Presentation by Dr Devi Revathi Pharmd Intern Ms Ramaiah Memorial Hospitals BangaloreIndia Cowards 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 w ID: 791050
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Slide1
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
Slide2Coward’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
2
Slide3INTRODUCTION
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.
3
Slide4For 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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Slide5The 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
5
Slide66
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
Slide7Study design: Cross-sectional descriptive study
.
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
Slide8STUDY 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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Slide9STUDY PROCEDURE 9
Slide10STUDY 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
Slide11DATA 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).
Slide12RESULTS
Slide1313
Figure 1
:
D
emographic variables of the study participants
Slide1414
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
Slide1515
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)
Slide1616
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)
Slide1717
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)
Slide1818
Figure 2: Classification of symptoms
Slide1919
Figure 3: Therapeutic drugs administered
Slide2020
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
Slide21DISCUSSION
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Slide22According 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
.
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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Slide23SOCIO-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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Slide24PATTERNS 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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Slide25HOSPITAL 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.,”
25
FIRST AID
Yes (62.4%)
No (36.8%)
Similar Studies
Ramesh KN et al.,
Shoba
Churi
et al.,
Slide26TREATMENT 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.,
26
Slide2727
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)
Slide28Strengths
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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Slide29FUTURE 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.
Slide31REFERENCES
31
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.
Slide3232
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.
Slide33Dr
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
Slide3434
Thanks!