W, Xiang H, Smith G. ED visits for drug-related poisoning in the United States, 2007. Am J Emerg Med. 2010; 30(2): 293–301.

22. Krajewski A, Friedman L. Hospital outcomes and economic costs from poisoning caes in Illinois. Clin Toxicol (Phila). 2015; 53(5): n 433–445. doi: 10.3109/15563650.2015.1030677 25871916

23. Kavalci G, Ethemoglu F, Batuman A, Kumral D, Emre C, Surgit M, et al. Epidemiological and cost analysis of self-poisoning cases in Ankara, Turkey. Iran Red Crescent Med J. 2014; 16(11): e10856. doi: 10.5812/ircmj.10856 25763203

24. McMahon A, Brohan J, Donnelly M, Fitzpatrick G. Characteristics of patients admitted to the intensive care unit following self-poisoning and their impact on resource utilisation. Ir J Med Sci. 2014; 183(3): 391–395. doi: 10.1007/s11845-013-1026-7 24101144

25. Okumura Y, Shimizu S, Ishikawa K, Matsuda S, Fushimi K, Ito H. Characteristics, procedural differences, and costs of inpatients with drug poisoning in acute care hospitals in Japan. Gen Hosp Psychiatry. 2012; 34(6): 681–685. doi: 10.1016/j.genhosppsych.2012.07.009 22902257

26. Riddell S, Shanahan M, Degenhardt L, Roxburgh A. Estimating the costs of drug-related hospital separations in Australia. Aust N Z J Public Health. 2008; 32(2): 156–161. doi: 10.1111/j.1753-6405.2008.00193.x 18412687

27. Inocencio T, Carroll N, Read E, Holfdford D. The economic Burden of Opioid-Related Poisoning in the United States. Pain Medicine. 2013; 2013(14): 1534–1547.

28. White A, Hingson R, Pan I, Yi H. Hospitalizations for alcohol and drug overdoses in young adults ages 18–24 in the United States, 1999–2008: results from the Nationwide Inpatient Sample. J Stud Alcohol Drugs. 2011; 72(5): 774–786. doi: 10.15288/jsad.2011.72.774 21906505

29. Prescott K, Stratton R, Freyer A, Hall I, Le Jeune I. Detailed analyses of self-poisoning episodes presenting to a large regional teaching hospital in the UK. Br J Clin Pharmacol. 2009; 68(2): 260–268. doi: 10.1111/j.1365-2125.2009.03458.x 19694747

30. Serinken M, Karcioglu O, Sengul C, Turkcuer I, Keysan M. Hospital costs of managing deliberate self-poisoning in Turkey. Med Sci Monit. 2008; 14(3): 152–158.

31. Kapur N, House A, Creed F, Feldman E, Friedman T, Guthrie E. General hospital services for deliberate self-poisoning: an expensive road to nowhere? Postgrad Med J. 1999; 75(888): 599–602. doi: 10.1136/pgmj.75.888.599 10621900

32. Verstraete A, Buylaert W. Survey of patients with acute poisoning seen in the Emergency Department of the University Hospital of Gent between 1983 and 1990. Eur J Emerg Med. 1995; 1995(2), 217–223.

33. STROBE Statement. Strenghtening the reporting of observational studies in epidemiology. [cited 2018 Jul 29]. https://strobe-statement.org/index.php?id=strobe-home.

34. ICD-10Version:2010. [cited 2018 Jul 29]. http://apps.who.int/classifications/icd10/browse/2010/en.

35. Cronin J. The introduction of the Manchester Triage scale to an emergency department in the Republic of Ireland. Accident and Emergency Nursing. 2003; 11: 121–125. 12633631

36. Vallersnes O, Bjornaas M, Lund C, Jacobsen D, Ekeberg Ø, Brekke M. Follow-up of young patients after acute poisoning by substances of abuse: a comparative cohort study at an emergency outpatient clinic. BMC Res Notes. 2016; 9:398. doi: 10.1186/s13104-016-2200-6 27506676

37. Heyerdahl F, Hovda K, Bjornaas M, Nore A, Figueiredo J, Ekeberg O, et al. Pre-hospital treatment of acute poisonings in Oslo. BMC Emerg Med. 2008; 8:15. doi: 10.1186/1471-227X-8-15 19025643

38. Lund C, Vallersnes O, Jacobsen D, Ekeberg O, Hovda K. Outpatient treatment of acute poisonings in Oslo: poisoning pattern, factors associated with hospitalization, and mortality. Scand J Trauma Resusc Emerg Med. 2012;20:1. doi: 10.1186/1757-7241-20-1 22217253

39. Improving health and social care through evidence-based guidance. Nice Guidance. [cited 2018 Jul 29]. guidelines https://www.nice.org.uk/guidance.

40. OECD health spending. [cited 2019 April 26]. https://data.oecd.org/healthres/health-spending.htm.

41. Health at a Glance 2017: OECD Indicators, OECD Publishing, Paris. [cited 2019 April 26]. http://dx.doi.org/10.1787/health_glance-2017-en.

42. Gross domestic product. [cited 2019 April 26]. https://data.oecd.org/gdp/gross-domestic-product-gdp.htm.

43. Anderson, P. & Baumberg, B. Alcohol in Europe. London: Institute of Alcohol Studies. 2006.

44. Cummins R, Chamberlain D, Hazinski M, Nadkarni V, Kloeck W, Kramer E, et al. Recommended guidelines for reviewing, reporting, and conducting research on in-hospital resuscitation: the in-hospital “Utstein Style”. Annals of Emergency Medicine. 1997; 29(5): 650–679.

45. Deutsche Gemeinschaft für Unfallchirurgie [cited 2019 Apr 20] https://www.dgu-online.de


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PLOS One


2019 Číslo 10

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