Pattern of poisoning cases at a tertiary health care centre – a cross sectional study

Abstract

BACKGROUND AND OBJECTIVES :- It is estimated that some type of poison, directly or indirectly are responsible for more than 3 million cases worldwide annually, with India being among the highest contributor for these cases, reporting more than 50,000 deaths every year from toxic exposure. But it is sad to say that all these figures are just like the tip of the iceberg, since most of the cases are unreported. Thus affecting the statistics at the central level, which is very important to form management plans and chart out preventive strategies. Going through all these facts and figures, the present study is done to study the various patterns of poisoning cases coming to the tertiary centre, which includes – commonest type of poison, age and sex distribution, effect of occupation and literacy rate, seasonal variations, distribution of poisoning cases with respect to manner and mode of poisoning, to find the triggering factor leading to poisoning and to find out the mortality rate due to poisoning in relation to age, sex, type of poison and overall. Study also helps to find out the burden of poisoning cases at our centre, thus contributing to formation of statistics at the central level, which will help to formulate prompt management protocols and preventive strategies. • MATERIALS AND METHODS This study is a cross sectional study, conducted at KLES’s Dr Prabhakar Kore Hospital and MRC, attached with autopsy block, Belagavi, for a period of one year from January 1, 2014 to December 31, 2014. Data was collected from patients of poisoning cases visiting casualty/wards, Poison Detection Centre reports, their medical records, laboratory reports, autopsy reports and Regional Forensic Science Laboratory reports in fatal cases, by universal sampling method. Informed and written consent was obtained and a preformed, pretested proforma was used to collect the required information. • RESULTS A total of 306 poisoning cases came to the tertiary centre during the study period, out of which, 35 cases (11.4%) expired. Maximum number of cases and deaths involved pesticide poisoning – 150 cases (49%) and 20 deaths (57.2%) respectively followed by poisoning due to animal bites – 73 cases (23.9%) and 5 deaths (14.2%). Maximum number of cases and deaths were seen in the age group between 21 - 30 years, 117 cases (38.2 %) and 11 deaths (31.4 %) respectively. Maximum number of cases and deaths involved males, 184 cases (60.1%) and 22 deaths (62.9%) respectively. Male : female ratio being 1.51 : 1 for total cases and 1.69 : 1 for total deaths. Maximum cases were seen in the month of June (11.8%) and maximum deaths in January and October (14.2% each). Maximum cases and deaths were seen in winter season 34.6% and 48.6% respectively. Most of the cases and deaths were suicidal - 67.1% and 80% respectively with maximum cases related to alleged family problems - 34.1% leading to poisoning. Most common mode of poisoning was oral - 74.2% cases and 82.9% deaths. Majority of the cases and deaths were literates - 53.3%. Majority of cases were farmers - 24.8%. 68.6% of cases were referred to tertiary centre out of which 10.5% cases expired. 59.8% of cases came to the tertiary centre within 5 hours of poisoning incident. Mortality was high in cases coming within 5 hours - 19.3%, followed by cases coming after 10 hours of incident – 17.3%. Majority of cases belonged to grade 1 (36.3%) of Poison Severity Score followed by Grade 2 – 33%. • CONCLUSION The study clearly shows pesticides are the most common means of poisoning owing to the fact that pesticides are easily available and can cause severe morbidity, leading to deaths. The most saddening fact is that most of the cases involve literate group of people, in the age group between 21 – 30 years, it’s the youth who are committing large number of suicides due to various triggering factors. This shows that poisoning is more of a mental issue to manage and preventive strategies should be formulated accordingly. The long standing problems of farmers still continues, as they continue to commit suicide due to financial problems and weather problems, which is a tough burden to resolve and requires combined efforts from the government and doctors to reduce this burden. Accidental cases in fields due to animal and insect bites are also increasing due to improper protective measures and lack of proper knowledge which has to be curbed. Industrial poisoning incidents are low compared to other causes. Homicidal cases are rare with only two cases being reported in the whole year. The study also shows that many cases are being referred from other smaller health centers and hospitals, which are leading to delays in early diagnosis and adequate management. With the introduction of poison detection centre it is helpful to diagnose the poison early and give proper care. Such centers should be increased so that proper care is given over a larger area and delays are reduced