Patterns of hospital transfer for self-poisoned patients in rural Sri Lanka : implications for estimating the incidence of self-poisoning in the developing world

• Published in: Bulletin of the World Health Organization Vol. 84; no. 4; pp. 276 - 282
• Main Authors: EDDLESTON, Michael, SUDARSHAN, K, SENTHILKUMARAN, M, REGINALD, K, KARALLIEDDE, Lakshman, SENARATHNA, Lalith, DE SILVA, Dhammika, REZVI SHERIFF, M. H, BUCKLEY, Nick A, GUNNELL, David
• Format: Journal Article
• Language: English
• Published: Genève Organisation mondiale de la santé 01.04.2006; World Health Organization; The World Health Organization
• Subjects: Adult; Biological and medical sciences; Care and treatment; Cohort analysis; Confidence intervals; Fatalities; Female; Gender; General aspects; Health Policy & Services; Hospitalization; Hospitalization - statistics & numerical data; Hospitals; Humans; Incidence; Intensive care; Male; Medical records; Medical referrals; Medical sciences; Miscellaneous; Patient Transfer; Patients; Pesticides; Poisoning; Poisoning - epidemiology; Poisoning - mortality; Poisons; Public health. Hygiene; Public health. Hygiene-occupational medicine; Referral and Consultation; Risk factors; Rural Population; Self-poisoning; Selfpoisoning; Services; Sri Lanka; Sri Lanka - epidemiology; Suicidal behaviour; Suicide, Attempted - statistics & numerical data; Suicide, Attempted/trends; Ventilators; Asia; Sri Lanka; Human; Rural environment; Estimation; Expert; Developing countries; Patient; Self; Orientation; Epidemiology; Source; Incidence; Suicide attempt; Consultation; Transfer; Tropical medicine; Poison; Poisoning; Hospital; Public health; Remisión y consulta; Suicide, Attempted; Sri Lanka; Referral and consultation; Envenenamiento; Tentative suicide; Consultation pour avis expert; Intento de suicidio; Intoxication
• ISSN: 0042-9686; 1564-0604
• DOI: 10.1590/S0042-96862006000400011

Most data on self-poisoning in rural Asia have come from secondary hospitals. We aimed to: assess how transfers from primary to secondary hospitals affected estimates of case-fatality ratio (CFR); determine whether there was referral bias according to gender or poison; and estimate the annual incidence of all self-poisoning, and of fatal self-poisoning, in a rural developing-world setting. Self-poisoning patients admitted to Anuradhapura General Hospital, Sri Lanka, were reviewed on admission from 1 July to 31 December 2002. We audited medical notes of self-poisoning patients admitted to 17 of the 34 surrounding peripheral hospitals for the same period. A total of 742 patients were admitted with self-poisoning to the secondary hospital; 81 died (CFR 10.9%). 483 patients were admitted to 17 surrounding peripheral hospitals. Six patients (1.2%) died in peripheral hospitals, 249 were discharged home, and 228 were transferred to the secondary hospital. There was no effect of gender or age on likelihood of transfer; however, patients who had ingested oleander or paraquat were more likely to be transferred than were patients who had taken organophosphorus pesticides or other poisons. Estimated annual incidences of self-poisoning and fatal self-poisoning were 363 and 27 per 100,000 population, respectively, with an overall CFR of 7.4% (95% confidence interval 6.0-9.0). Fifty per cent of patients admitted to peripheral hospitals were discharged home, showing that CFRs based on secondary hospital data are inflated. However, while incidence of self-poisoning is similar to that in England, fatal self-poisoning is three times more common in Sri Lanka than fatal self-harm by all methods in England. Population based data are essential for making international comparisons of case fatality and incidence, and for assessing public health interventions.