Radboud University Nijmegen Medical Centre, Pharmacology and Toxicology, PO Box 9101, Nijmegen, Netherlands.
Clin Toxicol (Phila). 2012 Feb;50(2):120-8. doi: 10.3109/15563650.2011.649092. Epub 2012 Jan 25.
Acute intoxications are frequently seen in Dutch hospitals. Based on single-centre studies and the fact that there are no clear guidelines, we hypothesised that hospital admission of acute intoxications may vary. Furthermore, decontamination treatment of poisonings may differ between hospitals, as earlier studies showed that adherence to international guidelines concerning decontamination may be poor.
We aim to identify possible variations in Dutch hospital admission and decontamination treatment of patients with acute intoxications.
Data on acute intoxications was retrospectively collected from patient records from the emergency departments of six Dutch hospitals. All patients older than 14 years who presented between 1 January 2008 and 31 December 2008 were included in the study.
The percentage of suicide attempts differed significantly between the hospitals (25-73%, p < 0.0001) as equally the percentage of intoxications with drugs of abuse (18-61%, p < 0.0001). Marked differences in admission rates were found (27-78%, p < 0.0001) and these differences remained even when intoxications because of suicide attempts and drugs of abuse were analysed separately (admission rate of 52-87%, p < 0.0001 and 8-71%, p < 0.0001 respectively). Reported consultation with the National Poisons Information Centre differed between hospitals (range 0% to 80-100%). No statistical differences were found between hospitals for the use of activated charcoal (16.1-42.5%, p = 0.037). Gastric lavage was used infrequently in all hospitals. (6.6-16.7%, p = 0.614).
The admission rate of patients with an acute intoxication varies considerably, especially in the case of intoxications with drugs of abuse. Consultations with the National Poisons Information Centre differed between the six hospitals. Rates of decontamination did not vary, which may indicate adherence to guidelines by the American Academy of Clinical Toxicology, European Association of Poisons Centres and Clinical Toxicologists. National guidelines or admission algorithms may reduce variations in poisoning management and make the care for these patients more efficient.
急性中毒在荷兰医院中经常出现。基于单中心研究以及缺乏明确指南的事实，我们假设急性中毒的住院治疗可能存在差异。此外，由于早期研究表明，去污治疗可能不符合国际指南，因此不同医院之间的中毒去污治疗可能存在差异。
我们旨在确定荷兰医院对急性中毒患者住院和去污治疗的可能差异。
从六家荷兰医院急诊科的患者记录中回顾性收集急性中毒数据。纳入研究的所有患者年龄均大于 14 岁，就诊时间为 2008 年 1 月 1 日至 2008 年 12 月 31 日。
不同医院的自杀企图比例差异显著（25%-73%，p < 0.0001），同样，滥用药物中毒的比例差异显著（18%-61%，p < 0.0001）。住院率也存在显著差异（27%-78%，p < 0.0001），即使将自杀企图和滥用药物引起的中毒分别进行分析，这种差异仍然存在（住院率分别为 52%-87%，p < 0.0001 和 8%-71%，p < 0.0001）。不同医院之间报告的国家毒物信息中心咨询情况存在差异（范围为 0%-80-100%）。不同医院之间使用活性炭的情况无统计学差异（16.1%-42.5%，p = 0.037）。所有医院均很少使用洗胃（6.6%-16.7%，p = 0.614）。
急性中毒患者的住院率差异很大，特别是在滥用药物中毒的情况下。六家医院之间的国家毒物信息中心咨询情况存在差异。去污治疗率没有差异，这可能表明美国临床毒理学学院、欧洲中毒中心和临床毒理学家协会指南得到了遵守。国家指南或入院算法可能会减少中毒管理的差异，使这些患者的治疗更加高效。
