Poisoning with malicious or criminal intent: characteristics and outcome of patients presenting for emergency care

Abstract

Background: Poisoning is the leading cause of injury-related death in the USA. Poisoning with malicious or criminal intent is uncommon, and poorly characterized.Objectives: To explore substances, patients’ demographics, clinical presentation, management and outcome in victims of malicious poisoning in the USA.Methods: Using the 47 participating sites of the Toxicology Investigators Consortium (ToxIC) Registry, a North American research consortium, we conducted an observational study of a prospectively collected cohort. We identified all patients exposed to malicious poisoning who had received medical toxicology consultation between January 2014 and June 2017. Clinical and demographic data were collected including age, sex, agents of exposure, clinical manifestations, treatment, disposition and outcome.Results: We identified 60 patients who presented to the emergency department with malicious poisoning, of whom 21 (35%) were children. Among 21 children, 17 (81%) were younger than 2 years. There was no sex dominance among patients. The main substances involved in pediatric patients were sympathomimetics (35%) and opioids (19%). In adults, a more varied panel of offending substances was used, with no specific dominant toxidrome. Children received more treatment interventions compared to adults (overall treatment 81% versus 46% [p = 0.0132]; mechanical ventilation: 29% versus 5% [p = 0.0176], respectively). Three (5%) patients died (two children, one adult).Conclusions: Poisonings with malicious intent are uncommon; they are disproportionally directed towards infants, frequently resulting in severe injury and carry relatively high mortality.