Record of hospitalized acute intoxication cases: a proposed statistical-epidemiological form

A form is presented for recording acute toxicological case histories for statistical purposes. It includes personal data, case history, social and environmental data, characteristics of the poison(s), history of the intoxication, general and prevailing signs and symptoms, criteria of diagnosis, emergency measures, specific and antagonistic treatment before and during hospitalization, clinical laboratory findings, toxicological analysis, and progression of symptoms until full or partial recovery or death. This form was developed in the course of retrospective research, and can be used either for telephone emergency calls or as a part of the clinical file. Through the elaboration of the compiled forms a strict cooperation between the assisting services and the Specialized Toxicology Centre may allow for better preventive and therapeutic measures.