[Paracetamol poisonings after the lifting of the place of sale restriction]. / Paracetamolforgiftninger etter innføring av ny salgsordning.

BACKGROUND: Before 2003, the sale of paracetamol in Norway was restricted to pharmacies only. In November 2003 this place of sale restriction was lifted, allowing sale of paracetamol in non-pharmacy locations. The purpose of this study was to investigate the incidence, severity and mortality of paracetamol poisoning before and after the lifting of the place of sale restriction. MATERIAL AND METHODS: Incidence was assessed using discharge data from three selected hospitals and the enquiry database of the National Poisons Information Centre (PIC). Evaluation of poisoning severity was based on degree of hepatotoxicity in admitted patients, number of requests regarding evaluation for liver transplantation at the National Transplantation Unit and PIC severity grading of cases. Data regarding mortality of paracetamol poisoning was obtained from the National Cause of Death Register. Data for the two-year period before (2001-2002) the place of sale restriction was lifted was compared with two years after (2005-2006). RESULTS: There was no significant change in the number of hospital admissions due to paracetamol poisoning in any of the three hospitals following the lifting of the place of sale restriction. The number of inquiries to PIC regarding paracetamol intake showed a statistical significant increase. The extent of severe paracetamol poisoning might be rising, but the mortality of paracetamol poisoning does not appear to have increased since the place of sale restriction was lifted. INTERPRETATION: There is no evidence that the number of paracetamol poisonings or deaths has increased since the place of sale restriction was lifted. The proportion of patients with liver toxicity/liver damage, and the number of patients evaluated for liver transplantation may be increasing. However, the development in paracetamol poisoning should be monitored in the coming years.

[Coding practice in fatal poisonings]. / Kodepraksis ved forgiftningsdødsfall.

BACKGROUND: Each year, nearly 100 deaths and more than 10,000 admissions to Norwegian hospitals can be attributed to acute poisoning from non-medical substances and drugs in supra-therapeutic doses. The aim of this study was to evaluate hospitals' routines for coding of acute poisoning deaths and to provide information on the toxic agents involved. MATERIAL AND METHODS: Medical records of deaths (at 6 Norwegian hospitals in the period 1.1.1999 -31.12.2005) due to acute poisoning were re-examined to assess accuracy of diagnosis codes. RESULTS: Acute poisoning was registered as the cause of 225 deaths in the study period. The re-evaluation concluded that 45 of these deaths had other causes. In 125 of the remaining 180 deaths, acute poisoning was only registered as a side diagnosis, although re-examination revealed it was the major contribution to death in 66 % (83 of 125) of cases. The hospitals had classified the drugs according to ATC codes in 16 % (28 of 180) of patients with acute poisoning. INTERPRETATION: The present Norwegian coding practice does not document acute poisoning deaths in hospital correctly, and registry studies based on diagnosis codes should be interpreted with care. Current registration of poisoning agents' ATC-codes is insufficient and the Norwegian version of ICD-10 alone is not suitable for classification of acute drug poisoning. Replacement of the Norwegian ICD-10 version by the original international version should be considered and/or the routines for registration of ATC-codes should be improved.