Citation

Maignan M, Pommier P, Clot S, Saviuc P, Debaty G, Briot R, Carpentier F, Danel V. Basic Clin. Pharmacol. Toxicol. 2013; 114(3): 281-287.

Affiliation

Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France; UJFGrenoble1 / CNRS / TIMC-IMAG UMR 5525 /PRETA Team, Grenoble, France.

Copyright

(Copyright © 2013, Nordic Pharmacological Society, Publisher John Wiley and Sons)

DOI

10.1111/bcpt.12132

PMID

23998644

Abstract

Deliberate drug poisoning leads to 1% of emergency department (ED) admissions. Even if most patients do not exhibit any significant complication, 5% need to be referred to an intensive care unit (ICU). Emergency physicians should distinguish between low and high-acuity poisoned patients at an early stage in order to avoid excess morbidity. Our aim was to identify ICU transfer factors in deliberately self-poisoned patients without life-threatening symptoms on admission. We performed a 3-year retrospective observational study in a university hospital. Patients over 18 years of age with a diagnosis of deliberate drug poisoning were included. Clinical and toxicological data were analysed with univariate tests between groups (ED stay versus ICU transfer). Factors associated with ICU admission were then included in a logistic regression analysis. 2565 patients were included. 63.2% were women and median age was 40 (28-49). 142 patients (5.5%) were transferred to ICU. Cardiac drugs (adjusted OR (aOR)=19.81; 95% confidence interval (95% CI): 7.93-49.50), neuroleptics (aOR=2.78; 95% CI: 1.55-4.97) and meprobamate (aOR=2.71; 95% CI: 1.27-5.81) ingestions were significantly linked to ICU admission. A presumed toxic dose ingestion (aOR=2.27; 95% CI: 1.28-4.02), number of ingested tablets (aOR=1.01; 95%CI: 1.01-1.02 for each tablet) and delay between ingestion and ED arrival less than two hours (aOR=2.85; 95%CI: 1.62-5.03) were also factors for ICU referral. The Glasgow Coma Scale was the only clinical feature associated with ICU admission (aOR=1.57; 95% CI: 1.44-1.70 for each point loss). These results suggest that emergency physicians should pay particular attention to toxicological data on ED admission to distinguish between low and high-acuity self-poisoned patients. This article is protected by copyright. All rights reserved.

Language: en