Intoxicaciones agudas atendidas en un servicio de urgencias. De la prepandemia a la nueva normalidad / Acute poisoning among patients attended to in an emergency department: From the pre-pandemic period to the new normality

Fundamentos La pandemia por COVID-19 ha provocado cambios globales que afectan a la vida diaria de la población mundial, con un impacto directo sobre la salud física y mental de los individuos, así como en sus hábitos sociales y recreativos. Métodos Análisis retrospectivo de aspectos demográficos y clínicos de los pacientes atendidos por intoxicaciones agudas en un servicio de urgencias hospitalario durante 3 períodos distintos: prepandemia (2019), tras el confinamiento domiciliario (2020) y en el período pospandémico (2021), analizando en cada uno los meses de junio y julio. Resultados Se incluyeron 1.182 intoxicaciones agudas. En relación con la etapa prepandémica, el número de intoxicados disminuyó durante el confinamiento (2019: 1,9 vs. 2020: 1,5%; p<0,01), incrementándose la ratio varón/mujer (2,0 vs. 1,4; p=0,02) y la edad media (2019: 31,4 vs. 2020: 41,3; p<0,001), tendencia que se mantuvo en el año 2021 (38,3). La intoxicación con motivación suicida también aumentó en dicho período (2019: 8,71 vs. 2020: 21,0%; p<0,01), mientras que las lúdicas decrecieron (2019: 76,1 vs. 2020: 62,0%; p<0,01), con un aumento no significativo en el último año 2021 (69,0%; p=0,07). Conclusiones La pandemia por COVID-19 ha generado cambios clínicos y epidemiológicos en las intoxicaciones agudas atendidas en un servicio de urgencias hospitalario durante las distintas fases de la pandemia (AU)

Background The COVID-19 pandemic has caused global changes that affect the daily life of the world's population, with a direct impact on individuals’ physical and mental health as well as on their social and recreational habits. Methods This study aimed to retrospectively analyze the demographic and clinical characteristics of patients attended to for acute poisoning in a hospital emergency department (ED) at three different periods of time: pre-pandemic (2019), after strict lockdown of the population in Spain (2020), and post-pandemic (2021). We analyzed 2 months (June and July) in each period. Results A total of 1,182 cases of acute poisoning were included. Compared to the pre-pandemic period, during lockdown, the number of patients with acute poisoning decreased (2019: 1.9% vs. 2020: 1.5%; p<.01); the ratio of men to women increased (2.0 vs. 1.4; p=.02); and the mean age of patients increased (2019: 31.4 vs. 2020: 41.3; p<.001), a trend which continued in 2021 (38.3). Poisoning with suicidal intention also increased during the pandemic (2019: 8.71% vs. 2020: 21.0%; p<.01) whereas poisonings with a recreational intention declined (2019: 76.1% vs. 2020: 62.0%; p<.01) with a non-significant increase in 2021 (69.0%, p=.07). Conclusion The COVID-19 pandemic generated clinical and epidemiological changes in the acute poisonings attended to in a hospital emergency department during the various phases of the pandemic (AU)

Acute poisoning among patients attended to in an emergency department: from the pre-pandemic period to the new normality.

BACKGROUND: The COVID-19 pandemic has caused global changes that affect the daily life of the world's population, with a direct impact on individuals' physical and mental health as well as on their social and recreational habits. METHODS: This study aimed to retrospectively analyze the demographic and clinical characteristics of patients attended to for acute poisoning in a hospital emergency department (ED) at three different periods of time: pre-pandemic (2019), after strict lockdown of the population in Spain (2020), and post-pandemic (2021). We analyzed 2 months (June and July) in each period. RESULTS: A total of 1,182 cases of acute poisoning were included. Compared to the pre-pandemic period, during lockdown, the number of patients with acute poisoning decreased (2019: 1.9% vs. 2020: 1.5%; p < 0.01); the ratio of men to women increased (2.0 vs. 1.4; p = 0.02); and the mean age of patients increased (2019: 31.4 vs. 2020: 41.3; p < 0.001), a trend which continued in 2021 (38.3). Poisoning with suicidal intention also increased during the pandemic (2019: 8.71% vs. 2020: 21.0%; p < 0.01) whereas poisonings with a recreational intention declined (2019: 76.1% vs. 2020: 62.0%; p < 0.01) with a non-significant increase in 2021 (69.0%, p = 0.07). CONCLUSION: The COVID-19 pandemic generated clinical and epidemiological changes in the acute poisonings attended to in a hospital emergency department during the various phases of the pandemic.

[Acute poisoning among patients attended to in an emergency department: From the pre-pandemic period to the new normality]. / Intoxicaciones agudas atendidas en un servicio de urgencias. De la prepandemia a la nueva normalidad.

Background: The COVID-19 pandemic has caused global changes that affect the daily life of the world's population, with a direct impact on individuals' physical and mental health as well as on their social and recreational habits. Methods: This study aimed to retrospectively analyze the demographic and clinical characteristics of patients attended to for acute poisoning in a hospital emergency department (ED) at three different periods of time: pre-pandemic (2019), after strict lockdown of the population in Spain (2020), and post-pandemic (2021). We analyzed 2 months (June and July) in each period. Results: A total of 1,182 cases of acute poisoning were included. Compared to the pre-pandemic period, during lockdown, the number of patients with acute poisoning decreased (2019: 1.9% vs. 2020: 1.5%; p<.01); the ratio of men to women increased (2.0 vs. 1.4; p=.02); and the mean age of patients increased (2019: 31.4 vs. 2020: 41.3; p<.001), a trend which continued in 2021 (38.3). Poisoning with suicidal intention also increased during the pandemic (2019: 8.71% vs. 2020: 21.0%; p<.01) whereas poisonings with a recreational intention declined (2019: 76.1% vs. 2020: 62.0%; p<.01) with a non-significant increase in 2021 (69.0%, p=.07). Conclusion: The COVID-19 pandemic generated clinical and epidemiological changes in the acute poisonings attended to in a hospital emergency department during the various phases of the pandemic.

Intoxicaciones en la tercera edad / Poisoning among the elderly

Objetivos Las intoxicaciones siguen siendo un problema de salud pública importante. En el presente estudio evaluamos la epidemiología de las intoxicaciones en la tercera edad. Métodos Estudio de cohorte retrospectivo realizado entre 2011 y 2019 en un hospital universitario. Analizamos variables demográficas, tipo de tóxico involucrado, naturaleza suicida o accidental de la intoxicación y la probabilidad de ingreso o muerte en el hospital. Resultados Un total de 880 (6,1%) de las 14.300 intoxicaciones atendidas en el mismo período sucedieron en mayores de 65 años. El grupo más numeroso fueron individuos entre 65-69 años (39%), seguidos por el grupo de 70-75 años (20%), siendo varones el 57%. En el 88% de los casos participó un único tóxico, por orden de frecuencia alcohol (51,6%), fármacos (29,5%) y productos domésticos o industriales (12,8%). Las intoxicaciones por alcohol predominaron en hombres hasta los 75 años y por encima de esta edad predominó la intoxicación farmacológica o suicida, principalmente en mujeres. Ingresaron un total de 145 (16%) sujetos, siendo los fármacos más frecuentemente implicados digoxina y benzodiacepinas. La probabilidad de ingreso se asoció con la intoxicación por metformina, digoxina, litio o la edad del paciente (OR por año = 1,03; IC 95%: 1,0-1,06). Fallecieron 19 pacientes (2,16%), principalmente por ingestas cáusticas suicidas (OR = 5,7: IC 95%: 1,4-23,6) o por fármacos, relacionados directamente con la metformina (OR = 10,1; IC 95%: 2,4-42,4). Conclusiones La prevalencia de intoxicaciones en la tercera edad no es despreciable, y los médicos deben sospecharlas ante situaciones clínicas complejas (AU)

Objectives Poisonings continue to be an important public health problem. Herein, we analyzed the epidemiology of poisonings in elderly individuals. Methods Retrospective cohort study conducted between 2011 and 2019 in a university hospital. We analyzed demographic variables, type of poison involved, suicidal or accidental nature of the poisoning, and the probability of admission, or death to the hospital. Results A total of 880 (6.1%) of the 14,300 poisonings treated in the same period occurred in people over 65 years of age. The most numerous group were individuals between 65-69 years-old (39%), followed by the group of 70-75 years-old (20%), being men 57%. In 88% of the cases a single poison participated, being by frequency alcohol (51.6%), drugs (29.5%), and household or industrial products (12.8%). Alcohol intoxication predominated in men up to 75 years of age, and above this age drug or suicidal intoxication predominated, mainly in women. A total of 145 (16%) subjects were hospitalized, the drugs most frequently implicated being digoxin and benzodiazepines. The probability of hospital admission was associated with intoxication by metformin, digoxin, lithium or with the age of the patient (OR per year = 1.03; 95% CI: 1.0-1.06). A total of 19 patients died (2.16%), mainly due to suicidal caustic ingestion (OR = 5.7: 95% CI: 1.4-23.6) or by drugs, directly related to metformin (OR = 10.1; 95% CI: 2.4-42.4). Conclusions The prevalence of poisoning in the elderly is not negligible, and physicians should have a high index of suspicion in a complex situation (AU)

Poisoning among the elderly.

OBJECTIVES: Poisonings continue to be an important public health problem. Herein, we analyzed the epidemiology of poisonings in elderly individuals. METHODS: Retrospective cohort study conducted between 2011 and 2019 in a university hospital. We analyzed demographic variables, type of poison involved, suicidal or accidental nature of the poisoning, and the probability of admission, or death to the hospital. RESULTS: A total of 880 (6.1%) of the 14,300 poisonings treated in the same period occurred in people over 65 years of age. The most numerous group were individuals between 65-69 years-old (39%), followed by the group of 70-75 years-old (20%), being men 57%. In 88% of the cases a single poison participated, being by frequency alcohol (51.6%), drugs (29.5%), and household or industrial products (12.8%). Alcohol intoxication predominated in men up to 75 years of age, and above this age drug or suicidal intoxication predominated, mainly in women. A total of 145 (16%) subjects were hospitalized, the drugs most frequently implicated being digoxin and benzodiazepines. The probability of hospital admission was associated with intoxication by metformin, digoxin, lithium or with the age of the patient (OR per year = 1.03; 95% CI: 1.0-1.06). A total of 19 patients died (2.16%), mainly due to suicidal caustic ingestion (OR = 5.7: 95% CI: 1.4-23.6) or by drugs, directly related to metformin (OR = 10.1; 95% CI: 2.4-42.4). CONCLUSIONS: The prevalence of poisoning in the elderly is not negligible, and physicians should have a high index of suspicion in a complex situation.

Poisoning among the elderly. / Intoxicaciones en la tercera edad.

OBJECTIVES: Poisonings continue to be an important public health problem. Herein, we analyzed the epidemiology of poisonings in elderly individuals. METHODS: Retrospective cohort study conducted between 2011 and 2019 in a university hospital. We analyzed demographic variables, type of poison involved, suicidal or accidental nature of the poisoning, and the probability of admission, or death to the hospital. RESULTS: A total of 880 (6.1%) of the 14,300 poisonings treated in the same period occurred in people over 65 years of age. The most numerous group were individuals between 65-69 years-old (39%), followed by the group of 70-75 years-old (20%), being men 57%. In 88% of the cases a single poison participated, being by frequency alcohol (51.6%), drugs (29.5%), and household or industrial products (12.8%). Alcohol intoxication predominated in men up to 75 years of age, and above this age drug or suicidal intoxication predominated, mainly in women. A total of 145 (16%) subjects were hospitalized, the drugs most frequently implicated being digoxin and benzodiazepines. The probability of hospital admission was associated with intoxication by metformin, digoxin, lithium or with the age of the patient (OR per year = 1.03; 95% CI: 1.0-1.06). A total of 19 patients died (2.16%), mainly due to suicidal caustic ingestion (OR = 5.7: 95% CI: 1.4-23.6) or by drugs, directly related to metformin (OR = 10.1; 95% CI: 2.4-42.4). CONCLUSIONS: The prevalence of poisoning in the elderly is not negligible, and physicians should have a high index of suspicion in a complex situation.

Adecuación de los botiquines de antídotos de los servicios de farmacia en hospitales públicos de la comunidad autónoma de Les Illes Balears / Adequacy of poisoning antidote stocks in the pharmacies of public health service hospitals in the Spanish autonomous community of the Balearic Islands

Objetivo: Analizar la adecuación del botiquín de antídotos en los servicios de farmacia de los hospitales de la red pública de la comunidad autónoma de Les Illes Balears. Método: Estudio descriptivo y transversal que revisa la composición del botiquín de antídotos y otros fármacos para el tratamiento de intoxicaciones agudas disponible en los servicios de farmacia de los diversos hospitales públicos de la Comunidad Autónoma, mediante cumplimentación de un formulario específico por un responsable de cada centro. Los resultados obtenidos se compararon con las recomendaciones CALITOX-2006 y las recomendaciones Antidote Stocking Guidelines (ASG-2009), se analizó la disponibilidad, cantidad y ubicación. Resultados: En los 7 hospitales, la disponibilidad supera el 85% según CALITOX y el68% según ASG. Las carencias principales fueron el sulfato sódico, la apomorfina, la cianida kit oral y el suero anticrotálide. La adecuación cuantitativa media es del 83%, y lapiridoxina es el que más veces está infradotado. Hay un exceso de carbón activado y de N-acetilcisteína. Se detectó una infradotación de glucagón y de fomepizol en el hospital de referencia. Los criterios de ubicación en el servicio de urgencias se siguieron en más del 80% (hospital de nivel I), 68% (hospital de nivel II) y 94% (hospital de referencia).Conclusiones: El grado de cumplimiento de las recomendaciones consultadas en cuanto a composición, accesibilidad y dotación del botiquín de antídotos y otros fármacos para el tratamiento de intoxicaciones agudas en los hospitales públicos de Les Illes Balears es alto, con una distribución en cada una de las islas segura para garantizar su disponibilidad. La situación geográfica del hospital y su proximidad al centro de referencia más dotado de antídotos predominan sobre el grado de complejidad del hospital en los de nivel 2

Objective: To analyze whether pharmacies in public health service hospitals in the Spanish autonomous community of the Balearic Islands are stocking sufficient amounts of poison antidotes. Methods: Descriptive cross-sectional study of public hospital pharmacy stocks of antidotes and other medicines for treating acute poisoning. The head of each hospital pharmacy completed a questionnaire about stocks. The results on which antidotes were in stock, the amounts, and the storage locations were assessed for compliance with recommended quality indicators for emergency care in acute poisonings (CALITOX-2006) and the Antidote Stocking Guidelines (ASG-2009).Results: The 7 hospitals met the CALITOX-2006 availability criteria for over 85% of items and the ASG-2009 criteria for68%. Inadequate stocking mainly involved sodium sulfate, apomorphine, oral cyanide antidote kits, and crotaline snake antivenom. An average of 83% of the stocks were adequate; pyridoxine was the substance most often found to be understocked. Activated charcoal and N-acetylcysteine were the items most often overstocked. Glucagon and fomepizole were understocked in the referral hospital. Over 80% of items were stored in appropriate ocations in the emergency departments of level 1 hospitals (68% in level 2 hospitals; 94% in the referral hospital). Conclusions: Public health system hospitals are highly compliant with recommendations on stocking antidotes and other medicines to treat acute poisoning (what to stock, where, and in what amounts); the distribution of stocks safely guarantees they will be available when needed. Among level 2 hospitals, a facility's location (proximity to the best-equipped referral hospital for poisonings) had greater influence on compliance than the hospital's level of complexity

Encuesta a urgenciólogos sobre el papel del laboratorio en el manejo de las intoxicaciones agudas / Role of laboratory tests in managing acute poisonings: a survey of emergency physicians

Objetivo: Evaluar mediante una encuesta la percepción que los facultativos que atienden a pacientes intoxicados agudos tienen sobre el papel del laboratorio y conocer la importancia subjetiva que otorgan a determinadas pruebas para realizar el manejo clínico de las intoxicaciones agudas frecuentes. Método: La encuesta se dirigió a urgenciólogos que trabajan en servicios de urgencias(SU) de dos hospitales con Unidades de Toxicología Clínica (UTC) y médicos asistentes a cursos de formación toxicológica. Se solicitaba: datos profesionales, grado de importancia atribuida a las pruebas del laboratorio para las diferentes etapas asistenciales, un máximo de tres pruebas fundamentales para el cuidado de 17 intoxicaciones agudas e indicar una determinación de analítica básica y que no se realizase en su laboratorio. Resultados: Ochenta y ocho encuestas se consideraron válidas, de las cuales 69 (78%)se recogieron en cursos y 19 (22%) en 2 SU. La etapa asistencial a la cual los facultativos encuestados otorgan una mayor importancia al laboratorio es la etapa diagnóstica, independientemente del grupo al que pertenecen (62% si pertenecen a SU y 58% si asistieron a cursos). El papel del laboratorio es más relevante (p < 0,05) para aquellos médicos encuestados que trabajan en SU de los hospitales con UTC (52%) que para los (..) (AU)

Objective: To survey physicians who treat acute poisoning cases to determine their attitudes toward laboratory testing in these cases and also toward certain tests for the management of common poisonings. Methods: A questionnaire was sent to physicians working in the emergency departments of 2 hospitals with toxicology units and to physicians attending toxicology training courses. Survey items asked about professional data; the degree of importance the physicians attached to laboratory testing at different stages in the care process; which 3 tests the respondents considered important in 17 different acute poisoning scenarios; and which laboratory test they considered highly important was unavailable at the hospitals where the physicians worked. Results: Eighty-eight valid questionnaires were returned; 69 of them (78%) were from physicians attending toxicology courses and 19 (22%) were from emergency room physicians. The respondents in both groups believed that laboratory tests were most important when cases of acute poisoning were being diagnosed; 62% of the emergency department physicians and 58% of the trainee physicians expressed that opinion. More emergency department physicians at(..)(AU)

Actuación de enfermería en las intoxicaciones porcardiotóxicos en un servicio de urgencias hospitalario / Cardiotoxin poisoning: analysis of nursing care in a hospital emergency department

Objetivo: Analizar la actuación de enfermería del servicio de urgencias en la asistenciaa los pacientes intoxicados por sustancias cardiotóxicas. Método: Estudio retrospectivo de pacientes atendidos por intoxicación con agentes cardiotóxicos en un hospital universitario de tercer nivel durante un año (2008), que utilizó como instrumento de medida los indicadores de calidad para la asistencia urgente de pacientes con intoxicaciones agudas definidos en el estudio CALITOX (2006).Resultados: Tras el análisis de 216 intoxicados, de los cuales 107 lo fueron por cocaína, se observa un escaso cumplimiento de algunos registros asistenciales fundamentales. Así, el registro del conjunto mínimo de datos completo sólo estaba en el 16%, elintervalo asistencial se especificó en el 32% y se realizó electrocardiograma en el 79%. Conclusiones: La participación activa de enfermería como miembros de una unidad de toxicología permite el análisis interno de la actividad realizada, así como la detección y priorización de los aspectos susceptibles de mejorar (AU)

Objective: To analyze the nursing care of patients seeking hospital emergency care for poisoning due to cardiotoxins. Methods: Retrospective study of cases of poisoning with cardiotoxins treated in a tertiary hospital emergency department in 2008. We used quality indicators to assess care given to patients with acute intoxication (Calitox-2006).Results: After analyzing 216 cases of poisoning, 107 of which involved cocaine, we observed lack of compliance with the recording of certain basic clinical data: correct recording of vital constants, 16%; specification of time between arrival and start of care, 32%; electrocardiogram, 79%. Conclusions: The active participation of nurses in a toxicology unit allowed our department to analyze the careprovided, detect short comings, and set priorities with regard to aspects that need to be improved (AU)

Valoración del riesgo de hepatotoxicidad en la intoxicación aguda por paracetamol cuando no es posible aplicar el nomograma de Rumack-Matthew / Assessing risk of liver toxicity in acute paracetamol intoxication when basing treatment on a Rumack-Matthew toxicity nomogram is not feasible

El nomograma de Rumack se utiliza para indicar el tratamiento antidótico con N-acetil-cisteína(NAC) en la intoxicación por paracetamol (PCT), pero tiene varias limitaciones de uso.La semivida de eliminación (t1/2) del PCT se incrementa a más de cuatro horas en caso de hepatotoxicidad. El objetivo de este trabajo es describir las características de los pacientes intoxicados por PCT de una serie en los que la aplicación del nomograma de Rumack nunca fuera posible y valorar su riesgo de hepatotoxicidad a través de la estimación de la t1/2.Se incluyeron los pacientes con una sobredosificación o intoxicación por PCT que acudieronal Hospital de Son Dureta de Palma de Mallorca y al Hospital Clínic de Barcelona durante un periodo de 5 años (julio 2005-julio 2010) en los que se dispusiera de al menos 2 determinaciones de PCT. La estimación de la t1/2 se realizó mediante un cociente entre dos determinaciones consecutivas separadas por un intervalo de tiempo de 2 o más horas. De 11 pacientes intoxicados por PCT a los que no se les pudo aplicar el nomograma de Rumack, tres desarrollaron hepatotoxicidad, dos de ellos fueron intoxicaciones accidentales producidas por ingesta fraccionada del fármaco y el tercero una intoxicación con intencionalidad suicida. En todos ellos la estimación del cálculo de la t1/2 puso de manifiesto que era superior a 4 horas. Proponemos que se complemente al nomograma de Rumack con la estimación de la t1/2 en los casos de intoxicación por PCT, y que esta estimación de la t1/2 sea la que aporte la información sobre la posible hepatotoxicidad de la intoxicación. Esto debe hacerse al menos en los casos en que existan dudas o se desconozca el tiempo transcurrido de la ingesta, o la misma haya sido fraccionada (AU)

The Rumack-Matthew nomogram is used to guide treatment with N-acetylcysteine (NAC) as an antidote for paracetamolintoxication, but this approach has limitations. The elimination half-life of paracetamol increases to over 4 hours in the presence of hepatic toxicity. The aim of this study is to describe the characteristics of a series of cases of paracetamol toxicity in which anomogram could not be used; the patient’s risk was assessed by means of the elimination half-life. Patients with paracetamolintoxication from a single or cumulative overdose who came to Hospital de Son Dureta de Palma de Mallorca and Hospital Clínic de Barcelona over a 5-year period (July 2005-July 2010) were included if the findings of at least 2 immunoas says for paracetamol concentration were available. Half-life was estimated by means of the ratio between 2 consecutive concentrations determined 2 hours apart. Of 11 patients with paracetamol intoxication for whom a Rumack-Matthew nomogram was not used, 3 had liver toxicity. Two of them were accidental intoxications caused by ingesting several doses of the drug. The third was an attempted suicide. In all cases, the elimination half-life exceeded 4 hours. We suggest that in cases of paracetamol intoxication the Rumack-Matthew nomogram be complemented by calculation of the elimination half-life, which will provide an indication of possible liver toxicity in these patients. This approach should be chosen at least when there are doubts about when paracetamol ingestion occurred or if intoxication is the result of several doses (AU)

Medida de la calidad asistencial que se ofrece a los pacientes con intoxicaciones agudas en el Servicio de Urgencias / Measurement of the quality of medical care of patients with acute poisoning in the Emergency Department

Objetivo: Medir la calidad asistencial ofrecida en el Servicio de Urgencias (SU) a los pacientes intoxicados, mediante un mapa de indicadores. Método: Se diseñan 25 indicadores de calidad (6 estructurales, 15 funcionales y 4 administrativos), definiendo unos estándares mínimos. Se evalúa la asistencia que reciben los intoxicados atendidos durante un mes, utilizando los mencionados indicadores, y analizando los informes asistenciales, médico y de enfermería, y los documentos administrativos del paciente. Resultados: Se han valorado 139 intoxicados. Se disponía del protocolo terapéutico, de los antídotos necesarios y de sondas gástricas adecuadas en el 100% de los casos. La analítica toxicológica cualitativa estaba disponible en el 89% y la cuantitativa en el 49%. El tiempo transcurrido entre la llegada al SU y la atención al paciente fue inferior a 15 min en el 78% de casos. El intervalo entre la llegada al SU y el inicio de la descontaminación digestiva fue inferior a 15 min en el 57% de casos. La aplicación adecuada de los diversos algoritmos de valoración clínica, diagnóstico y tratamiento osciló entre un 50 y un 95%. Los registros de presión arterial, frecuencia cardiaca, respiratoria y temperatura constaban entre un 35 y un 81% de los pacientes. El parte judicial se realizó en el 31% de los casos y la interconsulta con el psiquiatra en todos los intentos de suicidio. La mortalidad fue del 0%. Conclusiones: El SU ofrece a los intoxicados una calidad asistencial satisfactoria en aspectos estructurales (protocolos y técnicas analíticas), debe mejorarse a nivel funcional (aplicación de técnicas y tiempos de atención) y muestra deficiencias en los aspectos administrativos (AU)

Objective: To measure the quality of medical care of patients with acute poisoning in the Emergency Department (ED) using a series of indicators. Method: 25 indicators of quality were designed (6 structural, 15 functional and 4 administrative) to define minimum standards. The care received by patients with poisonings was evaluated for one month using the study indicators and relevant hospital, medical and nursing and administrative records. Results: 139 patients were evaluated. A therapeutic protocol, the necessary antidotes and adequate gastric tubes were available in 100% of the cases. Qualitative toxicological tests were available in 89% of cases and quantitative tests in 49%. The time from arrival at the ED to the first medical care was less than 15 minutes in 78% of cases. The time from arrival at the ED to commencement of digestive decontamination was less than 15 minutes in 57% of cases. The adequate use of various algorithms for clinical assessment, diagnosis and treatment ranged between 50 and 95%. Records of blood pressure, cardiac and respiratory frequency and temperature were available in between 35 and 81% of patients. A legal report was made in 31% of cases and psychiatric services were consulted in all cases of attempted suicide. Mortality was 0%. Conclusions: Emergency departments offer satisfactory medical care to patients with acute poisoning with respect to structural aspects (protocols and analytical tests), although improvements could be made at the functional level (application of techniques and rapidity of medical care). Some defects were found in administrative aspects of the process (AU)