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

Abstract

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.

Keywords

• Emergency room,costs,poisoning

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

Abstract

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. 

Keywords

• Acil servis,maliyet,zehirlenme

References

1. 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.