Acute poisoning: an epidemiological and clinical profile and analysis of the digestive tract decontamination techniques used in emergency departments in Spain in 2006– the HISPATOX study

Introduction: Epidemiological multicentre studies on acute poisonings attended at

hospital emergency departments (ED) in Spain are scarce. There is significant heterogeneity

among inclusion criteria, as concept of poisoning, age of patients, toxics registered,

and admission reasons. Besides, few studies have assessed the application of digestive

decontamination technologies in emergency departments, and the

aplicability/follow-up of European Association of Poison Centres and Clinical Toxicologist/

American Academy of Clinical Toxicology guidelines.

Material and methods: Prospective multicentre cross-sectional national study of acute

poisonings attended in 24 hospital emergency departments during 1 year (September

2005-August 2006). Each six days 24-hour information was collected beginning at 8:00 A.M. The study included the total of patients with digestive exposition to toxics, and

collected information related to demographic characteristics, assistance period, type of

assistance received before arriving to the hospital, type of poisoning, symptomatology

at admission, treatment of digestive rescue and patient destiny.

Results: A total of 2245 patients with a mean age of 35.77 years (SD 15.75) and moderate

prevalence of males (59.6%) were enrolled. Among all patients 51.2% presented

directly to the Hospital and one third of them were assisted primarily by the Emergency

Medical Systems; 35.6% arrived to the emergency department within an hour

and 78.2% within 4 hours. The rate of patients symptomatic was 18.7%. Digestive decontamination

was done in 29.84% of the sample. The most used technology was one

or repeated doses of coal (45.98%) followed by nasogastric or orogastric probe in

equal percentage (45.22%). A single dose of active coal was the technology most commonly

used (41.2%), being applied in 12.3% of all poisoned patients. About 58.84%

of patients were discharged from emergency department within 12 hours. The observation

extended until 12 P.M. in 21.45% of cases. The rate of patients admitted to

hospital was 14.1% (ICU 2.3%, conventional wards 3.5%, psychiatry department

3.7%). The corresponding figures for patients transferred to other centers were 4.6%.

Conclusions: For the first time in Spain active coal is the method of digestive decontamination

most used in acute digestive poisoning, improving the intervals of assistance

in ED.