Article

ED visits for drug-related poisoning in the United States, 2007

Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.
The American journal of emergency medicine (Impact Factor: 1.27). 02/2011; 30(2):293-301. DOI: 10.1016/j.ajem.2010.11.031
Source: PubMed

ABSTRACT

Fatal drug-related poisoning has been well described. However, death data only show the tip of the iceberg of drug-related poisoning as a public health problem. Using the 2007 Nationwide Emergency Department Sample, this study described the characteristics of emergency department visits for drug-related poisoning in the United States.
Any ED visit that had an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code of 960-979 was defined as a drug-related poisoning case. Intentionality of poisoning was determined by E-codes. Weighted estimates of ED visits were calculated by patient and hospital characteristics, intentionality of poisoning, and selected drug classes. Population rates by sex, age, urban/rural classification, median household income in patient's zip code, and hospital region were calculated.
An estimated 699 123 (95% confidence interval, 666 529-731 717) ED visits for drug-related poisoning occurred in 2007. Children 0 to 5 years old had the highest rate for unintentional poisoning (male, 237 per 100 000; female, 218 per 100 000). The rate of drug-related poisoning in rural areas (684 per 100 000) was 3 times higher than the rates in other areas. Psychotropic agents and analgesics were responsible for 43.7% of all drug-related poisoning. Women 18 to 20 years old had the highest ED visit rate for suicidal poisoning (245 per 100 000). The estimated ED charges were $1 394 051 262, and 41.1% were paid by Medicaid and Medicare.
Antidepressants and analgesics were responsible for nearly 44% of ED visits for drug-related poisoning in the United States. Interventions and future research should target prescription opioids, rural areas, children 0 to 5 years old for unintentional drug-related poisoning, and female ages 12 to 24 years for suicidal drug-related poisoning.

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Available from: Huiyun Xiang, Mar 20, 2015
    • "141011121314151617181920min, p < 0.001) and transport times (1156789101112131415161718192021222324vs. 1278910111213141516171819min, p < 0.001). Ninety percent fractile times in FAR areas were longer for response (17 min vs. 13 min) and transport (42 min vs. 28 min), but similar for scene times (28 min vs. 27 min). "
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    ABSTRACT: Although much is known about EMS care in urban, suburban, and rural settings, only limited national data describe EMS care in isolated and sparsely populated frontier regions. We sought to describe the national characteristics and outcomes of EMS care provided in frontier and remote (FAR) areas in the continental United States (US). We performed a cross-sectional analysis of the 2012 National Emergency Medical Services Information System (NEMSIS) data set, encompassing EMS response data from 40 States. We linked the NEMSIS dataset with Economic Research Service-identified FAR areas, defined as a ZIP Code >60 minutes driving time to an urban center with >50,000 persons. We excluded EMS responses resulting in intercepts, standbys, inter-facility transports, and medical transports. Using odds ratios, t-tests and the Wilcoxon rank-sum test, we compared patient demographics, response characteristics (location type, level of care), clinical impressions, and on-scene death between EMS responses in FAR and non-FAR areas. There were 15,005,588 EMS responses, including 983,286 (7.0%) in FAR and 14,025,302 (93.0%) in non-FAR areas. FAR and non-FAR EMS events exhibited similar median response 5 [IQR 3–10] vs. 5 [3–8] min), scene (14 [10–20] vs. 14 [10–20] min), and transport times (11 [5.,24] vs. 12 [7,19] min). Air medical (1.51% vs. 0.42%; OR 4.15 [95% CI: 4.03–4.27]) and Advanced Life Support care (62.4% vs. 57.9%; OR 1.25 [1.24–1.26]) were more common in FAR responses. FAR responses were more likely to be of American Indian or Alaska Native race (3.99% vs. 0.70%; OR 5.04, 95% CI: 4.97–5.11). Age, ethnicity, location type, and clinical impressions were similar between FAR and non-FAR responses. On-scene death was more likely in FAR than non-FAR responses (12.2 vs. 9.6 deaths/1,000 responses; OR 1.28, 95% CI: 1.25–1.30). Approximately 1 in 15 EMS responses in the continental US occur in FAR areas. FAR EMS responses are more likely to involve air medical or ALS care as well as on-scene death. These data highlight the unique characteristics of FAR EMS responses in the continental US.
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    • "The period of adolescence is defined by the WHO as 10–19 years of age [22]. Previous research found differences in the hospitalization rates for self-poisoning between adolescents in early and late adolescence [1]. Thus, we separated the adolescents into two groups: 10–14 years and 15–19 years, consistent with previous literature [4] [9] [23]. "
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    ABSTRACT: Objectives To examine characteristics of hospital admissions and risk-factors associated with re-hospitalization for self-poisoning with medications in adolescents aged 10–19 years. Method This study used data from the Norwegian Patient Register (NPR) from 2008 to 2011. The main outcome was hospital readmission within the observation period. A complementary log-log regression model was used to assess the effect of characteristics at index hospital admission on readmission. Results Of 1,497 patients, 76.4% were females and 89.8% were aged 15–19 years. At their first hospital admission, about one-third received a secondary psychiatric diagnosis. Females (47.5%) were registered with an E-code for intentional self-harm more often than males (33.7%) and females were more often than males discharged to further treatment (27.8% vs. 21.5%). As many as 18.4% was re-hospitalized for self-poisoning by medications. Significant predictors for hospital readmission were female sex (HR = 2.4, 95% CI 1.7, 3.6), discharge to further treatment (HR = 2.3, 95% CI 1.8, 2.9) and psychiatric secondary diagnoses (HR = 1.5, 95% CI 1.2, 1.9). Conclusion This national study demonstrated significant sex differences in adolescents treated in hospital for self-poisoning with medications. Psychiatric secondary diagnoses had a strong predictive effect on readmission, which indicates the importance of psychiatric/psychosocial assessment of adolescents who are admitted to hospital for self-poisoning with medications.
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    • "In other countries, Burillo-Putze et al. (9) reported that the average age of patients with toxic poisoning in Spain in 2003 was 33 yr. Xiang et al. (10) reported that most patients with toxic poisoning admitted to emergency departments in USA were aged 35-44 yr. In Korea, the highest portions of poisoning to toxic substances were found in young and socially active people in their 30s and 40s, and the average age appears to be increasing slightly. "
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    ABSTRACT: Social factors may affect the available sources of toxic substances and causes of poisoning; and these factors may change over time. Additionally, understanding the characteristics of patients with acute toxic poisoning is important for treating such patients. Therefore, this study investigated the characteristics of patients with toxic poisoning. Patients visiting one of 3 hospitals in 2003 and 2011 were included in this study. Data on all patients who were admitted to the emergency departments with acute toxic poisoning were retrospectively obtained from medical records. Total 939 patients were analyzed. The average age of patients was 40.0 ± 20 yr, and 335 (36.9%) patients were men. Among the elements that did not change over time were the facts that suicide was the most common cause, that alcohol consumption was involved in roughly 1 of 4 cases, and that there were more women than men. Furthermore, acetaminophen and doxylamine remained the most common poisoning agents. In conclusion, the average patient age and psychotic drug poisoning has increased over time, and the use of lavage treatment has decreased.
    Full-text · Article · Oct 2013 · Journal of Korean medical science
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