120 Acute intoxications: Differences in management between six Dutch hospitals CAROLINE DUINEVELD 1 , MAURICE VROEGOP 2 , LORI SCHOUREN 1 , ASTRID HOEDEMAEKERS 3 , JEROEN SCHOUTEN 4 , MARGRIET MORET-HARTMAN 5 & CORNELIS KRAMERS 1 1 Radboud University Nijmegen Medical Centre, Pharmacology and Toxicology, PO Box 9101, Nijmegen, Netherlands 2 Radboud University Nijmegen Medical Centre, Emergency Medicine, Nijmegen, Netherlands 3 Radboud University Nijmegen Medical Centre, Intensive Care Medicine, Nijmegen, Netherlands 4 Canisius Wilhemina Ziekenhuis, Intensive Care Medicine, Nijmegen, Netherlands 5 Radboud University Nijmegen Medical Centre, Epidemiology and Biostatistics, Nijmegen, Netherlands Abstract Context. Acute intoxications are frequently seen in Dutch hospitals. Based on single-centre studies and the fact that there are no clear guidelines, we hypothesised that hospital admission of acute intoxications may vary. Furthermore, decontamination treatment of poisonings may differ between hospitals, as earlier studies showed that adherence to international guidelines concerning decontamination may be poor. Objective. We aim to identify possible variations in Dutch hospital admission and decontamination treatment of patients with acute intoxications. Materials and methods. Data on acute intoxications was retrospectively collected from patient records from the emergency departments of six Dutch hospitals. All patients older than 14 years who presented between 1 January 2008 and 31 December 2008 were included in the study. Results. The percentage of suicide attempts differed signiicantly between the hospitals (25–73%, p  0.0001) as equally the percentage of intoxications with drugs of abuse (18–61%, p  0.0001). Marked differences in admission rates were found (27– 78%, p  0.0001) and these differences remained even when intoxications because of suicide attempts and drugs of abuse were analysed separately (admission rate of 52–87%, p  0.0001 and 8–71%, p  0.0001 respectively). Reported consultation with the National Poisons Information Centre differed between hospitals (range 0% to 80–100%). No statistical differences were found between hospitals for the use of activated charcoal (16.1–42.5%, p = 0.037). Gastric lavage was used infrequently in all hospitals. (6.6–16.7%, p = 0.614). Discussion and conclusion. The admission rate of patients with an acute intoxication varies considerably, especially in the case of intoxications with drugs of abuse. Consultations with the National Poisons Information Centre differed between the six hospitals. Rates of decontamination did not vary, which may indicate adherence to guidelines by the American Academy of Clinical Toxicology, European Association of Poisons Centres and Clinical Toxicologists. National guidelines or admission algorithms may reduce variations in poisoning management and make the care for these patients more eficient. Keywords CNS; Psychological; Other poisoning Introduction Acute intoxications pose a major healthcare problem in many countries. 1–6 In the Netherlands around 11 000 patients with an intentional intoxication are seen each year in accident and emergency departments. 7 Acute poisoning cause substantial workload and hospital costs. 8,9 Multiple drugs are frequently ingested and the patients’ reports of used substances are not reliable. 10–12 This makes adverse effects of poisonings difi- cult to predict. Due to the lack of admission guidelines, hos- pital admission rates are high and vary considerably between hospitals as shown by previous multi-centre research from the United Kingdom. This variability in hospital admission could not be explained by a disparity in population. 13,14 No similar study has been performed in the Netherlands, although single-centre studies suggest that admission policy may be just as variable. 15,16 Admission policy of intoxica- tions due to drugs of abuse (DOA) may also vary between Dutch hospitals; to our knowledge, no literature on this sub- ject has been published. Variable admission policy may indicate that the care for poisoned patients is suboptimal or ineficient. As many patients do not require medical treatment on the wards, 6,17 medical admission might be considered unnecessary. 16,17 To reduce the workload and high hospital costs caused by acute poisonings, 8 attempts have been made to identify clini- cal parameters which can help predict the need for medi- cal treatment and thus admission. 16,17 Both Meulendijks et al. and Ambrosius et al. have provided a set of criteria that Clinical Toxicology (2012), 50, 120–128 Copyright © 2012 Informa Healthcare USA, Inc. ISSN: 1556-3650 print / 1556-9519 online DOI: 10.3109/15563650.2011.649092 CRITICAL CARE Received 8 September 2011; accepted 8 December 2011. Address correspondence to Caroline Duineveld, Radboud University Nijmegen Medical Centre, Pharmacology and Toxicology, PO Box 9101, 6525 EZ Nijmegen, Netherlands. E-mail: c.duineveld@ic.umcn.nl Clinical Toxicology Downloaded from informahealthcare.com by Radboud Universiteit Nijmegen on 09/02/12 For personal use only.