Open access Research BMJ Open: first published as 10.1136/bmjopen-2018-021881 on 29 August 2018. Downloaded from Acute poisoning in Shenyang, China: a retrospective and descriptive study from 2012 to 2016 Yajie Zhang,1 Boxin Yu,2 Nana Wang,3 Tiegang Li1 To cite: Zhang Y, Yu B, Wang N, ABSTRACT Strengths and limitations of this study et al. Acute poisoning in Objectives Up-to-date information on the patterns of Shenyang, China: a retrospective acute poisoning is crucial for the proper management ► The cross-sectional and retrospective study design and descriptive study from of poisoning events. The objectives of this study were to 2012 to 2016. BMJ Open included over 5000 poisoning cases in five consec- analyse the characteristics of patients suffering from acute 2018;8:e021881. doi:10.1136/ utive years. poisoning admitted to the emergency department (ED) in a bmjopen-2018-021881 ► Although the sample size in this study was large, its tertiary medical centre in Northeast China and to compare retrospective nature made it difficult to obtain com- ► Prepublication history for these characteristics with those of a previous comparable plete information on all poisoning cases, which may this paper is available online. study. have introduced bias. To view these files, please visit Design Retrospective and descriptive study. the journal online (http:// dx. doi. ► Data from a single centre teaching hospital, even Setting Data were collected from the hospital information org/ 10. 1136/ bmjopen- 2018- with three branches, may not reflect the precise sit- system in Shengjing Hospital, China, from January 2012 to 021881). uation in this region. December 2016. Received 25 January 2018 Participants All cases aged ≥11 years old with a Revised 21 June 2018 diagnosis of acute poisoning. Accepted 19 July 2018 Results In total, 5009 patients aged ≥11 years presented however, patients who attempt suicide usually to the ED with acute poisoning during the study period. The have higher mortality.4–6 As the most common average age of the patients was 36.0±15.1 years and over form of fatal self-harm in rural Asia, poisoning half (52.7%) were in the 20–39age group. The female to accounts for more than 60% of deaths.7 male ratio was 1.2:1. Patients with acute poisoning mainly China is a developing country transitioning lived in rural areas rather than in urban areas. The majority from an agricultural to an industrialised of patients consumed poison as suicide attempts (56.7%). http://bmjopen.bmj.com/ Men were more commonly poisoned by drug abuse economy. In recent years, the number of than women, but women outnumbered men in suicidal acute poisoning cases in China has continued 8 poisoning. The most common form of poison intake was to increase, and both poisoning and injury 9 ingestion (oral intake; 86.2%). The five most common are now two of the top five causes of death. toxic agent groups, in descending order, were therapeutic Of the various types of poisoning, pesticide drugs (32.6%), pesticides (26.9%), alcohol (20.7%), fumes/ poisoning is the most common in most regions gases/vapours (11.4%) and chemicals (3.6%). Sedatives/ of China, while therapeutic drugs poisoning hypnotics in the therapeutic drugs group and paraquat in is the main type of poisoning in developed © Author(s) (or their on September 26, 2021 by guest. Protected copyright. the pesticides group were the most common toxic agents, regions or cities, such as Shanghai.9–13 Shen- employer(s)) 2018. Re-use respectively. The mortality rate of study participants was yang is the provincial capital of Liaoning permitted under CC BY-NC. No 1.3%, with 64 deaths. commercial re-use. See rights Conclusions The results of this study indicate the need to and the biggest city in Northeast China, and permissions. Published by with an estimated population of more than BMJ. strengthen education on the rational and safe use of drugs 8.1 million.14 Liaoning is an industrial prov- 1Emergency Department, in Shenyang. Shengjing Hospital of China ince, but agriculture is still an important Medical University, Shenyang, economic sector. The widespread use of pesti- China cides, such as organophosphorus compounds, 2Gerontology Department, INTRODUCTIOn by farmers may increase the risk of poisoning Shengjing Hospital of China Acute poisoning is defined as an acute events in this area.15 A previous investigation Medical University, Shenyang, exposure (less than 24 hours) to a toxic performed by Zhao et al16 in this region from China 1 3Endocrinology Department, substance. Acute poisoning is a major public 1997 to 2007 showed that (1) medicine was Shengjing Hospital of China and preventable health issue contributing to the most common poisoning agent (41.4%), Medical University, Shenyang, morbidity and mortality in many parts of the followed by pesticides (15.2%), alcohol China world. It is estimated that poisoning events (14.1%), carbon monoxide (CO) (12.5%) Correspondence to are responsible for more than one million and food (9.7%); (2) the major medicines 2 3 Dr Tiegang Li; illnesses annually. Low mortality contrasts were sedatives/hypnotics and the major litg@ sj- hospital. org with high morbidity in acute poisoning; pesticides were organophosphates; and (3) Zhang Y, et al. BMJ Open 2018;8:e021881. doi:10.1136/bmjopen-2018-021881 1 Open access BMJ Open: first published as 10.1136/bmjopen-2018-021881 on 29 August 2018. Downloaded from mortality decreased from 2.1% to 0.4% over the 10-year form. The circumstances of poisoning were deduced study period, with an average mortality rate of 1.0%. from the patient’s history. In the last few decades, China has witnessed significant Toxic agents were classified as therapeutic drugs, pesti- advancements in the fields of agriculture, industrial tech- cides, alcohol, poisonous fumes/gases/vapours, chemi- nologies and medical pharmacology. These advancements cals, food, other substances and unknown. The subgroup have been paralleled by marked changes in the trends of toxic agents was categorised based on the indications of acute poisoning,17 and have led to the development for use. Mixed drugs were defined as the ingestion of and easy accessibility of a vast number of toxic agents two or more drugs. The toxic agent was categorised as including pesticides, therapeutic drugs and other chemi- cals. Thus, the toxic agents associated with morbidity and mortality and the pattern of acute poisoning, which vary from place to place and over time, are expected to change. Table 1 Demographic characteristics of poisoned patients Therefore, there is a constant need to obtain up-to-date admitted to the emergency department from 2012 to 2016 information on acute poisoning for planning rational Variables categories n % use of resources and for evaluating public health inter- Age group ventions. The aims of this retrospective and descriptive study were to describe the clinical and sociodemographic 11–19 557 11.1 patterns of acute poisoning in the emergency department 20–29 1547 30.9 (ED) of Shengjing Hospital of China Medical University, 30–39 1094 21.8 a tertiary care centre, and to compare these patterns with 40–49 817 16.3 previous findings obtained by Zhao et al.16 50–59 575 11.5 60–69 267 5.3 METHODS ≥70 152 3.0 This retrospective and descriptive study based on hospital Gender records was carried out in Shengjing Hospital of China Male 2296 45.8 Medical University in Shenyang, China. Shengjing Female 2713 54.2 Hospital is a regional tertiary care hospital in Northeast China with three hospital areas and covers the entire Type for exposure Liaoning province and some areas of neighbouring prov- Suicidal 2842 56.7 inces. Moreover, the Liaoning Poisoning Diagnosis and Abusive 1105 22.1 Treatment Center was established in the ED of Sheng- Accidental 1017 20.3 jing Hospital in July 2011, and the ED has a specialised http://bmjopen.bmj.com/ Unknown 45 0.9 toxicology unit. Hence many patients with poisoning who seek treatment visit or are referred to this hospital. Route of exposure We reviewed all records of cases of poisoning admitted to Ingestion (oral) 4316 86.1 the ED (including cases referred to the ED from other Inhalation (nasal) 590 11.8 wards) over five consecutive years from January 2012 to Contact (dermal) 98 2.0 December 2016. Patients admitted to the ED with a diag- Other 5 0.1 nosis of drug poisoning and aged ≥11 years were enrolled in this study. Diagnoses were established by patients’ Place of residence on September 26, 2021 by guest. Protected copyright. history, physical examination, and routine and toxicolog- Urban 2415 48.2 ical laboratory evaluations. Poisoned patients <11 years Rural 2568 51.3 admitted to the paediatric ward and those with animal Unknown 26 0.5 bites (snake, insect) due to infrequency and chronic Length of hospital stay poisoning were excluded from the study. Relevant medical records were obtained from the elec- <48 hours 367 7.3 tronic hospital information system (HIS). The HIS is <1 week 3219 64.3 an electronic system used in the clinic to record patient >1 week 1423 28.4 information. Poisoning cases were retrieved by searching Outcome the HIS using the following keywords: poisoning, alcohol, Recovery 1416 28.3 CO and organophosphate. Demographic data including age, gender, place of residence, diagnosis, type of expo- Relative recovery 3255 65.0 sure (suicidal, abusive, accidental and unknown), type Referral to other centres 198 3.9 of toxic agent (the common name or trade name were Left against medical advice 76 1.5 indicated, where available), duration of hospital stay and Death 64 1.3 the outcome of treatment (whether the patient survived Total 5009 100.0 or died) were collected and documented on a structured 2 Zhang Y, et al.