Evaluation of Patients Presenting to the Emergency Department with Suicidal Drug Poisoning

Abstract

Introduction: Drug intoxications may be associated with accidental or suicidal ingestion of toxic agents. In both cases, emergency treatment includes administration of the relevant antidote and gastric decontamination. If necessary, patients are followed up in wards and intensive care units, whereas a group of patients are discharged directly from the emergency department. Materials and Methods: The aim of this study was to conduct a retrospective evaluation of examination findings, laboratory investigations, duration of treatments, psychiatric follow-up studies, hospitalization rates and mortality rates in patients admitted to our emergency department due to drug intoxication between 2017 and 2018. Results: Of the 126 patients included in our study, 83 were female, with a mean age of 33.58 ± 13.58 years and a range of 18 to 92 years. Of all patients, 76 were hospitalized in the ward and 1 in the intensive care unit, while 49 were treated in the emergency department. One patient had mortality on the eighth day of hospitalization. Eighty-six patients had been on psychiatric treatment prior to admission, whereas 82 patients were referred to the psychiatry department after admission. The rate of psychiatric consultation was significantly higher in patients who were hospitalized in any department due to drug intoxication than in patients who were discharged directly from the emergency department (p <0.001). Conclusion: Drug intoxications continue to be a growing problem for physicians working in emergency departments in Turkey as well as in the world. The incidence of drug intoxications was higher in patients who had previously applied to psychiatry outpatient clinics than those who had not. Our study highlighted the shortcomings of physicians in emergency departments in referring this patient group to the psychiatry department. There is a duty for health professionals in emergency departments to direct patients to receive adequate psychosocial support.

Keywords

• Drug intoxications
• Emergency departments
• Psychiatric consultation.

References

1. 1. Müller D, Desel H. Common causes of poisoning: etiology, diagnosis and treatment. Deutsches Ärzteblatt International 2013;110(41):690-700.
2. 2. Bronstein AC, Spyker DA, Cantilena LR, Jr., et al. 2010 Annual Report of the American Association of Poison Control Centers' National Poison Data System: 28th Annual Report. Clin Toxicol 2011;49(10):910-41.
3. 3. Dart RC, Bronstein AC, Spyker DA, et al. Poisoning in the United States: 2012 emergency medicine report of the National Poison Data System. Annals of emergency medicine 2015;65(4):416-22.
4. 4. Friedman LS, Krajewski A, Vannoy E, et al. The association between US Poison Center assistance and length of stay and hospital charges. Clinical toxicology 2014;52(3):198-206.
5. 5. Pekdemir M, Yıldız M, Durukan P, et al. Acil servise başvuran erişkin zehirlenme olgularının prospektif olarak incelenmesi. Toksikoloji dergisi 2004;2:41-8.
6. 6. Ozayar E, Degerli S, Gulec H, et al. Retrospective Analysis of Intoxication Cases in the ICU. Dahili ve Cerrahi Bilimler Yoğun Bakım Dergisi 2011;2(3):59-62.
7. 7. De Koning E, Piette MH. A retrospective study of murder–suicide at the Forensic Institute of Ghent University, Belgium: 1935–2010. Medicine, Science and the law 2014;54(2):88-98.
8. 8. Sena-Ferreira N, Pessoa VF, Boechat-Barros R, et al. Risk factors associated with suicides in Palmas in the state of Tocantins, Brazil, between 2006 and 2009 investigated by psycho-social autopsy. Ciencia & saude coletiva 2014;19(1):115-26.

9. 9. Bilici M, Bekaroğlu M, Hocaoğlu Ç, et al. Incidence of completed and attempted suicide in Trabzon, Turkey. Crisis: The Journal of Crisis Intervention and Suicide Prevention 2002;23(1):3-10.
10. 10. Teti GL, Rebok F, Rojas SM, et al. Systematic review of risk factors for suicide and suicide attempt among psychiatric patients in Latin America and Caribbean. Revista Panamericana de Salud Pública 2014;36:124-33.
11. 11. Duran M, Uludag O, Yuzkat N. The analysis of adult intoxication cases seen in Adıyaman Region and treated in intensive care unit. Medical Science and Discovery 2016;3(2):71-5.
12. 12. Köse I, Zincircioğlu Ç, Nimet Ş, Y et al. Yoğun bakım ünitemize kabul edilen zehirlenme olgularının bir yıllık geriye dönük incelemesi ve mortaliteyle ilişkili faktörlerin değerlendirilmesi. İzmir Tepecik Eğitim ve Araştırma Hastanesi Dergisi 2015;25(1):28-32.
13. 13. Özdemir R, Bayrakcı BZ. Zehirlenmeler ve Hacettepe deneyimi. Katkı Ped Derg 2009;31:47-87.
14. 14. Özhasenekler RA, Karaman H, Kavak GÖ, et al. Özkıyım amaçlı ilaç intoksikasyonlu hastalarımızın demografik özellikleri, glaskow koma skalası ve revize travma skoru’nun mortalite ile ilişkisi. Akad Acil Tıp Derg 2012;11(4):200-3.
15. 15. Dağlı R, Kocaoğlu N, Bayır H, et al. Yoğun bakım servisimizdeki intoksikasyon vakalarının incelenmesi. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 2016;3(1):17-20.
16. 16. Muhammedoğlu N, Başaranoğlu G, Gül YG, et al. Yeni açılan yoğun bakım ünitemize gelen suisid ve intoksikasyon vakalarının değerlendirilmesi. Haseki Tip Bült 2014;52(3):153-7.
17. 17. Özdemir A, Şen A, Erdivanlı B, et al. Intoxication Cases in an Intensive Care Unit. Journal of Turgut Ozal Medical Center 2015;22(4):218-20.
18. 18. Karcıoğlu Ö, Demirel Y, Esener Z, et al. Acil serviste ilaç ile zehirlenmeler: Bir yıllık olgu serisi. Türkiye Acil Tıp Dergisi 2002;2(2):26-33.
19. 19. Baydin A, Yardan T, Aygun D, et al. Retrospective evaluation of emergency service patients with poisoning: a 3-year study. Advances in therapy 2005;22(6):650-8.
20. 20. Satar S, Seydaoglu G. Analysis of acute adult poisoning in a 6-year period and factors affecting the hospital stay. Advances in therapy 2005;22(2):137-47.
21. 21. Tüfekçi IB, Curgunlu A, Şirin F. Characteristics of acute adult poisoning cases admitted to a university hospital in Istanbul. Human & experimental toxicology 2004;23(7):347-51.
22. 22. Miguel-Bouzas D, Carlos J, Castro-Tubío E, et al. Epidemiological study of acute poisoning cases treated at a Galician hospital between 2005 and 2008. Adicciones 2012;24(3):239-46.
23. 23. Islambulchilar M, Islambulchilar Z, Kargar-Maher M. Acute adult poisoning cases admitted to a university hospital in Tabriz, Iran. Human & experimental toxicology 2009;28(4):185-90.
24. 24. Heyerdahl F, Bjornas MA, Hovda KE, et al. Acute poisonings treated in hospitals in Oslo: a one-year prospective study II: clinical outcome. Clin Toxicol 2008;46(1):42-9.
25. 25. Lam SM, Lau ACW, Yan WW. Over 8 years experience on severe acute poisoning requiring intensive care in Hong Kong, China. Human & experimental toxicology 2010;29(9):757-65.
26. 26. Tas N, Yagan O, Demir EY, et al. Retrospective analysis of the intoxication cases followed in an intensive care unit. Journal of Experimental & Clinical Medicine 2015;32(2):51-4.
27. 27. Yağan Ö, Akan B, Erdem D, et al.The retrospective analysis of the acute poisoning cases applying to the emergency unit in one year. Şişli Etfal Hastanesi Tıp Bülteni 2009;43(2):60-4.
28. 28. Rotheram-Borus MJ, Piacentini J, Cantwell C, et al. The 18-month impact of an emergency room intervention for adolescent female suicide attempters. Journal of consulting and clinical psychology 2000;68(6):1081-93.
29. 29. Ryan J, Rushdy A, Perez-Avila C, et al. Suicide rate following attendance at an accident and emergency department with deliberate self harm. Journal of Accident & Emergency Medicine 1996;13(2):101-4.