Journal of The Korean Society of Clinical Toxicology (대한임상독성학회지)

Korean society of Clincal Toxicology (대한임상독성학회)
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Clinical and Epidemiological Characteristics of Severe Poisoning Patients and Analysis of Prognostic Factors

중증 중독환자의 임상 역학적 특징과 예후에 영향을 주는 요인분석

  • Jung, Young Yun (Department of Emergency Medicine, Hanil General Hospital) ;
  • Ha, Chul Min (Department of Emergency Medicine, Hanil General Hospital) ;
  • Jung, Sung Tae (Department of Emergency Medicine, Hanil General Hospital) ;
  • Lee, Hyoung Ju (Department of Emergency Medicine, Hanil General Hospital)
  • 정영윤 (한전의료재단 한일병원 응급의학과) ;
  • 하철민 (한전의료재단 한일병원 응급의학과) ;
  • 정성태 (한전의료재단 한일병원 응급의학과) ;
  • 이형주 (한전의료재단 한일병원 응급의학과)
  • Received : 2020.07.30
  • Accepted : 2020.10.26
  • Published : 2020.12.31
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Abstract

Purpose: This study examined the clinical and epidemiological characteristics of intensive care unit (ICU) patients admitted or died in the emergency medical center with acute-poisoning to investigate the variables related to the prognosis. Methods: The data were collected from poisoning patients admitted or died in the emergency medical center of a general hospital located in Seoul, from January 2014 to February 2020. The subjects of this study were 190 patients. The medical records were screened retrospectively, and the clinical and epidemiological characteristics of the patients in the emergency room (ER) and ICU were examined to investigate the contributing factors that influence the poor prognosis. Results: The study analyzed 182 patients who survived after being admitted to the intensive care unit (ICU). The results are as follows. The mental change (87.4%) was the most common symptom. Sedative poisoning (49.5%) was the commonest cause. For most patients, pneumonia (26.9%) was the most common complication. Hypotension (23.7%), tachycardia (42.1%), fever (15.8%), seizures (10.5%), dyspnea (2.6%), high poisoning severity score (PSS), type of toxic material, mechanical ventilator application (39.5%), inotropes application (39.5%), and pneumonia (55.3%) were correlated the LOS over 5 days in the ICU. 8 patients died. In the case of death pesticides and carbon monoxide were the main toxic materials; tachycardia, bradycardia, and hypotension were the main symptoms, and a mechanical ventilator and inotropes were applied. Conclusion: Patients with unstable vital signs, high PSS, and non-pharmaceutical poisoning had a prolonged LOS in the ICU and a poor prognosis.

Keywords

References

  1. Roh HK. Current Clinical Practice: Management of acute intoxication. Korean J Med 2003;65:117-21.
  2. Pisani MA. Considerations in caring for the critically ill older patient. J Intensive Care Med 2009;24:83-95. https://doi.org/10.1177/0885066608329942
  3. Arabi Y, Venkatesh S, Haddad S, et al. A prospective study of prolonged stay in the intensive care unit: predictors and impact on resource utilization. Int J Qual Health care 2002;14:403-10 https://doi.org/10.1093/intqhc/14.5.403
  4. Lin TJ, Jiang DD, Chan HM, et al. Prognostic factors of organophosphate poisoning between the death and survival groups. Kaohsjung J Med Sci 2007;23:176-82. https://doi.org/10.1016/S1607-551X(09)70394-8
  5. Pan K, Shen C, Lin F, et al. Prognostic factors of carbon monoxide poisoning in Taiwan: a retrospective observational study. BMJ Open 2019;9:e031135. https://doi.org/10.1136/bmjopen-2019-031135
  6. Persson HE, Sjoberg GK, Haines JA, et al. Poisoning Severity Score. Grading of acute poisoning. J Clin Toxicol 1998;36:205-13.
  7. Jennett B. Development of Glasgow coma and outcome scales. Nepal J Neuroscience 2005;2:24-8. https://doi.org/10.3126/njn.v2i1.19978
  8. Pentel PR, Benowitz NL. Tricyclic Antidepressant Poisoning. J Med Toxicol 1986;1:101-21. https://doi.org/10.1007/BF03259831
  9. Louise WK, Kristine AN. Toxicity associated with carbon monoxide. Clin Lab Med 2006;26:99-125. https://doi.org/10.1016/j.cll.2006.01.005
  10. Page C, Hacket LP, Isbister GK. The use of high-dose insulin-glucose euglycemia in beta-blocker overdose: a case report. J Med Toxicol 2009;5:139-43. https://doi.org/10.1007/BF03161225
  11. Ortega G, Rhee DS, Papandria, DJ et al. An evaluation of surgical site infections by wound classification system using the ACS-NSQIP. J Surg Res 2012;174:33-8. https://doi.org/10.1016/j.jss.2011.05.056
  12. Son YJ, Song HS, Won MH el al. Factors Influencing Intensive Care Unit Length of Stay of Patients with Critical Illness. Asia-pacific J Mm Ser Conv Art Huma Slgy 2017;7:525-36.
  13. Tarui T, Yoshikawa K, Miyakuni Y, et al. Independent risk factors for a complicated hospital course in intensive care unit overdose patients. Acute Med Surg 2014;2:98-104. https://doi.org/10.1002/ams2.77
  14. Lee HS, HAN JH, KIM JH, et al. Epidemiologic Characteristics of Intentional Poisoning: Emergency Department Based Injury in-depth Surveillance During 2011-2015. J Korean Soc Clin Toxicol 2017;15:131-39. https://doi.org/10.22537/jksct.15.2.131
  15. Lee JH, Oh SH, Park KN, et al. Epidemiologic Study of Poisoned Patients Who Presented to the Emergency Department of a High end Medical Facility in Seoul 1998-2009. J Korean Soc Clin Toxicol 2010;8:7-15.
  16. Klein-Schwartz W, Oderda GM. Poisoning in the Elderly. Epidemiological, clinical and management considerations. Drugs Aging 1991;1:67-89. https://doi.org/10.2165/00002512-199101010-00008
  17. Kim JY, Jung HM, Kim JH et al. Prognostic Factors of Acute Poisoning in Elderly Patients J Korean Soc Clin Toxicol 2011; 9:81-7.
  18. Kim JH, Cho JS, Kim JJ et al. Comparison of Epidemiology and Outcomes of Patients with Intentional Poisoning by Age Groups: Single Center Observation Study. J Korean Soc Clin Toxicol 2016;14:129-35. https://doi.org/10.22537/jksct.14.2.129
  19. Jeffery G, Brian M. Benzodiazepines I: Upping the Care on Downers: The Evidence of Risks, Benefits and Alternatives. J Clin Med 2018;7:17. https://doi.org/10.3390/jcm7020017
  20. Jose O, Nanda D, Ershad E, et al. Clinical and epidemiological characteristics of patients with acute drug intoxication admitted to ICU. J Community Hosp Intern Med Perspect 2017;7: 202-7. https://doi.org/10.1080/20009666.2017.1356189
  21. Mehrpour O, Akbari A, Jahani F et al. Epidemiological and clinical profiles of acute poisoning in patients admitted to the intensive care unit in eastern Iran (2010 to 2017). BMC Emerg Med 2018;18:30. https://doi.org/10.1186/s12873-018-0181-6
  22. Sahithya RR, Visalakshi K. A Study on the Pattern of Inotropes use in an Intensive Care Unit. J Int Pharm Res 2019;46:71-7.
  23. McMahon A, Brohan J, Donnelly M et al. Characteristics of patients admitted to the intensive care unit following self-poisoning and their impact on resource utilisation. Irish J Med Sci 2014;183:391-5. https://doi.org/10.1007/s11845-013-1026-7
  24. Christ A, Arranto CA, Schindler C, et al. Incidence, risk factors, and outcome of aspiration pneumonitis in ICU overdose patients. Intensive care med 2006;32:1423-7. https://doi.org/10.1007/s00134-006-0277-4
  25. Yoon HJ, Son JW, Choi EG. A Clinical Analysis of Pneumonia in Acute Drug Intoxication. Tuberc Respir Dis 2005;59:380-8. https://doi.org/10.4046/trd.2005.59.4.380