Poisoning is a unique driver of healthcare utilization among patients receiving care at the emergency department (ED) in Singapore. The Singhealth Toxicology Service offers insights in the management of this cohort, helping to prevent harm and improve resource allocation.
“Poisoned patients constitute a unique part of our patient cohort, with characteristic presentations and prognoses which can be improved with early recognition and institution of appropriate measures,” according to the authors, led by Dr Kaibin Kelvin Kuan, Accident and Emergency, Changi General Hospital, Singapore, Singapore.
Kuan and colleagues conducted this retrospective audit review of consultation records of all patients referred to the Singhealth Cluster Toxicology Service. They examined patient data on demographics, exposure patterns, clinical presentation, interventions received, and outcome.
A review was also conducted on information regarding resource use (eg, length of stay, critical care utilization), as well as on critical poisoning cases, cases placed on extracorporeal membrane, oxygenation, and fatalities.
A total of 911 records were included in the analysis, with 509 hospital admissions. Of these, 153 required care in the high dependency (HD)/intensive care unit (ICU), with a median length of stay of 3 and 5 days, respectively. Nine patients died, of whom three were due to poisoning. [Proc Singap Healthc 2026;doi:10.1177/20101058261424020]
Most poisoned patients were referred from the ED (87.2 percent), male (50.7 percent), and in the 20‒29 age group (29.9 percent). The majority were self-referred (84.3 percent) for oral ingestion (81.7 percent) of analgesics (20.4 percent), followed by sedatives (19.2 percent) and antidepressants (9.1 percent). About two in three individuals attended for intentional and deliberate self-harm (69.9 percent).
“Most patients were intentional poisonings, mostly due to deliberate self-harm and drug abuse, highlighting a problem for which harm prevention (improved psychiatric care, less toxic psychiatric medications, and more extensive support programs for abuse) can help to tackle,” the authors said.
“The epidemiology in our study is similar to other developed countries,” they added. [Clin Toxicol 2022;60:1381-1643]
The most common class of medications involved in poisoning (ie, analgesics, sedatives, and antidepressants) was also comparable to that observed in previous studies. The rates of nervous, gastrointestinal, and cardiovascular symptoms were, likewise, similar. [Proc Singap Healthc 2018;doi:10.1177/2010105818758783]
After office hours
The majority of calls were made after office hours (62.3 percent), during which senior staffing in hospitals was reduced.
“This illustrates how a 24-h toxicology phone consult service is a valuable resource for the management of poisoned patients, who often require prompt assessment and prognostication, experienced management from senior healthcare staff, expedient treatment including antidote use and employment of hospital resources to provide supportive care and extracorporeal toxin removal,” the authors said.
Notably, the use of antidotes, decontamination, and enhanced elimination was not common. Clinicians appeared unfamiliar with their use. About one in five patients (16.4 percent) required high acuity care and needed more interventions, according to Kuan and colleagues.
In previous studies, toxicology service was found to be of significant help for inpatient management. [Emerg Med Australasia 2017;29:310-314; J Toxicol Environ Health A 2007;70:107-110; Clin Toxicol 2014;52:198-206; Br J Clinical Pharmacol 2019;85:11-19; Hong Kong J Emerg Med 2007;14:134-143]
“The toxicology service can also serve a surveillance function for occupational health issues, medication error, drug abuse patterns, and poisonings from malicious/deliberate intent with risk to public health,” the authors said. “The service could work closely with stakeholders to introduce measures to improve medication safety and better protect workers and the public.”