Patterns of Acute Poisoning among Patients in the Emergency Wards of a Tertiary Care Hospital - PowerPoint Presentation

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Patterns of Acute Poisoning among Patients in the Emergency Wards of a Tertiary Care Hospital

Presentation by:

Dr. Devi Revathi

Pharm-d Intern

Ms Ramaiah Memorial Hospitals Bangalore-India

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Coward’s Weapon “No other form of murder in the history of homicide has been as dramatized, documented, romanticised, disparaged or has achieved such a high level of art as poisoning, which was described as 'the coward's weapon' by the Jacobean dramatist John Fletcher (1579–1625)”.1

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INTRODUCTION

Poison is any substance which interferes with normal body functions after it is swallowed, inhaled, injected, or absorbed. 

This category includes deaths from poisoning and medical conditions caused by use of legal or illegal drugs, medically prescribed and excludes unintentional injuries, homicides, and other causes indirectly related to drug use.

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For effective treatment and better outcomes, information on the nature of poisoning agents and extent of poisoning is required to reduce the high morbidity and mortality associated with poisoning.

The course of clinical management and ultimate outcome of the poisoning patients is determined by

Type of poisoning agent

Amount of poison consumed

Pre-existing comorbidities

Time from exposure to presentation at a healthcare facility and the experience of care provider and the services available at the hospital

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The present study was conducted:-

Due to the scarcity of poisoning data in the surrounding provinces

Changing trends in poisoning every year

Information obtained from previous studies were unclear about pattern of poisoning

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OBJECTIVE

To study the pattern of poisoning and their treatment outcomes.

Demographic Characteristics and Hospital admission characteristics

Demographic characteristics in association with pattern of poisoning

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Study design: Cross-sectional descriptive study

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Study duration

: The study was conducted for a period of Six months (November 16-April 2017)

Study setting:

Accident and Emergency department of M. S Ramaiah Memorial And Teaching Hospitals.

Study Tools:

Patient documentation form and study information sheets.Ethical Clearance: Institutional Ethics Committee Informed Consent: Written Informed Consent from the study participants

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METHODOLOGY

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STUDY CRITERIA

Inclusion Criteria:

Acute poisoning patients of known and unknown origin.

Exclusion Criteria:

Ingestion of non-

digestable

substances such as coins , pins and plastics.

Deliberate physical self harm such as hanging, self - inflicted wounds, burns and bruises.

Sexual assault, road traffic accidents, criminal abortion.

Sample Size

: n=133 patients

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STUDY PROCEDURE 9

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STUDY PROFORMA 10

Demographic Details

Patterns of poisoning

Hospital Attendance pattern

Age

Reasons for poisoning

Hospitalisation time after exposure

Gender

Route of poisoning

Reason for delay

Marital Status

Physical form

Location of exposure

Intended use of poisoning

First Aid

Treatment given

Symptoms of poisoning

Poison Severity Score

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DATA ANALYSIS

Demographic and hospital attendant variables were categorized and were subjected to analysis.

Binary logistic regression was applied to check the relationship between demographic profile and pattern of poisoning.

Statistical significance was considered at p<0.05(confidence interval of 95%).

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The data collected was entered into an excel spread sheet.

Data was analyzed using the Statistical Package for Social Sciences (SPSS) version 22 (SPSS Inc., Chicago, IL, USA).

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RESULTS

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Figure 1

:

D

emographic variables of the study participants

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Variable

N(%)=133

Reason for poisoning

 

Intentional

92(69.1)

Non-Intentional

41(30.8)

If non intentional

n(%)=41

Accidental

17(41.4)

Snake bite

09 (21.9)

Bee stings

15 (36.5)

Route of poisoning

n(%)=133

Ingestion

108(81.2)

Other route

25(18.8)

 

Table 2: Pattern of poisoning of study participants

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Ingestion Physical form

n(%)=108

Solid

65(60.2)

Liquid

38 (35.2)

Gas

05 (4.6)

Intended use of poisoning

n(%)= 91

Medication

47 (51.6)

Insecticides

19 (20.9)

Rodenticides

12(13.2)

Household chemicals

31(34.0)

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TABLE 3: Hospital attendance pattern of the poisoning of the study participants

Variables

N(%)=133

Hospitalisation time after exposure

 

≤60 mins

45(33.8)

>60 mins

88(66.2)

Reason for delay, if >60 mins.

 

Traffic/ transport

67 (76.2)

Medical referral

06 (06.8)

Others

15 (17.0)

Location of exposure

 

Home

109(82.0)

Workplace

14(10.5)

Others

10(7.5)

First aid

 

Yes

83(62.4)

No

49(36.8)

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Treatment given

 

Symptomatic

31(23.3)

Supportive

70(52.7)

Specific

32(24.0)

Symptoms due to poisoning

 

Yes

108(81.2)

No

25(18.8)

Type of symptoms

 

Systemic

76(70.4)

Local

16(14.8)

Both

16(14.8)

Poison severity scale

 

None

25(18.79)

Minor

81(60.90)

Moderate

21(15.78)

Severe /fatal

06(4.51)

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Figure 2: Classification of symptoms

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Figure 3: Therapeutic drugs administered

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Variable

Reason of exposure

Route of exposure

Physical form

 

 

Age

OR: 95% CI

OR :95%CI

OR: 95%CI

.523

(.14-1.94)

1.232

(.21-7.09)

1.182

(.47-2.92)

Gender

.722

(.231-2.25)

1.115

(.48-2.54)

.717

(0.33-1.52)

Marital Status

 

 

a. Single

18.525

(5.33-64.31)*

1.206

(.27-5.38)

4.2

(1.33-13.25)

b. Married

10.506

(3.39-32.54)*

.630

(.16-2.46)

3.000

(1.02-8.810)

Table 4: Sociodemographic Variables in association with Pattern of Poisoning

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DISCUSSION

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According to the CDC, 81% of intentional poisoning suicides were caused by drugs - both legal and illegal.

Intentional poisoning was the leading cause of emergency department visits for intentional injury in 2010

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Understanding the epidemiology of acute poisoning

, the

dominance of poisonous

agents and

severity scoring systems (PSS) are of major importance for providing immediate management and intense monitoring of treatment procedures in patients admitted to the emergency centers. Knowledge about the nature and magnitude of the problem in a particular area is essential for the doctors in hospital practice. Studies of this nature will serve as a useful tool in planning and management of critically ill poisoning victims

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SOCIO-DEMOGRAPHIC CHARACTERISTICS

AGE

< 30 Years (59.3)

27.76±15.5

Other studies

Tejas

Prajapathi, et alDevendranath Sarkar et al

GENDER

Females(52.4%)

Males (47.6%)

Other studies

Fahad et al.,

Eyosis

Teklemariam et al,

MARITAL STATUS

Single (36%)

Married (49.6%)

Other Studies

Sandesh et al.,

Niti

Mital

et al.,

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PATTERNS OF POISONING

MOTIVE FOR POISONING

Intentional (67.4%)

Non Intentional (32.6%)

Other studies

Raut

Aswari

et al., Mahabalasetti et al.,

ROUTE AND LOCATION OF EXPOSURE

Ingestion (81.2%)

Home (82%)

Other studies

Raju Prasad et al., (99%)

Zeinab et al., (82%)

INTENDED USE & IT’S PHYSICAL FORM

Medications (51.6%)

House hold chemicals (34%)

Solid form (60.2%)

Other studies

Ahmed Al

Baraqq

et al., (76.7%)

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HOSPITAL ATTENDANCE PATTERNS

TIME ELAPSED FROM EXPOSURE TO HOSPITALISATION.

<1 hour: 66.2%

Similar Studies

Ghaniya

S. et al.,

.,

SYMPTOMS

Systemic (70.4%)

Local (14.8%)

Similar Studies

Moazzam

M, et al., Abubakar S et al.,”

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FIRST AID

Yes (62.4%)

No (36.8%)

Similar Studies

Ramesh KN et al.,

Shoba

Churi

et al.,

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TREATMENT PROVIDED

Supportive (52.7%)

Specific (24%)

Symptomatic (23.3%)

Similar Studies

Leena Antony et al.,

Pratik D

Asari et al

POISON SEVERITY SCORE

None (18.79%)

Mild (60.90%)

Moderate (15.78%)

Fatal (4.51%

Similar Studies

Mohammad

Shafiqul

et al.,

Fahad Akhtar et al.,

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Reason of exposure was compared with marital status, study participants who were single(OR:18.525) were more likely to have intentional poisoning.

Ingestion of physical forms was significantly observed in both the single (0R:4.5) and married (0R:3)

No previous studies been conducted (Table 4)

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Strengths

Extensive clinical information

The hospital is a 1200 bedded provided with all facilities and majority of the patients were representative of poisoning.

Limitations

Duration of the study lasted for period of six months.

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FUTURE INSIGHTS

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Coupling the clinical pharmacist’s expertise with health care teams will amplify their usefulness to predict the severity outcomes in poisoning incidents

Legislations should be implemented to ban the over counter sales of medications and pesticides

As marital status demonstrated a strong significance in poisoning, implementing public health strategies along with certain education, interactive preventive programs

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Additionally, workshops and counselling programs on increasing the awareness about support programs for mentally disturbed people

Educating the general public on first aid measures

Increased knowledge regarding the poisoning pattern helps health care providers to improvise the treatment and ultimately patients quality of life.

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REFERENCES

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Abd-

Elhaleem

ZA,

Muqhem

BA. Pattern of acute poisoning in Al

Majmaah

region, Saudi Arabia. American Journal of Clinical and Experimental Medicine. 2014 Aug 1;2(4):79-85.

Centre for Disease Control and Prevention NCHS Data on Drug Poisoning Deaths August (Internet). 2017. Available from:

(

https://www.cdc.gov/nchs/data/factsheets/factsheet_drug_poisoning.htm

)

National Crime Records Bureau, Suicides in India- Accidental Deaths and Suicides in India (Internet). 2015. Available from:

http://ncrb.gov.in/

Singh O,

Javeri

Y,

Juneja

D, Gupta M, Singh G, Dang R. Profile and outcome of patients with acute toxicity admitted in intensive care unit: Experiences from a major corporate hospital in urban India. Indian journal of

anaesthesia

. 2011 Jul; 55(4):370.

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Prajapati T, Prajapati K, Tandon R, Merchant S. Acute chemical and pharmaceutical poisoning cases treated in civil hospital, Ahmedabad: one year study. Asia Pacific Journal of Medical Toxicology. 2013 Jun 1;2(2):63-7.

Hameed FA, Ansari HK, Al-Najjar FJ. Prevalent Poisonings in Adolescents and Adults in Dubai: A Compendium from Rashid Hospital. Asia Pacific Journal of Medical Toxicology. 2014 Sep 1;3(3):115-9.

Asawari

R,

Atmaram

P,

Bhagwan K,

Priti

D, Kavya S,

Jabeen

GA. Toxicological Pattern of Poisoning in Urban Hospitals of Western India. Journal of Young Pharmacists. 2017 Jul 1;9(3):315.

Suicidality and death by suicide among middle-aged adults in the united states, Kathryn

DownePiscopoPh

(Internet). Available from:

https://www.samhsa.gov/data/sites/default/files/report_3370/ShortReport-3370.html

Mittal N, Shafiq N, Bhalla A,

Pandhi

P, Malhotra S. A prospective observational study on different poisoning cases and their outcomes in a tertiary care hospital. SAGE open medicine. 2013 Sep 13;1:2050312113504213.

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Dr

Aruna

C Ramesh

HOD Accident and Emergency Medicine MS Ramaiah Teaching Hospitals Bangalore

Dr Lakshmi Prasanna

Marise

Assistant Professor Faculty of Pharmacy MS Ramaiah University of Applied Sciences Bangalore Dr Vijay Sharma Post Graduate student Department of Public Health Dentistry Government Dental College & Research Institute, BangaloreAssistant professors of the Faculty of Pharmacy

Friends and Family

All participants in the research work

Organizing Committee of the Toxicology Congress 2018

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ACKNOWLEDGEMENT

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Thanks!