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| A Prospective Observational Study on Pattern and Outcomes of Poisoning Cases at a Tertiary Care Teaching Hospital |
Afshan Naaz, Masarrat Naaz, Aliya Begum, Sayeda Naiyla, Dr. Sabiha Naseem, Dr. Ateequr Rahman, Dr. Rafia Sultana
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Abstract:
Background: Poisoning is a global public health problem causing significant morbidity and mortality, with thousands of deaths occurring every year, mainly in the developing countries. India, holding 70% of agricultural land, accounts for one third of pesticide poisoning cases, the farm workers being the worst affected. Most of the poisonings occur due to deliberate self-ingestion of the poison in an attempt to suicide. Organo-phosphorus (OP) compounds occupy the greatest burden of poisoning related morbidity and mortality. It is important to know the prevalence, pattern and to identify factors associated with outcomes of acute poisoning in such cases and to suggest strategies to improve them. Methods: This is a prospective observational study conducted in the Emergency medicine department of a tertiary care hospital. All patients who were presented with any type of acute poisoning including snake bite during span of 6 months were included in this study. Cases excluded from the study are those with improper history of poisoning and brought dead patients. A total of 113 cases were enrolled in the study after obtaining Informed consent. Data regarding demographics, relation to Age, Gender, Mode of poisoning, Socio-economic Class, Marital Status, Occupation, Literacy, Domicile, Cause of poisoning, Type of poison, Lag time in treatment, first aid, co-morbid illness, and final outcome were collected in a pre-structured proforma. The details of the first aid given, outdoor and indoor treatment received along with the treatment outcome was included in the study. All the data were presented as numbers and percentage. The observation and results are deduced and discussed. Finally, conclusion of the study found out after the discussion. Results: The number of poisoning cases found was (n=113) among all medico-legal cases (n=113) registered during the study period. Males (57.52%) dominated over Females (42.48%) as per the number of poisoning cases registered. Most common age group found was [20-29] year (39.82%), which is also same for the males (24.78%); & females (15.05%). Most of the poisoning victims belonged to lower class (79.64%), followed by middle class (20.35%) and none from the high socio-economic class. Most of the victims found were married (60%). Married males (23.89%) and married females (18.58%) were more prone for poisoning. Suicide (Intentional) was the most common manner of poisoning (75.22%), followed by accidental pattern (24.77%). No homicidal poisoning cases were detected during the study period. Suicidal pattern was more common in males (42.48%) (mostly married, 23.89%) and accidental pattern was also common in males (15.04%) (mostly married, 23.89%). Organophosphates (22.12%) was the most common poison encountered in this region irrespective of gender, followed by Drugs (17.69%), Disinfectants (14.16%), Rodenticide (12.39%), Snake bite (11.50%), Insecticide (9.73%), Household Products (7.96%), Unknown Bite (1.77%), Scorpion Sting (0.88%), Cyanide poisoning (0.88%), Honeybee Sting (0.88%). More than [two third] of the patients were presented to the hospital within [four hours] of incident. Most of the patients had been completely cured (92.62%) after the treatment. Case fatality rate was also low (only 7.38%). However, there is a relation between the lag period of incident and hospital presentation to the outcome of the treatment. Maximum patients were completely cured when the lag period was within [four hours]. With the increase in lag period there was increase in the number of complicated and fatal cases. The lag period when compared with the treatment outcome the results are statistically significant. Conclusion: Poisoning was more common in young males. Organophosphates and Drugs were major cause of poisoning. The huge burden of poisoning cases encountered in emergency department in this part of the country may be attributed due to easy availability of insecticides and other household poisons and these resulted usually from self-inflicted action. Measures observed in this study include early presentation to hospital to reduce lag time and provide immediate treatment at initial encounter may be effective in reducing duration of hospitalisation and possibly mortality in poisoning and snake bite cases. Awareness to handle the toxic materials and counselling. The proper enforcement of law in sale and distribution of addictive medicines, setting the boundaries of electronic media in exposure of critical facts and creating awareness amongst the society for education are a few goals in due. Need of the hour is to generate resources on a national level to eradicate poverty and use the young blood in employment to make them useful and responsible member of the society. Improve social awareness among the rural areas. It will not only save the precious lives but also reduce the expenditure of the health budget in combating the diseases according to set goals of WHO in the developing countries.
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