Abstract
BackgroundProcedures for the clinical assessment of acute poisoning by substances of abuse should identify patients in need of hospital admission and avoid hazardous discharges, while keeping the observation time short. We assess the safety of a systematic procedure developed at the Oslo Accident and Emergency Outpatient Clinic (OAEOC).MethodsAll patients 12 years and older treated for acute poisoning by substances of abuse at the OAEOC were included consecutively from October 2011 to September 2012. Data were collected on pre-set registration forms. Information on re-presentations to health services nation-wide during the first week following discharge was retrieved from the Norwegian Patient Register and from local electronic medical records. Information on fatalities was obtained from the Norwegian Cause of Death Registry.ResultsThere were 2343 cases of acute poisoning by substances of abuse. The main toxic agent was ethanol in 1291 (55 %) cases, opioids in 539 (23 %), benzodiazepines in 194 (8 %), central stimulants in 132 (6 %), and gamma-hydroxybutyrate (GHB) in 105 (4 %). Median observation time was four hours. The patient was hospitalised in 391 (17 %) cases. Two patients died during the first week following discharge, both from a new opioid poisoning. Among 1952 discharges, 375 (19 %) patients re-presented at the OAEOC or a hospital within a week; 13 (0.7 %) with a diagnosis missed at the index episode, 169 (9 %) with a new poisoning, 31 (2 %) for follow-up of concomitant conditions diagnosed at index, and 162 (8 %) for unrelated events. Among the patients with missed diagnoses, five needed further treatment for the same poisoning episode, two were admitted with psychosis, one had hemorrhagic gastritis, another had fractures in need of surgery and four had minor injuries.ConclusionThe procedure in use at the OAEOC can be considered safe and could be implemented elsewhere. The high re-presentation rate calls for better follow-up.
Highlights
Procedures for the clinical assessment of acute poisoning by substances of abuse should identify patients in need of hospital admission and avoid hazardous discharges, while keeping the observation time short
The Oslo Accident and Emergency Outpatient Clinic (OAEOC), in Oslo, Norway, has for decades used a systematic clinical procedure for the assessment of patients presenting with suspected poisoning by substances of abuse [9]
Further aims were to describe the acute poisonings by substances of abuse treated at the OAEOC and to identify factors associated with hospitalisation
Summary
Procedures for the clinical assessment of acute poisoning by substances of abuse should identify patients in need of hospital admission and avoid hazardous discharges, while keeping the observation time short. Patients with self-inflicted poisoning often need hours of observation in emergency departments and are frequently admitted to hospital [1,2,3] Many of these poisonings are by substances of abuse. The Oslo Accident and Emergency Outpatient Clinic (OAEOC), in Oslo, Norway, has for decades used a systematic clinical procedure for the assessment of patients presenting with suspected poisoning by substances of abuse [9]. This procedure is designed to enable the physician to identify patients in need of more intensive care than mere observation, and to identify conditions
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