Clinical features related to alcohol co-ingestion of deliberate self-poisoning patients visiting the emergency department
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Purpose: Alcohol is one of the most commonly co-ingested agents in deliberate self-poisoning (DSP) cases presenting at the emergency department (ED). The increased impulsivity, aggressiveness, and disinhibition caused by alcohol ingestion may have different clinical features and outcomes in cases of DSP. This study investigates whether alcohol co-ingestion affects the clinical features and outcomes of DSP patients in the ED. Methods: This was a single-center retrospective study. We investigated DSP cases who visited our ED from January 2010 to December 2016. Patients were classified into two groups: with (ALC+) or without (ALC–) alcohol co-ingestion. The clinical features of DSP were compared by considering the co-ingestion of alcohol, and the factors related to discharge against medical advice (AMA) of DSP were analyzed. Results: A total of 689 patients were included in the study, with 272 (39.5%) in the ALC+ group. Majority of the ALC+ group patients were middle-aged males (45-54 years old) and arrived at the ED at night. The rate of discharge AMA from ED was significantly higher in the ALC+ group (130; 47.8%) compared to the ALC– group (p=0.001). No significant differences were obtained in the poisoning severity scores between the two groups (p=0.223). Multivariate analysis revealed that alcohol co-ingestion (odds ratio [OR]=1.42; 95% confidence interval [CI], 1.01-1.98), alert mental status (OR=1.65; 95% CI, 1.17-2.32), past psychiatric history (OR=0.04; 95% CI, 0.01-0.28), age >65 years (OR=0.42; 95% CI, 0.23-0.78), and time from event to ED arrival >6 hrs (OR=0.57; 95% CI, 0.37-0.88) were independent predictive factors of discharge AMA (p=0.043, p=0.004, p=0.001, p=0.006, and p=0.010, respectively). Conclusion: Our results determined a high association between alcohol co-ingestion and the outcome of discharge AMA in DSP patients. Emergency physicians should, therefore, be aware that DSP patients who have co-ingested alcohol may be uncooperative and at high risk of discharge AMA.
Abstract
Purpose: Alcohol is one of the most commonly co-ingested agents in deliberate self-poisoning (DSP) cases presenting at the emergency department (ED). The increased impulsivity, aggressiveness, and disinhibition caused by alcohol ingestion may have different clinical features and outcomes in cases of DSP. This study investigates whether alcohol co-ingestion affects the clinical features and outcomes of DSP patients in the ED. Methods: This was a single-center retrospective study. We investigated DSP cases who visited our ED from January 2010 to December 2016. Patients were classified into two groups: with (ALC+) or without (ALC–) alcohol co-ingestion. The clinical features of DSP were compared by considering the co-ingestion of alcohol, and the factors related to discharge against medical advice (AMA) of DSP were analyzed. Results: A total of 689 patients were included in the study, with 272 (39.5%) in the ALC+ group. Majority of the ALC+ group patients were middle-aged males (45-54 years old) and arrived at the ED at night. The rate of discharge AMA from ED was significantly higher in the ALC+ group (130; 47.8%) compared to the ALC– group (p=0.001). No significant differences were obtained in the poisoning severity scores between the two groups (p=0.223). Multivariate analysis revealed that alcohol co-ingestion (odds ratio [OR]=1.42; 95% confidence interval [CI], 1.01-1.98), alert mental status (OR=1.65; 95% CI, 1.17-2.32), past psychiatric history (OR=0.04; 95% CI, 0.01-0.28), age >65 years (OR=0.42; 95% CI, 0.23-0.78), and time from event to ED arrival >6 hrs (OR=0.57; 95% CI, 0.37-0.88) were independent predictive factors of discharge AMA (p=0.043, p=0.004, p=0.001, p=0.006, and p=0.010, respectively). Conclusion: Our results determined a high association between alcohol co-ingestion and the outcome of discharge AMA in DSP patients. Emergency physicians should, therefore, be aware that DSP patients who have co-ingested alcohol may be uncooperative and at high risk of discharge AMA.
참고문헌 (23)
- Boenisch S, "The role of alcohol use disorder and alcohol consumption in suicide attempts--a secondary analysis of 1921 suicide attempts", Eur Psychiatry, 25(7), pp.414~420 (2010)
- Hendrix L, "Deliberate selfpoisoning : characteristics of patients and impact on the emergency department of a large university hospital", Emerg Med J, 30(1), pp.e9~ (2013)
- Teo AI, "The epidemiology and management of adult poisonings admitted to the short-stay ward of a large Scottish emergency department", Scott Med J, 58(3), pp.149~153 (2013)
- Salles J, "Suicide Attempts: How Does the Acute Use of Alcohol Affect Suicide Intent?", Suicide Life Threat Behav, 50(1), pp.315~328 (2020)
- Salles J, "Factors associated with hospitalization after self-poisoning in France : special focus on the impact of alcohol use disorder", BMC Psychiatry, 18(1), pp.287~ (2018)
- Borruso LD, "Acute Alcohol Co-Ingestion and Hospital-Treated Deliberate Self-Poisoning: Is There an Effect on Subsequent Self-Harm?", Suicide Life Threat Behav, 49(1), pp.293~302 (2019)
- Weathermon R, "Alcohol and medication interactions", Alcohol Res Health, 23(1), pp.40~54 (1999)
- 이학수, "의도적 중독으로 응급실을 방문하는 환자들의 특성: 2011-2015년 응급실 손상환자 심층조사 분석", 대한임상독성학회지, 15(2), pp.131~139 (2017), 대한임상독성학회[DOI]
- Hong, S., "Elderly patients visiting the emergency department for deliberate self-poisoning: do they present a more severe poisoning severity score than the nonelderly patients in the initial 24 h?", Aging Clin Exp Res, 31, pp.1139~1146 (2019)
- Persson HE, "Poisoning severity score. Grading of acute poisoning", J Toxicol Clin Toxicol, 36(3), pp.205~213 (1998)
- Chitty KM, "Relationship between prescribed psychotropic medications and co-ingested alcohol in intentional self-poisonings", Br J Psychiatry, 210(3), pp.203~208 (2017)
- Oh SH, "Which deliberate self-poisoning patients are most likely to make high-lethality suicide attempts", Int J Ment Health Syst, 7(9), pp.35~ (2015)
- O’Loughlin S, "A 20-year review of trends in deliberate self-harm in a British town, 1981-2000", Soc Psychiatry Psychiatr Epidemiol, 40(6), pp.446~453 (2005)
- Michel K, "Methods used for parasuicide : results of the WHO", EURO Multicentre Study on Parasuicide, 2000, pp.35(4), 156~163
- Parra-Uribe I, "Risk of re-attempts and suicide death after a suicide attempt : A survival analysis", BMC Psychiatry, 17(1), pp.163~ (2017)
- Weisman AD, "Risk-rescue rating in suicide assessment", Arch Gen Psychiatry, 26(6), pp.553~560 (1972)
- Kristinsson J, "Acute poisonings in Iceland: a prospective nationwide study", Clin Toxicol(Phila), 46(2), pp.126~132 (2008)
- Spiller HA, "Epidemiological trends of suicide and attempted suicide by poisoning in the US: 2000-2008", Leg Med(Tokyo), 12(4), pp.177~183 (2010)
- Chitty KM, "Co-ingested alcohol and the timing of deliberate self-poisonings", Aust N Z J Psychiatry, 52(3), pp.271~278 (2018)
- Peter JV, "Performance of clinical scoring systems in acute organophosphate poisoning", Clin Toxicol(Phila), 51(9), pp.850~854 (2013)
- Akdur O, "Poisoning severity score, Glasgow coma scale, corrected QT interval in acute organophosphate poisoning", Hum Exp Toxicol, 29(5), pp.419~425 (2010)
- 전민재, "의도적인 중독 환자들의 음주 여부에 따른 중독 중증도 지수의 비교", 대한임상독성학회지, 19(1), pp.17~23 (2021), 대한임상독성학회[DOI]
- Vancayseele N, "Medication used in intentional drug overdose in Flanders 2008-2013", PLoS One, 14(5), pp.e0216317~ (2019)