Characteristics of Drug Poisonings Presenting to the Emergency Department: An Electronic Medical Record Database Analysis

Abstract

Rationale: Drug poisonings are a frequent diagnosis in the Emergency Department (ED), requiring patient management from multiple services. Although there is considerable research detailing the fatal opioid overdose epidemic, little is known about drug poisonings as a whole. Our objective was to describe the drug poisonings seen in the ED at St. Joseph’s Hospital Hamilton (SJHH), a large academic urban hospital. Methods: This study was a retrospective, descriptive study using data abstracted from Dovetale – Epic®, an electronic medical record for calendar years 2018 through 2020. Patients were identified by ICD-10 drug poisoning codes and data were collected on demographics, drugs involved, hospital management and outcomes to the end of the acute admission. Data were stratified by the intent of drug poisoning. Results: In total, 2983 drug poisoning visits were included, patient mean age 38.3 years (SD 16.2), 54.7% female, yielding an overall incidence rate of 16.0 drug poisonings/1000 ED visits (8.1 intentional, 6.6 non-intentional and 1.3 unknown). The intentional drug poisoning cohort was younger (mean 36.1 +/-15.7 versus 41.0 +/- 16.6 years) with a higher proportion of females (67.1% versus 42.5%) than the non-intentional cohort. The most prevalent drugs for intentional drug poisonings were antidepressants (26.9%), benzodiazepines (24.9%) and acetaminophen (21.9%) compared to opioids (any opioid, 46.9% including fentanyl, 15.9%, heroin, 11.5%, other opioids, 15.0%) for non-intentional. An antidote was ordered for 26.7% of patients; most commonly N-acetylcysteine for intentional (7.9%) and naloxone for non-intentional (17.1%). The rate of return visit to the ED with a subsequent drug poisoning was 25.9% within a mean follow up of 18.4 months. Mental Health Services (Psychiatric Emergency referral or consult) and Addictions Services consults were ordered in 33.5% and 6.5% of patients respectively. Only 716 (24.0%) of patients were admitted for inpatient care from the ED with an accompanying acute in-hospital mortality rate of 1.0%. The mean length of stay for the initial ED stay and acute hospitalization was 2.2 days (SD 5.8). Conclusion: This study illustrates a high rate of hospital utilization due to drug poisoning associated with several drugs and suggesting a significant rate of poor outcome, resource utilization and recidivism.