Purpose: This study investigates the characteristics and prognosis of acute poisoning patients visiting nationwide emergency departments before and after the Coronavirus disease 2019 (COVID-19) pandemic. Data were obtained from the National Emergency Department Information System (NEDIS). Methods: This nationwide retrospective observational study included acute poisoning patients who visited the emergency departments between February 1 to December 31, 2020, which has been determined as the pandemic period. The same periods in 2018 and 2019 were designated as the control periods. The primary outcome assessed was the length of stay in emergency departments (EDLOS). The secondary outcomes examined were intensive care unit admission rate and in-hospital mortality rate before and after the pandemic. A subgroup analysis was performed for inpatients and intentional poisoning patients. Results: A total of 163,560 patients were included in the study. During the pandemic, the proportion of women increased from 50.0% in 2018 and 50.3% in 2019 to 52.5% in 2020. Patients aged 20-29 years increased from 13.4% in 2018 and 13.9% in 2019 to 16.6% in 2020. A rise in cases of intentional poisoning was also noted - from 33.9% in 2018 and 34.0% in 2019 to 38.4% in 2020. Evaluating the hospitalized poisoned patients revealed that the EDLOS increased from 3.8 hours in 2018 and 3.7 hours in 2019 to 4.2 hours in 2020. ICU admissions were also markedly increased (2018, 48.2%; 2019, 51.8%; 2020, 53.2%) among hospitalized patients. Conclusion: The COVID-19 pandemic has changed the epidemiology, clinical characteristics, and prognosis of acute poisoning patients visiting nationwide emergency departments in Korea. The proportion of young adults, women, and intentional poisoning patients has increased after the COVID-19 pandemic. Prolonged length of stay at the emergency department and an increased rate of intensive care unit admissions were determined in hospitalized acute poisoning patients.
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Demographic characteristics of patients admitted to the emergency department for intoxication and a time series analysis during the COVID-19 period Bongmin Son, Nayoon Kang, Eunah Han, Gina Yu, Junho Cho, Jaiwoog Ko, Taeyoung Kong, Sung Phil Chung, Minhong Choa Journal of The Korean Society of Clinical Toxicology.2023; 21(2): 92. CrossRef
Changes in the characteristics of acute carbon monoxide poisoning patients who visited the emergency department during the COVID-19 pandemic Jun bo Sim, Tae kyu Ahn, Hyun Kim Journal of The Korean Society of Clinical Toxicology.2023; 21(2): 108. CrossRef
Purpose: This study utilizes the NEDIS (National Emergency Department Information System) database to suggest a predictive model for snakebite and envenomation in Korea by analyzing the geographical distribution and seasonal variation of snakebite patients visiting the ER. Methods: This was a retrospective study on snakebite patients visiting the ER using the NEDIS database from January 2014 to December 2019. The subjects include patients with the KCD (Korea Standard Classification of Disease) disease code T63.0 (Toxic effect of contact with snake venom). Geographical location, patient gender, patient age, date of ER visit, treatment during the ER stay, and disposition were recorded to analyze the geographical distribution and seasonal variation of snakebite patients in Korea. Results: A total of 12,521 patients were evaluated in this study (7,170 males, 54.9%; 5,351 females, 40.9%). The average age was 58.5±17.5 years. In all, 7,644 patients were admitted with an average admission time of 5.04±4.7 days, and 2 patients expired while admitted. The geographical distribution was Gyeongsang 3,370 (26.9%), Cheonra 2,692 (21.5%), Chungcheong 2,667 (21.3%), Seoul Capital area 1,999 (16.0%), Kangwon 1,457 (11.6%), and Jeju 336 (2.7%). The seasonal variation showed insignificant incidences in winter and higher severity in spring and summer than in fall: winter 27 (0.2%), spring 2,268 (18.1%), summer 6,847 (54.7%), and fall 3,380 (27.0%). Conclusion: Patients presenting with snakebites and envenomation in the emergency room were most common in the Gyeongsang area and during summer. The simple seasonal model predicted that 436 snakebites and 438 envenomation cases occurred in July and August. The results of this study can be applied to suitably distribute and stock antivenom. Appropriate policies can be formed to care for snakebite patients in Korea.
Scombroid fish poisoning (SFP) is a form of histamine food poisoning caused by the ingestion of improperly stored fish. The term "scombroid" derives from the family name of the fish family first implicated, such as tuna and mackerel. On the other hand, non-scombroid fish species, such as sardine and herring, can also cause histamine poisoning. The histamine is converted from histidine by a bacterial enzyme in the causative fish. Because the symptoms of SFP can easily be confused with food allergies, it is believed to have been significantly under-reported. In 2016, an outbreak of SFP occurred among primary school students who had eaten yellowtail steak in Korea. The most common findings consisted of a rapid onset of flushing of the face and trunk, erythematous and urticarial rash, diarrhea, and headache occurring soon after consuming the spoiled fish. Usually, the course is self-limiting and antihistamines can be used successfully to relieve symptoms, but several life-threatening SFP cases have been reported. Clinical toxicologists should be familiar with SFP and have competency to make a differential diagnosis between fish allergy and histamine poisoning. SFP is a histamine-induced reaction caused by the ingestion of histamine-contaminated fish, whereas a fish allergy is an IgE-mediated reaction. This review discusses the epidemiology, pathophysiology, diagnosis, treatment, and preventive measures of SFP.
Purpose: The purpose of this study was to investigate the epidemiologic characteristics of patients who visited emergency departments (EDs) after intentional poisoning in Korea. Methods: This study retrospectively analyzed the data of of 23 hospitals during a five-year period, between 2011 and 2015. We included patients who inflicted injury to themselves - attempt of suicide - by means of poisoning. Results: A total of 18,121 patients visited an ED after intentional poisoning. Among them, 58.3% were females; however, there were more males among those aged 60 years or older. The mortality rate for males was 8.6%, which was 3.1 times higher than that for females with 2.8%. The most common poison was pesticides (35.4%) in males and sedative-hypnotics (44.0%) in females. The most common causative agent of death was pesticide in both sexes (75.2% and 65.3%, respectively). Since the production of paraquat was discontinued in 2011, the number of deaths from pesticide poisoning has decreased. The mortality rate declined in both males and females, from 12.6% and 4.5% in 2011 to 7.1% and 2.1% in 2015, respectively. Conclusion: In this study, we analyzed the epidemiologic characteristics of intentional poisoning, especially the frequency of suicide attempts by gender and age group, the cause of suicide, and the causative agent. This can be used as basic data for establishing policies to reduce and prevent suicide attempts by poisoning.
Purpose: This study was conducted to compare demographic and characteristic differences in self-poisoned patients by age groups using a comprehensive trauma database. Methods: This study included 1,823 patients who were admitted to the emergency room following self-poisoning. Three age groups were defined: young patients (less than 19 years), adult patients (19 to 64 years) and elderly patients (65 years and old). From January 2011 to December 2015, data were obtained from in a single emergency medical center. We investigated the materials of poisoning, ingestion time, GCS, systolic blood pressure, heart rate, and outcomes of patients. Results: A total of 1,823 self-poisoned patients visited the hospital during 5 years. Among these, 130 (7.1%) were categorized as young, 1,460 (80.1%) were adults and 233 (12.8%) were elderly. The most common drug of self-poisoning substances was antipyretics (50.0%) for those in the young group, sedative drugs (45.0%) for adults, and pesticides (41.2%) for the elderly. Mortality was 2.7% in the adult group and 14.6% in the elderly group. After adjusting for all factors related to mortality, the odds ratio (OR) of mortality was 2.63 in the elderly group (95% confidence interval [CI]: 1.44-4.81). Conclusion: There were definite differences in the characteristics of three groups. The younger patients used drugs that could be easily obtained while older patients used more lethal drugs.
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Factors Associated with Mortality in Elderly Patients Admitted to Intensive Care Unit due to Acute Drug Intoxication from Suicide Attempts Kyung-Eun Kim, Sun-Hee Moon, Chieun Song, Minjeong An Journal of Korean Critical Care Nursing.2024; 17(2): 1. CrossRef
Clinical features of adolescents with suicide attempt and the factors associated with their outcomes: poisoning versus non-poisoning Myoung Hoon Lee, Jae Ho Jang, Jin-Seong Cho, Woo Sung Choi, Jea Yeon Choi Pediatric Emergency Medicine Journal.2020; 7(2): 85. CrossRef
Purpose: Intentional poisoning is a major public health issue in many parts of the world. This study was conducted to provide details regarding the epidemiology of intentional poisoning in a metropolitan emergency department and to identify the changing patterns and epidemiology of poisoning. Methods: A retrospective study was conducted to evaluate intentional poisoning of patients who visited the emergency department in a tertiary teaching hospital between 2001 and 2015. All intentional poisoning-related emergency department visits over three five year periods (2001-2005 (P1), 2006-2010 (P2) and 2011-2015 (P3)) were reviewed to investigate trends in intentional poisoning patients. Information regarding patient sex, age, time from episode to admission, psychiatric history, type of intoxicants, alcohol co-ingestion, gastric lavage, charcoal administration, any previous suicide attempts, need for hospitalization and death before discharge was reviewed. Results: A total of 1269 patients were enrolled in this study. The number of patients admitted during each period was P1=515, P2=439 and P3=315. Comparison of the three groups revealed significant differences according to age (p<0.001), psychiatric history (p<0.001), alcohol co-ingestion (p=0.013), gastric lavage (p<0.001), charcoal administration (p<0.001), need for hospitalization (p=0.044), repeated attempt (p<0.001) and type of intoxicants (p<0.001). Conclusion: The average age of intentional poisoning patients has increased. While the use of sedatives and multiple drugs increased, the use of pesticides and the antihistamine decreased.
Purpose: The aim of this study was to describe the epidemiologic characteristics of adult patients with carbon monoxide poisoning who presented to the emergency department in recent years. Methods: This was a retrospective cohort study on adult consecutive patients with carbon monoxide (CO) poisoning who presented to the emergency department of a tertiary care university-affiliated hospital from January 1, 2008 to December 31, 2011. Results: A total of 91 patients were included in this study; there were 56(61.5%) unintentional and 35(38.5%) intentional poisonings. For the unintentional CO poisonings, the principal sources of exposure to CO were fire (39.3%), charcoal (17.9%), briquette charcoal (7.1%), wood burning boiler (7.1%), gas boiler (5.4%), automobile heater (3.6%), briquette boiler (3.6%), firewood (3.6%), and other items (12.5%). For the intentional CO poisonings, the sources were ignition charcoal (60.0%), briquette (31.4%), charcoal (5.7%) and butane gas (2.9%). For the unintentional CO poisonings, the places of poisoning were the home (58.9%), workplace (10.7%), public accommodation (8.9%), tent (8.9%), automobile (3.6%) and parking place (1.8%). For the intentional CO poisonings, the places of poisoning were the home (77.1%), public accommodation (11.4%) and automobile (11.4%). The proportion of intentional CO poisonings among total poisonings has increased significantly in recent years; 0.0% in 2008, 3.3% in 2009, 5.5% in 2010, and 29.7% in 2011. Conclusion: This study showed that in recent years in Korea, the source of CO has diversified broadly and intentional CO poisonings from burning ignition charcoal or briquettes has increased. Prevention efforts should consider these factors.
Purpose: The purpose of this study was to examine the occurrence of toxic exposure cases in Korean emergency centers using a toxic exposure surveillance system-based report form and to provide guidelines for the prevention and treatment of toxic exposures. Methods: We retrospectively reviewed the medical records of toxic exposure patients who had visited emergency centers from January 2009 to December 2009. Epidemiology data points for the toxic exposure cases included age, gender, type of exposure, number and kind of substances involved, reason and route of poison exposure, management of the patients in the emergency departments, and the clinical outcome. Results: A total of 3,501 patients from 12 emergency departments were enrolled in the study. 50.0% of the total exposure patients were male and 63.0% of the total cases were fatal. Acute intoxication occurred in 91.3% of the total patients and suicidal intent was the most common (43.3%) reason for exposure. The most common route of exposure was ingestion (75.9%). Of the total cases, pesticides were involved in 26.3%, sedatives/hypnotics/antipsychotics were involved in 22.0%, and bites and envenomations were involved in 15.7%. Conclusion: We provided a database of patients who were admitted to emergency departments after poisoning incidents. We recommend that toxicology professionals develop a classification scheme for toxicants which is adequate for Korean domestic circumstances and initiate a toxic surveillance system for all types of exposures. With support of a psychiatric surveillance system for suicidal patients and establishment of social mediation for pesticide poisoning, major reductions in poison exposures can be achieved.
Purpose: The aim of this study was to investigate toxic exposures in emergency centers with using a toxic exposure surveillance system-based report form as a preliminary study. Methods: We retrospectively reviewed the medical records of toxic exposure patients who visited emergency centers from January to December 2008. Results: 3,157 patients from 11 emergency centers were enrolled. Males were involved in 47.9% of the total cases of exposure and in 60.1% of the cases of fatal exposure. Suicidal intent was the most common (61.0%) reason and most (87.4%) fatal exposures were suicidal. Pesticides were involved in 30.7% of the cases and sedative/hypnotics/antipsychotics were involved in 20.5%. The substances most frequently involved in fatalities were pesticides, and a 48.4% fatality rate was recorded for paraquat exposure. Conclusion: The toxic exposure data showed the preliminary poisoning events in emergency centers. It is recommended that toxicology professionals should develop a toxic surveillance system and serial reporting should be performed.
Purpose: There are an insignificant number of studies done on the demographics of intoxication patients and on the characteristics of toxic exposure on a long term basis in Korea. The objective of our survey is to investigate the epidemiologic characteristics of intoxication in a metropolitan emergency department in order to more efficiently manage intoxication patients. Methods: We retrospectively reviewed the medical records of intoxication patients who visited the emergency department of a high end medical facility between January, 1998 and June, 2009. We investigated the trend of the substances people became intoxicated with during the study period and we analyzed the age, gender, year and distribution of patients and the outcome of the patients. Results: There were 1544 cases of intoxication during the study period, and the cases made up 0.37% of the total visitors to our emergency department, which is a high end medical facility located in the city. Most of the patients were female (70%) in their twenties and thirties. The most commonly ingested intoxication substances were sedatives, analgesics and pesticides. Unlike in the province, antidepressant abuse is on the rise while pesticide abuse is falling. The overall admission rate was 24.8% and the mortality rate was 1.6%. Pesticides intoxication was the most common cause of death (76%). Pesticides intoxication, a male gender and old age were the most significant fatality-related factors. Conclusion: We think that there is a need to investigate the actual conditions of drug intoxication in the city and prepare measures to prevent drug intoxication.
Purpose: Dichlorvos has been in widespread use as an organophosphate (OP) insecticide compound. The purpose of this study was to access the epidemiology and clinical features of dichlorvos in Korea. Methods: This was a 38 multi-center prospective study of dichlorvos poisoning using surveys, a structural reporting system and review of hospital records from August 2005 to July 2006. A total of 54 patients with acute dichlorvos poisoning on a national basis were enrolled. We analyzed the epidemiologic characteristics and clinical manifestations of dichlorvos poisoning. In addition, the clinical features of dichlorvos poisoning were compared with others OP compounds. Results: During the study period, compounds involving pure OP poisoning were dichlorvos (22.7%), methidathion (8.4%), and phosphamidon (6.7%). In acute dichlorvos poisoning, all ingestion routes were oral. Intentional poisoning involved 74.1% of cases. The common initial complaints involved gastrointestinal (64.8%), systemic (61.1%), central or peripheral nervous system (53.7%), and respiratory symptoms (50.0%). The median arrival time to hospital after dichlorvos poisoning was 2.6 hours and mean hospitalization duration was 7.1 days. 2-PAM was administered in 35 patients in mean doses of 6.3 g/day intravenously. Atropine was administered in 30 patients with a mean dose of 62.8 mg/day (maximal 240 mg/day). Overall mortality rate for dichlorvos poisonings were 14.8% (8/54). Immediate causes for death included sudden cardiac arrest or ventricular dysrhythmias (50%), multi-organ failure (25%), acute renal failure (12.5%), and unknown causes (12.5%). Conclusion: When compared to previous reports, dichlorvos poisoning displayed relatively moderate severity. The presence of a lower GCS score, altered mental status, serious dysrhythmias, systemic shock, acute renal failure, and respiratory complications upon presentation were associated with a more serious and fatal poisoning.
Purpose: To assess the epidemiology and the clinical features of Glufosinate herbicide in Korea. Methods: Data was prospectively collected during 1 year since August 2005 from 38 hospital in Korea. We analyzed the epidemiologic characters and clinical manifestations of Glufosinate poisoning. In addition, the characteristics of patients with severe central nervous system toxicity were separately analyzed to find poor prognosis relating factors. Results: During study periods, there were 715 persons of poisoning of herbicides and insecticides. 6.3% (45 persons) of the agricultural chemicals poisoning had Glufosinate poisoning. There were 36 cases of suicide attempts and 7 cases of accidental exposure, The major of poisoning route was oral ingestion (44 cases). 28.9 % of the study patients had not toxic symptoms. The most common symptoms were gastrointestinal symptoms relating surfactant irritation. 67.7% of central nervous symptoms occurred lately. 10 persons showed severe central nervous system toxicity. 4 persons of them showed poor outcomes (1 death, 3 hopeless discharged). Complications of respiratory failure and renal failure related with poor outcome. Conclusion: Majority of patients ingested Glufosinate for suicide attempt. 22.2% of patients with Glufosinate poisoning showed delayed serious central nervous system toxicity. Early supportive care of altered mentality may prevent late respiratory complications and improve the outcomes.
Purpose: Toxic Exposure Surveillance System (TESS) is widely used for poisoning data collection and making a counterplan. But, there were few reports about poisoning data collection using TESS in Korea. The aim was to collect poisoning data using TESS report form and investigate the recognition of emergency physician about the necessity of TESS as preliminary survey. Methods: Retrospectively, we gathered data from hospital records about the patient who admitted hospital emergency room due to poisoning. Date were gathered by paper and/or web client system report form in patients recruited by ICD-10 codes Results: From Jun 2004 to May 2005,3,203 patients were enrolled in 30 hospitals and their mean age was $44.9{pm}20.3years$ old(male: female = 1,565: 1,638). The most frequent site of exposure was their own residence (73.2%, 2,345/3,203) and most of reported patients were older than 20 years(89.7%, 2,871/3,203). Frequent substances involved in poisoning were medication(41.9%) and pesticide(33.3%). Intentional poisoning was 60.7%(1,954). In fatality, overall frequency was 5.1%(162/3,203) and the most frequent route of exposure was ingestion(96.3%, 156/162) and the most frequent substance was pesticide(85.2%, 138/ 162). Antidotes were administered in 202 patients(2-PAM, atropine, antivenin, N-acetylcystein, vitamin K, flumazenil, ethanol, methylene blue, naloxone, calcium compound). 19 of 20 emergency physicians agreed with necessity of TESS. Conclusion: Data collection using TESS report form showed preliminary poisoning events in Korea. Frequent poisoning substance were medication and pesticide. The fatality was mainly related with pesticide ingestion. Many doctors in emergency room recognized the necessity of TESS.
The caustic drugs are classified into acid and alkali. Oral intake of these drugs cause histological injuries to the surfaces of oral cavity, laryngopharynx, and esophagus. Caustic drugs such as detergents and brilliants are easily contacted at homes. However, until now, the epidemiology and the clinical statistics of caustic drug ingestion in Korea were not carried out. This is a case report of sodium hydroxide - lye, a caustic drug more toxic than the others - ingestion with complication of gastroesophageal perforation, rapidly progressed mediastinitis and prompt death in the course of treatment.
Background s: Deaths from pesticides poisoning has increased annually, but no studies have been reported. Especially paraquat is suspected to be a major material in pesticide poisoning deaths. In Korea, simple epidemiology of pesticides poisoning is not well known. So, there is no effective method to prevent pesticides poisoning. We tried to investigate the present status of pesticides poisoning with data from Korea National Statistical Office and suggest an effective counterplan. Methods: We analysed death cause data derived from Korean Statistical association, deaths causes being pesticides poisoning in the year 2002. Also, we investigated data from internet, mainly from Korea National Statistical Office home page. Results: Total 2,875 persons died after pesticides poisoning in 2002 year. Average age is 54.2 year, standard deviation being 17.7 year. Many victims (about $41\%$) died during the herbicides' non-necessary period (JanuaryMarch, October-December) Conclusion: Herbicides sale should be restricted only during herbicides' necessary period, and so called a pesticides safety supervisor system shall effectively prevent herbicides poisoning.