Forgiftninger i akuttmottaket ved St. Olavs hospital i perioden 2019-2020 - en retrospektiv deskriptiv studie

Abstract

Bakgrunn: Akutt forgiftning er en vanlig problemstilling i akuttmottaket. Forgiftningsmønsteret endrer seg over tid og det er stadig behov for oppdaterte data, både for forebygging og behandling. Imidlertid foreligget det ingen studier det siste tiåret fra norske sykehus, og få studier er fra andre regioner enn Oslo. Hovedformålet med denne retrospektive deskriptive studien var å kartlegge forgiftningsmønsteret blant pasienter med akutt forgiftning i akuttmottaket ved St. Olavs hospital i Trondheim. Forgiftningsagens, samt karakteristika ved ankomst, klinisk og logistisk håndtering og mortalitet ble undersøkt. Metode: Pasienter som ankom akuttmottaket i perioden 01.01.2019-31.12.2020 med akutt forgiftning, definert som nylig eksponering for en eller flere substanser i en antatt toksisk mengde, basert på gjennomgang av sykehusjournal ble inkludert. Data om forgiftningsagens og behandling ble hentet fra pasientjournal, mens demografiske og logistiske data ble hentet fra akuttmottakets database (Akuttdatabasen) og Pasientadministrasjonssystem. Resultater: Totalt ble 1423 tilfeller inkludert. Dette utgjorde 2.7% av alle pasientbesøk i akuttmottaket i perioden. Median alder var 34 år (interkvartilområde 24-50, aldersspekter 14-101) og 53.6% (n=763) var menn. Mange pasienter var gjengangere (>1 kontakt med akutt forgiftning i perioden: n=168, 20.1%). Flest ankom i ambulanse (n=844, 59.3%) og 23.3% (n=331) hadde høyeste hastegrad. Etanolforgiftning var klart vanligst (n=802, 56.4%), etterfulgt av benzodiazepiner (n=341, 24.0%), opiater (n=243, 17.1%), paracetamol (n=155, 10.9%) og antipsykotika (n=153, 10.8%). Blant alle tilfeller var 46.8% (n=666) blandingsforgiftninger. En rekke rusmidler var signifikant vanligere blant menn, mens legemidler var signifikant vanligere blant kvinner. Det var 20.1% (n=286) som ble behandlet med antidot, 3.8% (n=54) fikk aktivt kull 3.0% (n=42) ble ventrikkelskylt. Omkring 3 av 4 ble innlagt (n=1086), og 17.9% (n=254) ble lagt på intensiv- eller overvåkningsavdeling. Ingen døde under sykehusoppholdet. Konklusjon: Pasientene med akutt forgiftning i akuttmottaket ved St. Olavs hospital hadde tatt et bredt spekter av forgiftningsagens, og det var høy forekomst av blandingsforgiftninger. Forgiftning med etanol og opiater var vanligere enn i tidligere studier fra norske sykehus. Prognosen i akuttfasen på sykehus er god.

Background: Acute poisoning is a common cause of patient admissions to emergency departments (ED). The pattern of poisoning changes over time and up to date information is important both for prevention and treatment. Studies of hospitalized patients with poisoning have not been conducted the last decade in Norway, and there is a lack of data from other Norwegian regions than Oslo. The main aim of this retrospective study was to describe the pattern of poisoning among patients with acute poisoning in the ED at St Olav’s Hospital in Trondheim. Poisoning agents, patients and treatment characteristics, and mortality were investigated. Methods: Patients admitted to the ED between 1 January 2019 and 31 December 2020 with acute positioning based on information in electronic patient records were included. Acute poisoning was defined as recent exposure to one or more substances in an assumed toxic amount. Data concerning poisoning agents and treatment were collected from patient records, while demographic and logistic data were collected from the ED database (Akuttdatabasen) and Patient Administration System. Results: In total, 1423 cases were included. This comprised 2.7% of all patient visits to the ED during the period. Median age was 34 years (interquartile range 24-50, range 14-101) and 53.6% (n=763) were males. Many patients were readmitted for acute poisoning (>1 admission during the period: n=168, 20.1%). Most patient arrived by ambulance (n=844, 59.3%) and 23.3% (n=331) had the highest acuity level. The most frequent poisoning agents were ethanol (n=802, 56.4%), benzodiazepines (n=341, 24.0%), opioids (n=243, 17.1%), paracetamol (n=155, 10.9%), and antipsychotics (n=153, 10.8%). Multiple substances were taken by 46.8% (n=666). Several substances of abuse were significant more common among males, while pharmaceuticals were significant more common among females. After arrival to the ED, 20.1% (n=286) received antidote(s), 3.8% (n=54) received activated charcoal, and gastric lavage was performed in 3.0% (n=42) of cases. Among the ED visits, 76.3% (n=1086) resulted in hospital admission, and 17.9% (n=254) were assigned to a step-down unit or an intensive care unit. None died during the hospital stay. Conclusion: There was a wide range of poisoning agents among patients with acute poisoning in the ED at St Olav’s Hospital, and the incidence of poisoning with multiple agents was high. Poisoning with ethanol and opioids were more common than in previous studies of hospitalized patients in Norway. The in-hospital prognosis is good.