Abstract
BackgroundMost patients with acute poisoning are treated as outpatients worldwide. In Oslo, these patients are treated in a physician-led outpatient clinic with limited diagnostic and treatment resources, which reduces both the costs and emergency department overcrowding. We describe the poisoning patterns, treatment, mortality, factors associated with hospitalization and follow-up at this Emergency Medical Agency (EMA, "Oslo Legevakt"), and we evaluate the safety of this current practice.MethodsAll acute poisonings in adults (> or = 16 years) treated at the EMA during one year (April 2008 to April 2009) were included consecutively in an observational study design. The treating physicians completed a standardized form comprising information needed to address the study's aims. Multivariate logistic regression analysis was used to identify the factors associated with hospitalization.ResultsThere were 2348 contacts for 1856 individuals; 1157 (62%) were male, and the median age was 34 years. The most frequent main toxic agents were ethanol (43%), opioids (22%) and CO or fire smoke (10%). The physicians classified 73% as accidental overdoses with substances of abuse taken for recreational purposes, 15% as other accidents (self-inflicted or other) and 11% as suicide attempts. Most (91%) patients were treated with observation only. The median observation time until discharge was 3.8 hours. No patient developed sequelae or died at the EMA. Seventeen per cent were hospitalized. Gamma-hydroxybutyric acid, respiratory depression, paracetamol, reduced consciousness and suicidal intention were factors associated with hospitalization. Forty-eight per cent were discharged without referral to follow-up. The one-month mortality was 0.6%. Of the nine deaths, five were by new accidental overdose with substances of abuse.ConclusionsMore than twice as many patients were treated at the EMA compared with all hospitals in Oslo. Despite more than a doubling of the annual number of poisoned patients treated at the EMA since 2003, there was no mortality or sequelae, indicating that the current practice is safe. Thus, most low- to intermediate-acuity poisonings can be treated safely without the need to access hospital resources. Although the short-term mortality was low, more follow-up of patients with substance abuse should be encouraged.
Highlights
Most patients with acute poisoning are treated as outpatients worldwide
The study objectives were (1) to describe all acutely poisoned adults presenting at the the Emergency Medical Agency (EMA) in one year beginning in April 2008 by collecting data on the number of patients, toxic agents, evaluated intention and complications; (2) to evaluate the treatment given and to identify factors associated with hospitalization and referral to follow-up; and (3) to discuss whether treatment of acute poisonings at the EMA may be considered safe with respect to mortality at the EMA and after one month
The factors associated with hospitalization were gamma-hydroxybutyric acid (GHB) or paracetamol as the main toxic agent, suicidal intention, presence of complications and reduced consciousness
Summary
In Oslo, these patients are treated in a physician-led outpatient clinic with limited diagnostic and treatment resources, which reduces both the costs and emergency department overcrowding. We describe the poisoning patterns, treatment, mortality, factors associated with hospitalization and follow-up at this Emergency Medical Agency (EMA, “Oslo Legevakt”), and we evaluate the safety of this current practice. Oslo has a long tradition of treating acute poisoning by substances of abuse in a unique outpatient clinic, the Emergency Medical Agency (EMA, “Oslo Legevakt”). This physician-led walk-in clinic has served the entire city 24 hours a day, seven days a week since 1900 and treats low- to intermediate-acuity patients who would otherwise present to hospital emergency departments. Because the diagnostic tools and treatment options are limited, treatment at the EMA is less resource consuming than in-hospital treatment of equivalent conditions
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