Etiological characterization of acute poisonings in the emergency department

An investigation of emergency department (ED) poisonings was conducted to characterize poisoning demographics and evaluate correlations with select co-morbidities.

The study population evaluated consisted of 649 poisoning cases admitted between 2004 and 2007 to an inner-city, level 1 emergency department.

Ethnicity, age, and gender had a substantial impact on the population distribution as poisoning cases were predominantly African Americans (79.9%) between 36 and 45 years old with a 1:3 male to female ratio. Intentional illicit drug overdose was the most prevalent cause of poisoning, heroin being the most frequent substance found in 35.4% ( n = 230) of cases, followed by cocaine overdose at 31.7% ( n = 206), concomitant heroin and cocaine overdose at 4.3% ( n = 28), multiple drug poisoning at 5.5% ( n = 36), and antidepressant/antipsychotic poisoning at 6% ( n = 39). Significant correlations were found between heroin poisoning and asthma (F = 20.29, DF = 1, P = 0.0001), cocaine poisoning and hypertension (F = 33.34, DF = 1, P = 0.0001), and cocaine poisoning and cardiovascular disease (F = 35.34, DF = 1, P = 0.0001). A change in the pattern of illicit drug use from injection to inhalation was detected and the resulting increase of inhalation and insufflation of illicit substances may partially explain the correlation found between heroin use and asthma.

These results provide supporting evidence that deliberate poisoning with illicit drugs remains a serious healthcare issue that significantly aggravates co-morbidities and raises treatment costs by increasing both the rate of hospitalization and hospital length of stay.