Heyerdahl Fridtjof, Hovda Knut E, Bjornaas Mari A, Nore Anne K, Figueiredo Jose C P, Ekeberg Oivind, Jacobsen Dag
Department of Acute Medicine, Ullevaal University Hospital, Oslo, Norway.
BMC Emerg Med. 2008 Nov 24;8:15. doi: 10.1186/1471-227X-8-15.
Poisoned patients are often treated in and discharged from pre-hospital health care settings. Studies of poisonings should therefore not only include hospitalized patients.
To describe the acutely poisoned patients treated by ambulance personnel and in an outpatient clinic; compare patients transferred to a higher treatment level with those discharged without transfer; and study the one-week mortality after pre-hospital discharge.
A one-year multi-centre study with prospective inclusion of all acutely poisoned patients > or = 16 years of age treated in ambulances, an outpatient clinic, and hospitals in Oslo.
A total of 3757 health service contacts from 2997 poisoning episodes were recorded: 1860 were treated in ambulances, of which 15 died and 750 (40%) were discharged without transfer; 956 were treated in outpatient clinic, of which 801 (84%) were discharged without transfer; and 941 episodes were treated in hospitals. Patients discharged alive after ambulance treatment were mainly poisoned by opiates (70%), were frequently comatose (35%), had respiratory depression (37%), and many received naloxone (49%). The majority of the patients discharged from the outpatient clinic were poisoned by ethanol (55%), fewer were comatose (10%), and they rarely had respiratory depression (4%). Among the hospitalized, pharmaceutical poisonings were most common (58%), 23% were comatose, and 7% had respiratory depression. Male patients comprised 69% of the pre-hospital discharges, but only 46% of the hospitalized patients. Except for one patient, who died of a new heroin overdose two days following discharge from an ambulance, there were no deaths during the first week after the poisonings in the 90% of the pre-hospital discharged patients with known identity.
More than half of the poisoned patients treated in pre-hospital treatment settings were discharged without transfer to higher levels. These poisonings were more often caused by drug and alcohol abuse than in those who were hospitalized, and more than two-thirds were males. Almost half of those discharged from ambulances received an antidote. The pre-hospital treatment of these poisonings appears safe regarding short-term mortality.
中毒患者通常在院前医疗环境中接受治疗并出院。因此，中毒研究不仅应包括住院患者。
描述由救护人员和门诊治疗的急性中毒患者；比较转至更高治疗水平的患者与未转诊即出院的患者；并研究院前出院后的一周死亡率。
一项为期一年的多中心研究，前瞻性纳入奥斯陆所有年龄大于或等于16岁、在救护车、门诊和医院接受治疗的急性中毒患者。
共记录了来自2997次中毒事件的3757次医疗服务接触：1860例在救护车中接受治疗，其中15例死亡，750例（40%）未转诊即出院；956例在门诊接受治疗，其中801例（84%）未转诊即出院；941例在医院接受治疗。救护车治疗后存活出院的患者主要因阿片类药物中毒（70%），经常昏迷（35%），有呼吸抑制（37%），许多人接受了纳洛酮治疗（49%）。门诊出院的大多数患者因乙醇中毒（55%），昏迷较少（10%），很少有呼吸抑制（4%）。在住院患者中，药物中毒最为常见（58%），23%昏迷，7%有呼吸抑制。男性患者占院前出院患者的69%，但仅占住院患者的46%。除一名患者在从救护车出院两天后死于新的海洛因过量外，在90%身份已知的院前出院患者中，中毒后第一周内无死亡病例。
在院前治疗环境中接受治疗的中毒患者中，超过一半未转诊至更高水平即出院。这些中毒比住院患者更常由药物和酒精滥用引起，且超过三分之二为男性。从救护车出院的患者中近一半接受了解毒剂治疗。就短期死亡率而言，这些中毒的院前治疗似乎是安全的。
