Abstract
ObjectiveThe 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.MethodsData 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.ResultsA 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.ConclusionPoisonings 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.
Highlights
Poisoning poses a significant global public health problem
Poisonings entail a considerable percentage of patients admitted to an emergency department (ED) and financial burden
Ethanol poisonings account for the largest proportion of all ED admissions
Summary
1,214/34,000 (3.6%) admissions were included, of whom 62.2% were male (Table 1). In cases of ethanol poisoning (whether or not in combination with other agents, the mean cost per admission was €1,216 (SD €2,691) for the 1,175 admissions (including readmissions), with a median cost of €376 (IQR 154–1,389). Age >60y 41-60y 21-40y 14-20y Hour of admission 8am-12am 12am-4pm 4pm-8pm 8pm-12pm 12pm-4am 4am-8am Victim location Other Public place Home Manchester triage score Urgent or very urgent Less urgent Not urgent Use of antidotes Yes No Antidepressants Yes No Antipsychotics Yes No Psychostimulants Yes No Benzodiazepines Yes No Ethanol Yes No. 3.31 (1.53–7.12) 5.40 (2.75–10.61) 7.36 (3.91–13.85) 8.94 (4.80–16.65) 0.85 (0.42–1.72). When medicinal agents were involved (T36-T50, poisoning by drugs, medicaments and biological substances), the median cost for hospitalised poisoned patients (including readmissions) was €1,983 (IQR €1,310–2,036). When non-medicinal agents were involved (T51-T65, toxic effects of substances nonmedicinal as to source), the median cost was €1,534 (IQR €1,272–2,782)
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