Evaluation of the Patients Admitted to the Emergency Room due to Poisoning in terms of Clinical Characteristics and Costs

Yıl 2019, , 470 - 478, 16.09.2019

Hakan Hakkoymaz , Ali İhsan Kilci , Özlem Güler , Fatih Nazmi Yaman , Ramazan Azim Okyay

https://doi.org/10.31832/smj.542548

Öz

Objective:
In this study, it is aimed to evaluate the demographic, etiologic and clinical
characteristics of the poisoning cases admitted to emergency room along with
their costs to Social Security Institution.

Materials
and Methods: This is a descriptive study. The data
were obtained by retrieving the files of the patients who were registered for
poisoning to XXXXXX University
Faculty of Medicine Training and Research Hospital adult emergency service between October 2015
and October 2017 from the automation system.

Results:
Of the patients, 60.3% were in the 18-24 age group, 30.6% were in the 25-34 age
group and 60.0% were females. Of the admissions, 56.8% were due to suicide
attempt. In the 18-24 age group and in women, poisonings were found more likely
to be a suicide attempt. Of the patients, 50.6%
admitted with drug poisoning. The second common cause of poisoning after drugs
was carbon monoxide (CO) with 20.6%.

Conclusion:
Poisoning is an important public health problem requiring urgent diagnosis and
treatment. Most of the drug poisonings, which have a significant share in all
poisonings, are suicide attempts. For this reason, the presence of psychiatric
symptoms must be investigated in patients with drug poisoning. The second
common cause of poisoning after drugs was found to be CO in our study. This
situation should be taken into account especially for applications in winter
period. Poisoning is also costly in terms of the health economy. It is
important to raise public awareness of poisoning in order to prevent both
health-related and financially adverse consequences.

Anahtar Kelimeler

Emergency room, costs, poisoning

Zehirlenme Nedeniyle Acil Servise Başvuran Hastaların Klinik Özellikler ve Maliyet Açısından Değerlendirilmesi

Öz

Amaç:
Bu çalışmada acil servise başvuran zehirlenme olgularının demografik,
etiyolojik ve klinik özellikleri ile bunların sosyal güvenlik kurumuna olan
maliyetlerinin değerlendirilmesi amaçlanmıştır.

Gereç
ve Yöntemler: Çalışmamız tanımlayıcı tiptedir.
Veriler, Ekim 2015-Ekim 2017 tarihleri arasında XXXXXX Üniversitesi Tıp
Fakültesi Araştırma ve Uygulama Hastanesi yetişkin acil servisine zehirlenme ön tanısıyla kaydı yapılan hastaların
dosyalarının otomasyon sisteminden retrospektif olarak incelenmesi ile elde
edilmiştir.

Bulgular:
Hastaların %60,3’ü 18-24, %30,6’sı 25-34 yaş grubunda olup, %60,0’ı kadındır.
Başvuruların %56,8’inde etkenle maruziyet, intihar amacıyla gerçekleşmiştir.
18-24 yaş grubunda ve kadınlarda zehirlenmelerin daha çok intihar amaçlı olarak
gerçekleştiği bulunmuştur. Hastaların %50,6’sı ilaç nedenli zehirlenme ile
başvurmuştur. İlaç dışı başvuruların en sık nedeni ise %20,6 ile karbonmonoksit
(CO) zehirlenmesi olmuştur.

Sonuçlar:
Zehirlenmeler, acil tanı ve tedaviyi gerektiren önemli bir halk sağlığı
sorunudur. Tüm zehirlenmeler içinde önemli bir paya sahip olan ilaca bağlı
zehirlenmelerin büyük bölümü intihar amaçlı alım sonucu gerçekleşmiştir. Bu
nedenle ilaç zehirlenmesi ile gelen hastalarda psikiyatrik tabloların varlığı
mutlaka araştırılmalıdır. Çalışmamızda ilaç dışı nedenlerle gerçekleşen
zehirlenmelerin en büyük nedeni CO olarak bulunmuştur. Özellikle kış döneminde
gelen başvurularda bu durum dikkate alınmalıdır. Zehirlenmeler, sağlık ekonomisi
açısından da maliyetlidir. Zehirlenmelerin gerek sağlıkla ilgili, gerekse de
mali açıdan yarattığı olumsuzlukların önlenmesi açısından toplumsal
farkındalığın arttırılması önemlidir. 

Anahtar Kelimeler

Acil servis, maliyet, zehirlenme

Kaynakça

• Referans1. Yeşil O, Akoğlu H, Onur Ö, Güneysel Ö. Retrospective evaluation of poisoning patients in the Emergency Department. Marmara Medical Journal 2008; 21(1): 26-32.Referans2. Ayan M, Başol N, Karaman T, Taş U, Esen M. Retrospective Evaluation of Emergency Service Patients with Poisoning: a 20 Month Study. JAEM 2012; 11: 146-50.Referans3. Deniz T, Kandiş H, Saygun M, Büyükkoçak Ü, Ülger H, Karakuş A. Evaluation of Intoxication Cases Applied to Emergency Department of Kirikkale University Hospital. Düzce Tıp Fakültesi Dergisi 2009; 11(2): 15-20.Referans4. Demirel İ. A Retrospective Analysis of Intoxication Cases in Intensive Care Unit of Elazığ Education and Research Hospital. Fırat Tıp Dergisi 2010; 15(4): 184-187.Referans5. Ozayar E, Değerli S, Gulec H, Şahin Ş, Dereli N. Retrospective Analysis of Intoxication Cases in the ICU. Yoğun Bakım Derg 2011; 3: 59-62.Referans6. Çanakçı E, Kaya Y, Karataş A. Retrospective analysis of intoxication cases admitted to our intensive care unit. Kocatepe Medical Journal 2017; 18: 100-5.Referans7. Kondolot M, Akyıldız B, Görözen F, Kurtoğlu S, Patıroğlu T. Evaluation of the poisoning cases who applied to the Pediatrics Emergency Unit. Çocuk Sağlığı ve Hastalıkları Dergisi 2009; 52: 68-74.Referans8. Mowry JB, Spyker DA, Brooks DE, McMillan N, Schauben JL. 2014 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 32nd Annual Report. Clin Toxicol (Phila) 2015; 53(10): 962-1147.Referans9. Gjersing L, Jonassen KV, Biong S, Ravndal E, Waal H, Bramness JG, et al. Diversity in causes and characteristics of drug-induced deaths in an urban setting. Scand J Public Health 2013; 41(2): 119-25.Referans10. Gallagher LM, Kappatos D, Tisch C, Ellis PM. Suicide by poisoning in New Zealand--a toxicological analysis. N Z Med J 2012; 125(1362): 15-25.Referans11. McCaig LF, Burt CW. Poisoning-related visits to emergency departments in the United States, 1993-1996. J Toxicol Clin Toxicol 1999; 37(7): 817-26.Referans12. Pinar A, Fowler J, Bond GR. Acute poisoning in Izmir, Turkey--a pilot epidemiologic study. J Toxicol Clin Toxicol 1993; 31(4): 593-601.Referans13. Thomas SH, Bevan L, Bhattacharyya S, Bramble MG, Chew K, Connolly J, et al. Presentation of poisoned patients to accident and emergency departments in the north of England. Hum Exp Toxicol 1996; 15(6): 466-70.Referans14. Hanssens Y, Deleu D, Taqi A. Etiologic and demographic characteristics of poisoning: a prospective hospital-based study in Oman. J Toxicol Clin Toxicol 2001; 39(4): 371-80.Referans15. Karakaya A, Vural N. Acute poisoning admissions in one of the hospitals in Ankara. Hum Toxicol 1985; 4(3): 323-6.Referans16. Albert M, McCaig LF, Uddin S. Emergency department visits for drug poisoning: United States, 2008-2011. NCHS Data Brief 2015; 196: 1-8.Referans17. Dal O, Kavak H, Akay S, Ünlüer E, Aksay E. Retrospective evaluation of poisoning patients in the emergency department. Journal of Contemporary Medicine 2013; 3(1): 22-27.Referans18. Akbaba M, Nazlican E, Demirhindi H, Sütoluk Z, Gökel Y. Etiological and demographical characteristics of acute adult poisoning in Adana, Turkey. Hum Exp Toxicol 2007; 26(5): 401-6.Referans19. Ayoğlu FN, Ayoğlu H, Kaptan YM, Turan IÖ. A Retrospective Analysis of Cases with Acute Poisoning in Zonguldak, Turkey. Journal of the Turkish Anaesthesiology & Intensive Care Society 2009; 37(4): 240-8.Referans20. Abdollahi M, Jalali N, Sabzevari O, Hoseini R, Ghanea T. A retrospective study of poisoning in Tehran. J Toxicol Clin Toxicol 1997; 35(4): 387-93.Referans21. Milev V, Mikhov D. Attempted suicide by poisoning in the Sofia region. Br J Psychiatry. 1992; 160: 560-2.Referans22. Akköse Aydın Ş, Köksal Ö, Fedakar R, Emircan Ş, Durmuş O. Poisoning Cases in Adults in the Years 1996-2004. Uludağ Üniversitesi Tıp Fakültesi Dergisi 2006; 32(1): 25-27.Referans23. Mowry JB, Spyker DA, Brooks DE, McMillan N, Schauben JL. 2014 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 32nd Annual Report. Clin Toxicol (Phila) 2015; 53(10): 962-1147.Referans24. Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths - United States, 2010-2015. MMWR Morb Mortal Wkly Rep 2016; 65(50-51): 1445-1452.Referans25. Meredith TJ. Epidemiology of poisoning. Pharmacol Ther 1993; 59(3): 251-6.Referans26. Karcioğlu Ö, Ayrik C, Tomruk Ö, Topaçoğlu H, Keleş A. Retrospective Analysis of Adult Poisoning Cases in the Emergency Department. Journal of Experimental and Clinical Medicine 2000; 17(3): 156-62.Referans27. Ozköse Z, Ayoglu F. Etiological and demographical characteristics of acute adult poisoning in Ankara, Turkey. Hum Exp Toxicol 1999; 18(10): 614-8.Referans28. Fountain JS, Hawwari H, Kerr K, Holt A, Reith D. Awareness, acceptability and application of paracetamol overdose management guidelines in a New Zealand emergency department. N Z Med J 2014; 127(1402): 20-9.Referans29. Fernando SM, Reardon PM, Ball IM, van Katwyk S, Thavorn K, Tanuseputro P, et al. Outcomes and Costs of Patients Admitted to the Intensive Care Unit Due to Accidental or Intentional Poisoning. J Intensive Care Med 2018 (doi: 10.1177/0885066617754046).Referans30. Serinken M, Karcioglu O, Sengul C, Turkcuer I, Keysan MK. Hospital costs of managing deliberate self-poisoning in Turkey. Med Sci Monit 2008; 14(3): 152-8.Referans31. Sut N, Memis D. Intensive care costs of acute poisoning cases. Clin Toxicol (Phila) 2008; 46(5): 457-60.Referans32. Kılıçlı E. Characteristics and cost analysis of poisoning cases who admitted to Başkent University Ankara Hospital Adult Emergency Service between 2011 and 2014. Tıpta uzmanlık tezi, Başkent Üniversitesi Tıp Fakültesi, Acil Tıp Kliniği, Ankara; 2015.Referans33. Akar T, Derinöz O, Demirel B. Drug intoxications and hospital costs. Turk Arch Ped 2007; 42: 103-6.Referans34. Seydaoglu G, Satar S, Alparslan N. Frequency and mortality risk factors of acute adult poisoning in Adana, Turkey, 1997-2002. Mt Sinai J Med 2005; 72(6): 393-401.Referans35. Cengiz M, Baysal Z, Ganidagli S, Altindag A. Characteristics of poisoning cases in adult intensive care unit in Sanliurfa, Turkey. Saudi Med J 2006; 27(4): 497-502.Referans36. Yeo HM. The cost of treatment of deliberate self-harm. Arch Emerg Med 1993; 10(1): 8-14.