Patients presenting with acute poisoning at Sahlgrenska University hospital in 2015 - a one-year observational study

Background: Acute poisoning is a major health problem accounting for about 4-16% of all annual hospital admissions. Though most poisonings are related to recreational drug use or substance abuse, some are the result of suicidal behaviour. It is unknown if short-term prognosis after acute poisoning, depends on a referral for further treatment, type of poisoning, suicidal intention, psychiatric comorbidity or on a propensity to re-intoxicate. Our objective is to identify possible risk factors for repetition or poor prognosis. Methods: For one year, all patients presenting with acute poisoning at the emergency unit in Sahlgrenska University hospital were recorded in a retrospective observational cohort study, with a subsequent one-year follow-up. Data was collected from our hospital’s electronical medical records database. Main outcome measures were toxic agents, gender, age, psychiatric comorbidity, referral, suicidal intention and repetition of poisoning. Results: A total of 668 patients were treated for 784 episodes of acute poisoning. In total 85 patients (13%) presented more than once with 2-10 presentations. Twenty-five different toxic substances were registered as main agents or co-agents. Most common agents taken were ethanol, benzodiazepines opioids and paracetamol. Eighty-five percent of all poisonings presented with substance of abuse (SOA). We recorded 189 (24%) episodes with suicidal intention, 336 patients (50%) received a referral and 19 died (2,8%) during a one-year follow-up. Risk factors for repetition was identified as psychiatric comorbidity and intake of benzodiazepines, whereas intake of cannabis or ethanol was associated with lower risk for repetition. Seventy-two percent of poisonings presenting with intake of SOA had a history of psychiatric comorbidity and 62% of those had received a referral. Of those poisoned by substances other than SOA, 82% had psychiatric comorbidity and 84% of cases received a referral. Women were more likely to receive a referral than men. Intake of benzodiazepines or opioids as well as presence of psychiatric comorbidity were significantly more common among those who died within a year. Conclusion: Strongest risk factor for repetition of poisoning was psychiatric comorbidity. Type of poisoning also matters where intake of benzodiazepines may indicate an increased risk. The tendency to give a referral was higher amongst intake of other substances than SOA without presence of more psychiatric comorbidity. Repetition of acute poisoning was high irrespective of intention behind the poisoning, toxic agent taken or if the patient received a referral for further treatment. The high incidence of re-presentations calls for better follow-up in the future