A 24/7 hospital toxicology service: Experience of a new start-up

Objectives: A toxicology team providing round-the-clock consultations for poisoning was established in Changi General Hospital in November 2014. This study aims to describe the epidemiology of patients referred to this service in 2015. Methods: A retrospective electronic and paper records review of...

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Published inProceedings of Singapore healthcare Vol. 27; no. 4; pp. 223 - 228
Main Authors Arciaga, Gabriel Joseph, Tan, Hock Heng, Kuan, Kaibin Kelvin, Mong, Rupeng, Kant, Abhay
Format Journal Article
LanguageEnglish
Published London, England SAGE Publications 01.12.2018
Sage Publications Ltd
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Abstract Objectives: A toxicology team providing round-the-clock consultations for poisoning was established in Changi General Hospital in November 2014. This study aims to describe the epidemiology of patients referred to this service in 2015. Methods: A retrospective electronic and paper records review of all patients referred to the toxicology service from January to December 2015 was performed for demographics, poisoning, clinical, and outcome data. The cases were graded for poisoning severity score (PSS), likelihood of poisoning exposure and relative contribution to fatality for death cases. Results: A total of 306 cases were referred to this service in 2015. The median age was 34 years with majority being females (54%). The most common cause of poisoning was deliberate self-harm (62%) and the most common route of poisoning was oral (85%). Analgesics (21%) and sedatives (19%) were the most common poisoning classes. Six per cent of patients received decontamination and 17% received antidotes. The likelihood of poisoning exposure was probable to definite certainty for 85% of the cases. Mild poisoning (PSS 0–1) constituted 76% of the cohort, while 22% had moderate to severe poisoning (PSS 2–3). Out of the five fatalities, three were exposure-related fatalities contributing to a fatality rate of 1%. Fifty-four per cent of patients were admitted to the emergency department observation unit, 17% to general inpatient wards and 9% to either intensive care unit or high dependency wards. Conclusions: Although most poisoning cases resulted in mild clinical effects, a small but significant number of severe acuity cases occurred in this cohort.
AbstractList Objectives: A toxicology team providing round-the-clock consultations for poisoning was established in Changi General Hospital in November 2014. This study aims to describe the epidemiology of patients referred to this service in 2015. Methods: A retrospective electronic and paper records review of all patients referred to the toxicology service from January to December 2015 was performed for demographics, poisoning, clinical, and outcome data. The cases were graded for poisoning severity score (PSS), likelihood of poisoning exposure and relative contribution to fatality for death cases. Results: A total of 306 cases were referred to this service in 2015. The median age was 34 years with majority being females (54%). The most common cause of poisoning was deliberate self-harm (62%) and the most common route of poisoning was oral (85%). Analgesics (21%) and sedatives (19%) were the most common poisoning classes. Six per cent of patients received decontamination and 17% received antidotes. The likelihood of poisoning exposure was probable to definite certainty for 85% of the cases. Mild poisoning (PSS 0–1) constituted 76% of the cohort, while 22% had moderate to severe poisoning (PSS 2–3). Out of the five fatalities, three were exposure-related fatalities contributing to a fatality rate of 1%. Fifty-four per cent of patients were admitted to the emergency department observation unit, 17% to general inpatient wards and 9% to either intensive care unit or high dependency wards. Conclusions: Although most poisoning cases resulted in mild clinical effects, a small but significant number of severe acuity cases occurred in this cohort.
Objectives: A toxicology team providing round-the-clock consultations for poisoning was established in Changi General Hospital in November 2014. This study aims to describe the epidemiology of patients referred to this service in 2015. Methods: A retrospective electronic and paper records review of all patients referred to the toxicology service from January to December 2015 was performed for demographics, poisoning, clinical, and outcome data. The cases were graded for poisoning severity score (PSS), likelihood of poisoning exposure and relative contribution to fatality for death cases. Results: A total of 306 cases were referred to this service in 2015. The median age was 34 years with majority being females (54%). The most common cause of poisoning was deliberate self-harm (62%) and the most common route of poisoning was oral (85%). Analgesics (21%) and sedatives (19%) were the most common poisoning classes. Six per cent of patients received decontamination and 17% received antidotes. The likelihood of poisoning exposure was probable to definite certainty for 85% of the cases. Mild poisoning (PSS 0–1) constituted 76% of the cohort, while 22% had moderate to severe poisoning (PSS 2–3). Out of the five fatalities, three were exposure-related fatalities contributing to a fatality rate of 1%. Fifty-four per cent of patients were admitted to the emergency department observation unit, 17% to general inpatient wards and 9% to either intensive care unit or high dependency wards. Conclusions: Although most poisoning cases resulted in mild clinical effects, a small but significant number of severe acuity cases occurred in this cohort.
Author Arciaga, Gabriel Joseph
Tan, Hock Heng
Kant, Abhay
Mong, Rupeng
Kuan, Kaibin Kelvin
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  givenname: Abhay
  surname: Kant
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  organization: Accident and Emergency Department, Changi General Hospital, Singapore, Republic of Singapore
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Cites_doi 10.1177/102490791101800402
10.1136/emermed-2016-206531
10.1007/s12245-008-0080-9
10.1258/msl.2012.012058
10.1111/1742-6723.12755
10.1177/102490791602300605
10.1177/102490790701400302
10.1080/15563650.2016.1245421
10.1080/15287390600755042
10.3109/15563659809028940
10.1177/102490791001700108
10.3109/15563650.2014.892125
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Issue 4
Keywords Poison
decontamination
toxicology service
poisoning severity
antidote
Language English
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References Friedman, Krajewski, Vannoy 2014; 52
Persson, Sjöberg, Haines 1998; 36
Isoardi, Armitage, Harris 2017; 29
Albert, McCaig, Uddin 2015; 196
Vassilev, Marcus 2007; 70
Ponampalam, Loh 2010; 17
Kuan, Tan, Lim 2016; 57
Chiu, Lim, Vasu 2011; 18
Tay, Tai, Seow 1998; 27
Chung, Tsui, Tong 2007; 14
Mong, Arciaga, Tan 2017; 34
Ponampalam, Tan, Ng 2009; 2
Mowry, Spyker, Brooks 2016; 54
Wang, Ching 2013; 53
Chan, Tse, Lau 2016; 23
bibr6-2010105818758783
bibr1-2010105818758783
bibr4-2010105818758783
bibr12-2010105818758783
bibr10-2010105818758783
bibr14-2010105818758783
bibr7-2010105818758783
Tay SY (bibr18-2010105818758783) 1998; 27
Albert M (bibr2-2010105818758783) 2015; 196
bibr9-2010105818758783
bibr16-2010105818758783
bibr5-2010105818758783
bibr11-2010105818758783
bibr3-2010105818758783
bibr8-2010105818758783
bibr19-2010105818758783
bibr13-2010105818758783
Kuan KK (bibr17-2010105818758783) 2016; 57
bibr15-2010105818758783
References_xml – volume: 70
  start-page: 107
  year: 2007
  end-page: 110
  article-title: The impact of a poison control center on the length of hospital stay for patients with poisoning
  publication-title: J Toxicol Environ Health A
  contributor:
    fullname: Marcus
– volume: 29
  start-page: 310
  year: 2017
  end-page: 314
  article-title: Establishing a dedicated toxicology unit reduces length of stay of poisoned patients and saves hospital bed days
  publication-title: Emerg Med Australas
  contributor:
    fullname: Harris
– volume: 57
  start-page: S78
  year: 2016
  article-title: Efficacy and safety in the management of paracetamol poisoning treated with n-acetyl cysteine in a 23-hour observation unit of an emergency department: a comparison with standard inpatient care
  publication-title: Singapore Med J
  contributor:
    fullname: Lim
– volume: 23
  start-page: 358
  year: 2016
  end-page: 370
  article-title: Hong Kong Poison Information Centre: annual report 2015
  publication-title: Hong Kong J Emerg Med
  contributor:
    fullname: Lau
– volume: 52
  start-page: 198
  year: 2014
  end-page: 206
  article-title: The association between U.S. Poison Center assistance and length of stay and hospital charges
  publication-title: Clin Toxicol
  contributor:
    fullname: Vannoy
– volume: 27
  start-page: 347
  year: 1998
  end-page: 352
  article-title: Patients admitted to an intensive care unit for poisoning
  publication-title: Ann Acad Med Singapore
  contributor:
    fullname: Seow
– volume: 34
  start-page: 755
  year: 2017
  end-page: 760
  article-title: Use of a 23-hour emergency department observation unit for the management of patients with toxic exposures
  publication-title: Emerg Med J
  contributor:
    fullname: Tan
– volume: 18
  start-page: 197
  year: 2011
  end-page: 203
  article-title: Poison exposure in the emergency department: a Singaporean experience
  publication-title: Hong Kong J Emerg Med
  contributor:
    fullname: Vasu
– volume: 17
  start-page: 45
  year: 2010
  end-page: 53
  article-title: Cost benefits of the Drug and Poison Information Centre in preventing unnecessary hospitalisation: the Singapore experience
  publication-title: Hong Kong J Emerg Med
  contributor:
    fullname: Loh
– volume: 2
  start-page: 25
  year: 2009
  end-page: 31
  article-title: Demographics of toxic exposures presenting to three public hospital emergency departments in Singapore 2001–2003
  publication-title: Int J Emerg Med
  contributor:
    fullname: Ng
– volume: 36
  start-page: 205
  year: 1998
  end-page: 213
  article-title: Poisoning severity score. Grading of acute poisoning
  publication-title: J Toxicol Clin Toxicol
  contributor:
    fullname: Haines
– volume: 196
  start-page: 1
  year: 2015
  end-page: 8
  article-title: Emergency department visits for drug poisoning: United States, 2008–2011
  publication-title: NCHS Data Brief
  contributor:
    fullname: Uddin
– volume: 14
  start-page: 134
  year: 2007
  end-page: 143
  article-title: The impact of an emergency department toxicology team in the management of acute intoxication
  publication-title: Hong Kong J Emerg Med
  contributor:
    fullname: Tong
– volume: 53
  start-page: 149
  year: 2013
  end-page: 153
  article-title: Pattern of coroner’s autopsies at Health Sciences Authority, Singapore: a retrospective study (2009–2010)
  publication-title: Med Sci Law
  contributor:
    fullname: Ching
– volume: 54
  start-page: 924
  year: 2016
  end-page: 1109
  article-title: 2015 Annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 33rd annual report
  publication-title: Clin Toxicol
  contributor:
    fullname: Brooks
– ident: bibr9-2010105818758783
  doi: 10.1177/102490791101800402
– ident: bibr15-2010105818758783
  doi: 10.1136/emermed-2016-206531
– ident: bibr4-2010105818758783
  doi: 10.1007/s12245-008-0080-9
– ident: bibr1-2010105818758783
– volume: 196
  start-page: 1
  year: 2015
  ident: bibr2-2010105818758783
  publication-title: NCHS Data Brief
  contributor:
    fullname: Albert M
– ident: bibr8-2010105818758783
– volume: 57
  start-page: S78
  year: 2016
  ident: bibr17-2010105818758783
  publication-title: Singapore Med J
  contributor:
    fullname: Kuan KK
– ident: bibr19-2010105818758783
  doi: 10.1258/msl.2012.012058
– ident: bibr7-2010105818758783
– ident: bibr12-2010105818758783
  doi: 10.1111/1742-6723.12755
– ident: bibr10-2010105818758783
  doi: 10.1177/102490791602300605
– ident: bibr11-2010105818758783
  doi: 10.1177/102490790701400302
– ident: bibr3-2010105818758783
  doi: 10.1080/15563650.2016.1245421
– ident: bibr6-2010105818758783
– ident: bibr13-2010105818758783
  doi: 10.1080/15287390600755042
– ident: bibr5-2010105818758783
  doi: 10.3109/15563659809028940
– ident: bibr16-2010105818758783
  doi: 10.1177/102490791001700108
– volume: 27
  start-page: 347
  year: 1998
  ident: bibr18-2010105818758783
  publication-title: Ann Acad Med Singapore
  contributor:
    fullname: Tay SY
– ident: bibr14-2010105818758783
  doi: 10.3109/15563650.2014.892125
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Snippet Objectives: A toxicology team providing round-the-clock consultations for poisoning was established in Changi General Hospital in November 2014. This study...
Objectives: A toxicology team providing round-the-clock consultations for poisoning was established in Changi General Hospital in November 2014. This study...
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SubjectTerms Fatalities
Poisoning
Toxicology
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Title A 24/7 hospital toxicology service: Experience of a new start-up
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