%0 Journal Article
%T Effect of the UK's revised paracetamol poisoning management guidelines on admissions, adverse reactions, and costs of treatment
%J British journal of clinical pharmacology
%D 2014
%A Bateman, D. Nicholas
%A Carroll, Robert
%A Pettie, Janice
%A Yamamoto, Takahiro
%A Elamin, Muhammad Emo
%A Peart, Lucy
%A Dow, Margaret
%A Coyle, Judy
%A Cranfield, Kristina R.
%A Hook, Christopher
%A Sandilands, Euan A.
%A Veiriaiah, Aravindan
%A Webb, David J.
%A Gray, Alasdair
%A Dargan, Paul I.
%A Wood, David M.
%A Thomas, Simon H. L.
%A Dear, James W.
%A Eddleston, Michael
%V 78
%N 3
%P 610-618
%X AIMS: In September 2012 the UK's Commission on Human Medicines (CHM) recommended changes in management of paracetamol poisoning: use of a single '100mg/L' nomogram treatment line; ceasing risk assessment; treating all staggered/uncertain ingestions; increasing the duration of the initial acetylcysteine (NAC) infusion from 15 to 60min. We evaluated the effect of this on presentation, admission, treatment, adverse reactions, and costs of paracetamol poisoning. <br><br>METHODS: Prospectively collected data from adult patients presenting to 3 large UK hospitals from 3 Sept 2011 to 3 Sept 2013 (year before and after change). Infusion duration effect on vomiting and anaphylactoid reactions was examined in one centre. A cost analysis from an NHS perspective was performed for 90,000 patients/annum with paracetamol overdose. <br><br>RESULTS: There were increases in the numbers:- presenting to hospital (before 1703, after 1854; increase 8.9%[95%CI 1.9-16.2] p=0.011); admitted (1060/1703 [62.2%] vs 1285/1854 [69.3%]; increase: 7.1% [4.0-10.2], p<0.001); and proportion treated (626/1703 [36.8%] vs 926/1854 [50.0%]; increase: 13.2% [10.0-16.4] p<0.001). Increasing initial NAC infusion did not change the proportion of treated patients developing adverse reactions (15min 87/323[26.9%], 60min 145/514[28.2%]; increase: 1.3%[-4.9-7.5] p=0.682). Across the UK the estimated cost impact is £8.3M (6.4M to 10.2M) annually, with a cost-per-life saved of £17.4 M (95% CI 13.4 to 21.5 M). <br><br>CONCLUSIONS: The changes introduced by the CHM in September 2012 have increased the numbers of patients admitted to hospital and treated with acetylcysteine without reducing adverse reactions. A safety and cost-benefit review of the CHM guidance is warranted, including novel treatment protocols and biomarkers in assessment of poisoning.<p /> <p>Language: en</p>
%G en
%I John Wiley and Sons
%@ 0306-5251
%U http://dx.doi.org/10.1111/bcp.12362