engleski

Trends in acute poisoning by drugs and chemicals in Zagreb, Croatia: a prospective, observational, single-centre study

Background: Acute poisonings make up 0.6 to 2.1% of all reasons for emergency department (ED) visits in various European countries, with a case fatality of 0.2 to 1.7%. As this is a potentially preventable cause of illness and death, it is important to define the affected population and the most frequently used agents for each area. There is no published data about acute intoxications in Zagreb, Croatia, since 2000. The objective of this study was to determine the demographic characteristics of acutely intoxicated patients treated in the ED, main toxic agents, intention of drug/chemical intake and outcomes. Methods: This prospective, observational, single-centre study included acutely intoxicated patients treated in the Emergency Department of the University Hospital Centre Sisters of Charity, Zagreb, Croatia, during the years 2001, 2010 and 2015. All patients were treated according to evidence-based medicine guidelines. The study comprised only patient data collection, without any influence on planned diagnostic or therapeutic procedures. Results: A total of 1593 patients were enrolled in the study (331 patients in 2001, 618 in 2010, 644 in 2015), with a predominance and increasing number of men during the study period (55.9%, 65.2%, 70.7%, respectively; P(2001vs.2010)=0.005, P(2010vs.2015)=0.04). The intoxicated patients in 2001 were significantly younger than those in 2010 and 2015 (median age 28 years [18-89], 39 years [18-92], 40 years [18-95], respectively; P(2001vs.2010)<0.001, P(2010vs.2015)=0.11). There was a decline in the number of suicide attempts during the study (46.2% of all patients in 2001, 22.2% in 2010, 17.1% in 2015; P(2001vs.2010)<0.001, P(2010vs.2015)=0.02, significant P<0.008) and an escalation in the number of unintentional overdoses by substances of abuse (50.2% of all patients in 2001, 72.3% in 2010, 81.7% in 2015; P(2001vs.2010)<0.001, P(2010vs.2015)<0.001, significant P<0.008). Ethanol was the main toxic agent (40.2% of all patients in 2001, 69.4% in 2010, 75.8% in 2015; P(2001vs.2010)<0.001, P(2010vs.2015)=0.11), used primarily as a substance of unintentional overdose and as a co-agent in suicide attempts. Anxiolytics were the second most frequently used agent among all patients (46.5% of all patients in 2001, 32.0% in 2010, 18.5% in 2015; P(2001vs.2010)<0.001, P(2010vs.2015)<0.001) and the main substance used in suicide attempts. The frequency of acute poisonings by heroin significantly reduced from 2001 to 2015 (18.1% of all patients in 2001, 3.6% in 2010, 0.6% in 2015; P(2001vs.2010)<0.001, P(2010vs.2015)<0.001). Intoxications by paracetamol were extremely rare (0.9% of all patients in 2001, 0.5% in 2010, 0.3% in 2015) and mostly occurred in suicide attempts. During 2015 sporadic cases of acute intoxications by gamma hydroxybutyrate (0.47% of all patients in 2015) and Galaxy (0.16% of all patients in 2015) were recorded, all of them as unintentional overdoses by substances of abuse. In-hospital mortality caused by acute intoxications was low (0.9% of all patients in 2001, 0.8% in 2010, 0.8% in 2015). Conclusions: The escalation of overdoses by substances of abuse, primarily ethanol, is a major medical and public concern in Zagreb, according to this study. Caution is needed when prescribing anxiolytics, as they are the main substance used in suicide attempts.

poisoning; intoxication; overdose; emergency department; ethanol; anxiolytics

Ethical approval: The study had been approved by the Ethics Committee of the University Hospital Centre Sisters of Charity, Zagreb, Croatia, and was performed in accordance with the principles of the Declaration of Helsinki and Good Clinical Practice guidelines.