Volume 73, Issue 2 , Pages 78-87, February 2010
Features and Prognostic Factors for Elderly With Acute Poisoning in the Emergency Department
Article Outline
Background
Elderly persons with acute poisoning in the emergency department (ED) and prognostic factors of outcomes have not been well addressed in previous research. This study aimed to investigate the characteristics of elderly patients with acute poisoning visiting the ED, and to identify the possible predictive factors of mortality.
Methods
Patients aged ≥ 65 years with acute poisoning who visited the ED in Taipei Veterans General Hospital from January 1, 2006 through to September 30, 2008 were enrolled in the study. We collected demographic information on underlying diseases, initial presentations, causes and toxic substances, complications, dispositions, and outcomes. Analyses were conducted among different groups categorized according to age, suicide attempt, and outcome. Multiple logistic regression was applied to identify possible predictive clinical factors influencing mortality in the elderly with acute poisoning.
Results
A total of 250 patients were enrolled in the study, with a mean age of 77 years and male predominance. The most common cause of intoxication was unintentional poisoning. Medication accounted for 57.6% of poisonous substances, of which benzodiazepine was the most common drug, followed by warfarin. The overall mortality rate was 9.6%. The average length of stay in the ED increased significantly in the old (65–74 years), very old (75–84 years) and extremely old (≥ 85 years) groups. Suicide attempt patients experienced more complications including respiratory failure, aspiration pneumonia, hypotension and mortality. Three clinical predictive factors of mortality were identified: herbicide poisoning, hypotension and respiratory failure upon presentation.
Conclusion
Our results demonstrated that elderly patients with acute poisoning had a mortality rate of 9.6%. Suicide attempts resulted in more serious complications. The risk factors for mortality were herbicide intoxication, hypotension and respiratory failure.
Key Words: emergency department , geriatrics , poisoning
No full text is available. To read the body of this article, please view the PDF online.
References
- . Mortality due to poisoning in a developing agricultural country: trends over 20 years . Hum Exp Toxicol . 1995;14:808–811
- . Acute poisonings: a ten-year retrospective hospital based study . Ann Natl Acad Med . 1994;30:35–44
- . Frequency and mortality risk factors of acute adult poisoning in Adana, Turkey, 1997–2002 . Mt Sinai J Med . 2005;72:393–401
- . The National Poisons Information Centre in Sri Lanka: the first ten years . J Toxicol Clin Toxicol . 2002;40:551–555
- . Pattern of acute poisonings in Mashhad, Iran, 1993–2000 . J Toxicol Clin Toxicol . 2004;42:965–975
- . Human poisoning in Thailand: the Ramathibodi Poison Center's experience (2001–2004) . Clin Toxicol (Phila) . 2007;45:582–588
- . World Health Statistics 2008 . Geneva: WHO; 2008;
- . Poisoning in older adults: the experience of the National Poisons Information Centre . Ir Med J . 2008;101:268–270
- . Pattern of poisoning in the elderly: an experience from Tehran . Clin Toxicol (Phila) . 2008;46:211–217
- . Acute poisoning in old and very old patients: a longitudinal retrospective study of 5883 patients in a toxicological intensive care unit . Z Gerontol Geriatr . 2005;38:182–189
- . Clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification . Am J Kidney Dis . 2002;39:S1–266
- . Acute renal failure–definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group . Crit Care . 2004;8:R204–R212
- . Aspiration pneumonitis and aspiration pneumonia . N Engl J Med . 2001;344:665–671
- . Diagnosis of ventilator-associated pneumonia: a systematic review of the literature . Crit Care . 2008;12:R56
- . APACHE II: a severity of disease classification system . Crit Care Med . 1985;13:818–829
- . An epidemio-logical study of poisoning cases reported to the National Poisons Information Centre, All India Institute of Medical Sciences, New Delhi . Hum Exp Toxicol . 2005;24:279–285
- Taiwan National Poison Center: epidemiologic data 1985–1993 . J Toxicol Clin Toxicol . 1996;34:651–663
- . Pattern of acute intoxication in Florence: a comparative investigation . Intensive Care Med . 1991;17:S24–S31
- . A prospective study of 1212 cases of acute poisoning: general epidemiology . Hum Toxicol . 1984;3:93–106
- . Changing pattern of drugs used for self-poisoning . Br Med J . 1978;1:90–93
- . The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries and Risk Factors in 1990 and Projected to 2020 . Cambridge, MA: Harvard School of Public Health; 1996;
- . Global Health Statistics. A Compendium of Incidence, Prevalence and Mortality Estimates for Over 200 Conditions . Cambridge, MA: Harvard School of Public Health and World Health Organization; 1996;
- . World Health Report 2004 . Geneva: WHO; 2004;
- . Deliberate self-harm in people aged 60 years and over: characteristics and outcome of a 20-year cohort . Int J Geriatr Psychiatry . 2006;21:275–281
- . Patterns and problems of deliberate self-poisoning in the developing world . QJM . 2000;93:715–731
- . The global distribution of fatal pesticide self-poisoning: systematic review . BMC Public Health . 2007;7:357
- . Acute poisoning in Izmir, Turkey: a pilot epidemiological study . J Toxicol Clin Toxicol . 1993;31:593–601
- . Characteristics of acute adult poisoning in Gaziantep, Turkey . J Toxicol Clin Toxicol . 2002;40:833–837
- . Acute poisoning admissions in one of the hospitals in Ankara . Hum Toxicol . 1985;4:323–326
- . Drug overdosage and other poisoning in Hong Kong: the Prince of Wales Hospital (Shatin) experience . Hum Exp Toxicol . 1994;13:512–515
- . Etiology of intoxication: a study of 557 cases . Eur J Epidemiol . 1993;9:361–367
- . The epidemiological surveillance of acute poisoning in 1997: a study of 1140 cases from the area south of the Madrid community . Rev Clin Esp . 1999;7:424–430
- . Parasuicidal poisoning treated in a Greek medical ward: epidemiology and clinical experience . Hum Exp Toxicol . 2001;20:611–617
- . Predictors of survival after acute paraquat poisoning . Toxicol Ind Health . 2002;18:201–206
- . The early prognostic factors of glyphosate-surfactant intoxication . Am J Emerg Med . 2008;26:275–281
- . Prognostic factors in methanol poisoning . Hum Exp Toxicol . 2007;26:583–586
PII: S1726-4901(10)70006-X
doi:10.1016/S1726-4901(10)70006-X
© 2010 Elsevier. Published by Elsevier Inc. All rights reserved.
Volume 73, Issue 2 , Pages 78-87, February 2010
