Five-year mortality after acute poisoning treated in ambulances, an Emergency outpatient clinic and hospitals in Oslo

Cathrine Lund,Dag Jacobsen,Leiv Sandvik,Mari A Bjornaas,Oivind Ekeberg,Knut E Hovda

doi:10.1186/1757-7241-21-65

Abstract

BackgroundThe long-term mortality after prehospital treatment for acute poisoning has not been studied previously. Thus, we aimed to estimate the five-year mortality and examine the causes of death and predictors of death for all acutely poisoned patients treated in ambulances, the emergency outpatient clinic, and hospitals in Oslo during 2003–2004.MethodsA prospective cohort study included all adults (≥16 years; n=2045, median age=35 years, male=58%) who were discharged after treatment for acute poisoning in ambulances, the emergency outpatient clinic, and the four hospitals in Oslo during one year. The patients were observed until the end of 2008. Standardized mortality rates (SMRs) were calculated and multivariate Cox regression analysis was applied.ResultsThe study comprised 2045 patients; 686 treated in ambulances, 646 treated in the outpatient clinic, and 713 treated in hospitals. After five years, 285 (14%) patients had died (four within one week). The SMRs after ambulance, outpatient, and hospital treatment were 12 (CI 9–14), 10 (CI 8–12), and 6 (CI 5–7), respectively. The overall SMR was 9 (CI 8–10), while the SMR after opioid poisoning was 27 (CI 21–32). The most frequent cause of death was accidents (38%). In the regression analysis, opioids as the main toxic agents (HR 2.3, CI 1.6–3.0), older age (HR 1.6, CI 1.5–1.7), and male sex (HR 1.4, CI 1.1–1.9) predicted death, whereas the treatment level did not predict death.ConclusionsThe patients had high mortality compared with the general population. Those treated in hospital had the lowest mortality. Opioids were the major predictor of death.

Highlights

The long-term mortality after prehospital treatment for acute poisoning has not been studied previously
Characteristics of study subjects Of the 2298 patients with acute poisoning during the inclusion period, we excluded 236 patients with unknown social security numbers, 15 patients who died during the index episode, and two patients with residency outside Norway
Main results During the five-year follow-up, 285 patients died, i.e., 112 (16%) of those treated in ambulances, (13%) of those treated in the emergency outpatient clinic, and

Summary

Introduction

The long-term mortality after prehospital treatment for acute poisoning has not been studied previously. We aimed to estimate the five-year mortality and examine the causes of death and predictors of death for all acutely poisoned patients treated in ambulances, the emergency outpatient clinic, and hospitals in Oslo during 2003–2004. In Oslo, acute poisonings are treated at three different health care levels: the ambulance service, an emergency outpatient clinic, and hospitals. Poisonings with a suicidal intent or with prescription medications are treated in hospital, whereas poisonings with drugs of abuse are treated mainly in the ambulance or outpatient clinic [1]. The evaluation of intent can be difficult in patients presenting with acute poisoning because they are often comatose, unwilling to report the use of illicit drugs, and even ambivalent about their wish to die, which can complicate the evaluation. Analyzing all self-poisonings within a geographical area may make it possible to generalize from the sample to a well-defined population

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