Emergency Department, Changi General Hospital, Singapore, Singapore.
Emerg Med J. 2017 Nov;34(11):755-760. doi: 10.1136/emermed-2016-206531. Epub 2017 Aug 2.
A significant proportion of patients with toxic exposures presenting to the ED require admission. However, most will improve within 24 hours, and so could potentially be managed in a short-stay observation unit. We describe the management and outcomes of these patients in a 23-hour ED observation unit (EDOU).
A retrospective chart review of all patients with toxic exposures admitted to the EDOU in Singapore between 1 April 2013 and 31 March 2015 was performed. Patient demographics, exposure patterns, clinical presentation and interventions received were abstracted. The poisoning severity score (PSS) was retrospectively determined. Outcomes were length of stay and disposition.
A total of 286 patients were analysed, of which 78.0% had intentional self-poisoning, 12.2% had bites/stings and 9.8% had unintentional or occupational toxic exposures. Analgesics (29.4%), sedatives (12.3%) and antidepressants (6.8%) were the most common drugs encountered. The majority of patients had a mild (68.9%) or moderate (15.4%) PSS, but 4.2% were graded as severe. Most patients with deliberate self-poisoning were reviewed by psychiatry (88.8%) and social services (74.9%). Most patients (92.0%) were medically cleared during their stay in EDOU, including all 12 with a severe PSS. Of these, 200 (69.9%) were discharged and 63 (22.0%) were transferred directly to a psychiatric unit. The median length of stay in the EDOU was 18 hours (IQR 13-23).
Most patients admitted to the EDOU were successfully managed and medically cleared within 23 hours, including those with a severe PSS. The EDOU appears to be a suitable alternative to inpatient admission for selected patients.
大量接触毒物并到急诊就诊的患者需要住院治疗。然而，大多数患者在 24 小时内会有所改善，因此可能可以在短期观察病房中进行管理。我们描述了在新加坡 23 小时急诊观察病房（EDOU）中这些患者的管理和结局。
对 2013 年 4 月 1 日至 2015 年 3 月 31 日期间在 EDOU 住院的所有接触毒物的患者进行了回顾性图表审查。提取患者的人口统计学数据、暴露模式、临床表现和接受的干预措施。回顾性确定中毒严重程度评分（PSS）。结果是住院时间和出院情况。
共分析了 286 例患者，其中 78.0%为故意自服中毒，12.2%为咬伤/蛰伤，9.8%为意外或职业性毒物接触。最常见的药物是镇痛药（29.4%）、镇静剂（12.3%）和抗抑郁药（6.8%）。大多数患者的 PSS 为轻度（68.9%）或中度（15.4%），但有 4.2%为重度。大多数故意自服中毒患者由精神科（88.8%）和社会服务部门（74.9%）进行了评估。大多数患者（92.0%）在 EDOU 期间接受了医学检查，包括所有 12 例严重 PSS 患者。其中，200 例（69.9%）出院，63 例（22.0%）直接转至精神科病房。EDOU 的中位住院时间为 18 小时（IQR 13-23）。
大多数收入 EDOU 的患者在 23 小时内成功管理和接受医学检查，包括严重 PSS 患者。EDOU 似乎是为选定患者提供的一种替代住院治疗的合适选择。
