Abstract
ObjectivesSome patients with deliberate drug poisoning subsequently have an adverse clinical course. The present study aimed to examine whether the type of drugs ingested and psychiatric diagnoses were related to an adverse clinical course.MethodsWe conducted a cohort study of patients with deliberate drug poisoning admitted to the intensive care unit of a university hospital located in Tokyo, Japan, between September 2006 and June 2013. Intensive care unit (ICU) stay of ≥4 days was used as a primary outcome measure, while the incidence of aspiration pneumonitis was used as a secondary outcome measure. Ingested substances and psychiatric diagnoses were used as explanatory variables.ResultsOf the 676 patients with deliberate drug poisoning, 88% had a history of psychiatric treatment and 82% had ingested psychotropic drugs. Chlorpromazine-promethazine-phenobarbital combination drug (Vegetamin®) ranked fifth among the most frequently ingested substances in cases of deliberate drug poisoning and had the highest incidence of prolonged ICU stay (20%) and aspiration pneumonitis (29%). The top three major classes consisted of benzodiazepines (79%), new-generation antidepressants (25%), and barbiturates/non-barbiturates (23%). Barbiturate overdose was independently associated with increased odds of both prolonged ICU stay (8% vs. 17%; odds ratio [OR], 2.97; 95% confidence interval [CI], 1.60–5.55) and aspiration pneumonitis (8% vs. 24%; OR, 3.83; 95% CI, 2.18–6.79) relative to those associated with overdose of only other sedative-hypnotics (i.e., benzodiazepines).ConclusionThese results suggest that judicious prescribing of barbiturates by psychiatrists could reduce the risk of an adverse clinical course when a patient attempts an overdose.
Highlights
Drug poisoning is a worldwide public health concern and places a serious burden on emergency medical service
Intensive care unit (ICU) stay of 4 days was used as a primary outcome measure, while the incidence of aspiration pneumonitis was used as a secondary outcome measure
Barbiturate overdose was independently associated with increased odds of both prolonged intensive care unit (ICU) stay (8% vs. 17%; odds ratio [odds ratios (ORs)], 2.97; 95% confidence interval [confidence intervals (CIs)], 1.60– 5.55) and aspiration pneumonitis (8% vs. 24%; OR, 3.83; 95% CI, 2.18–6.79) relative to those associated with overdose of only other sedative-hypnotics
Summary
Drug poisoning is a worldwide public health concern and places a serious burden on emergency medical service. A non-negligible subgroup of patients with deliberate drug poisoning may show an adverse clinical course such as aspiration pneumonia [8, 9], respiratory failure [10], hypothermia [9], and cardiovascular events [11], almost all (99%) patients survive their hospital stay [12,13,14]. Aspiration pneumonia is the most common adverse event among patients with deliberate drug poisoning [8] and doubles the length of intensive care unit (ICU) stay owing to physical recovery from the overdose-related complications [10]. 35% of patients are hospitalized for more than 3 days in acute care hospitals [16], these patients are generally discharged from the ICU within only 16–32 hours of admission [4, 10]
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