Discussion
A large variation in poisoning agents was observed in the review of patient records from the emergency department in Trondheim, and almost half of the cases involved combined drug intoxication. As in other comparable studies, the use of ethanol was most common in intoxications, followed by benzodiazepines. Our findings showed higher proportions of ethanol, benzodiazepine and opioid intoxication than a study from Oslo with data from 2008–09 (2), while GHB cases made up a smaller proportion. The proportion of paracetamol intoxications was similar in both studies, but our study showed a higher proportion of opioid intoxication than paracetamol intoxication (1–3). The A&E clinic in Oslo deals with a large number of intoxications, especially substance-related intoxications, which are referred to hospitals elsewhere in the country (9). This may explain the differences compared to our study.
The age and gender distribution in our study was comparable to previous findings (2), and there were apparent gender disparities in the use of substances and medications. Intoxication with ethanol, opioids, amphetamine/methamphetamine and GHB was more common among men, while women were more likely to use benzodiazepines and medication, which is consistent with previous findings (2, 3).
The Oslo study reported a higher usage of antidotes, charcoal and gastric lavage. The proportion of patients who underwent haemodialysis in our study was similar to that in Oslo, but fewer of our patients required intensive care (2). Previous studies have reported mortality rates of 0.5–1.1 % (1, 2, 5), while in our study, no deaths occurred during the hospital stay.
The study is a retrospective review of activity data, based on cases identified as acute intoxication in an emergency department and registered in Akuttdatabasen. This allowed us to examine a large number of real patient events over a two-year period. Combined with a manual review of patient records, this provided a comprehensive and broad insight into cases and the patient population. Events that were not identified or registered in the emergency department for various reasons are not included in the study. Although the number of such events is assumed to be low, their exclusion could be obscuring systematic weaknesses in the source data. Patients receiving care from the ambulance service, a primary care overdose team, an A&E clinic or other external entity were also excluded. Although we assume that the most critically ill patients are sent to the emergency department, we do not know the composition of the rest of the population. The results are based on a manual review and interpretation of patient records in which the quality of documentation varied. Data from 2020 were impacted by the COVID-19 pandemic. We were unable to determine whether this had an effect on the incidence of acute intoxication or the treatment of these in the health service.