Abstract
Objectives: The State of Qatar, in recent decades, underwent rapid, and substantial population growth. The country's emergency medicine (EM) needs are met by government-operated facilities of the Hamad Medical Corporation (HMC), which see virtually all acute-care cases in adults and children. In 2017, emergency departments (ED) established the Medical Toxicology Consulting Service (MTCS). This report aims to outline the MTCS's initial 100 cases’ experience and report salient findings that can help ongoing national strategies in meeting Qatar's medical toxicology needs. Methods: The study setting is Qatar, and the clinical base for the MTCS was the country's sole level I center, Hamad General Hospital. The MTCS group is composed of six physicians, all with advanced training in medical toxicology. The study group is composed of the first 100 consecutive cases of the MTCS registry. Registry entry was triggered by in-person consultation, telephone consultation, or identification of cases by daily MTCS rounder surveillance of the ED's electronic tracking board. Results: The MTCS institution identified a significant number of medical toxicology cases within the national hospital system. The trends of poisoning in this study showed a median age of 30 years (range 1–81 years, IQR 22–36 years). Fourteen patients were < 18 years old. The median interval between exposure and ED presentation was 2 hours, with a range of 15 minutes to 24 hours (IQR 1–3 hours). Most patients (71%, 95% CI, 51%–80%) were symptomatic because they were exposed. The MTCS recommended therapeutic intervention in over a third of cases (36%, 95% CI, 27%–46%). Decontamination procedures were ordered in 8% of cases (95% CI, 4%–15%) and specific therapies recommended in 13 cases (13%, 95% CI, 7%–21%). Conclusions: The study highlighted that the availability of experts in medical toxicology, such as with a poison center or toxicology consultation service, results in significant resource conservation in the management of poisoned patients.
Highlights
Patients with acute poison exposure and acute poisoning typically present to medical care in an emergency department (ED)
Medical toxicology services can be a useful complement to care provided to such patients,[1,2] which in Qatar would typically be managed in an ED or a Pediatric Emergency Center (PEC)
Though only one pregnant patient (1% overall, 2% of females) was recorded, this is higher than the national average of 0.6% of poisonings occurring in pregnant women in the USA and Canada.[12]
Summary
Medical toxicology services can be a useful complement to care provided to such patients,[1,2] which in Qatar would typically be managed in an ED or a Pediatric Emergency Center (PEC). As the providers of essentially all urgent and emergency care for the country, HMC’s EDs, and PECs encounter most of the nation’s caseload of acute poisonings, overdoses, envenomation, and other medical toxicology cases. In recognition of this caseload, the clinical services providing emergency and pediatric emergency care collaborated to form a Medical Toxicology Consulting Service (MTCS). Telephone consultations were provided beginning in 2015, and bedside consults with daily rounding were instituted in mid-2017
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