A 5-year follow-up study of 253 patients discharged after self-poisoning is presented. Repeated acts of self-poisoning occurred mainly in the first year after discharge; 20% and 22% of female and male patients, respectively. This number is a minimum, the migration frequency being high. Very few patients responded to a letter asking them for a follow-up interview, only 56% and 42% of female and male patients, respectively. Five years after discharge 18% of male patients and 11% of female patients had died. The 5-year mortality rate was 73 times the expected value for male patients and 109 times the expected value for female patients.
1 In a prospective study of patients hospitalized for deliberate self-poisoning between 1978 and 1987 the number of admissions increased from 303 to 425. The annual incidence increased significantly for both women (P < 0.05) and men (P < 0.01). The mean age decreased significantly in the male group (P < 0.05), but increased in the female group (P < 0.05). 2 The median latency time for patients presenting at the hospital was short; 3.7 h in 1978 and 2.9 h in 1987. 3 There was a significant reduction in the percentage using barbiturates (9% in 1978 and 1% in 1987; P < 0.001) and the use of benzodiazepines increased (18% in 1978 and 32% in 1987; P < 0.05). The percentage of unconscious patients did not change significantly. 4 In 1987 N-acetyl-cysteine was the most frequently used antidote. Physostigmine has almost been abandoned since 1978. 5 Significantly more patients were hypotensive in 1978: 24% vs 11% in 1987; (P < 0.001) and significantly less patients needed treatment in the central intensive care unit (2% in 1987 and 5% in 1978; P < 0.05). Complications were few (8-10%) and the mortality low (approximately 1%) in both years studied. 6 The mean duration of hospitalization in 1978 was 65 h vs 30 h in 1987, (P < 0.001).
1. In a prospective, unselective study of self-poisoned patients in 1978 and 1987 blood samples for drug analyses were drawn on admission in 265 and 400 cases, respectively. 2. The results from the drug analyses were compared with the clinical information obtained on admission. The main drug taken was identified on admission in 228 (86%) in 1978 and in 383 cases (96%) in 1987 (P < 0.001). 3. The clinical impression was completely in accordance with the results from the drug analyses in 192 cases (72%) in 1978 and 232 cases (58%) cases in 1987 (P < 0.001). The discrepancies mainly involved secondary drugs. 4. There was no significant difference in the clinical course of the poisonings in situations where the correct main drug was identified on admission and where the wrong main drug was suspected. 5. Knowledge of the correct drugs used when admitted would not have prevented complications or deaths. 6. We conclude that extensive pharmacological drug analyses play a limited role in the routine management of patients admitted for deliberate self-poisoning.
Our experience with this postoperative epidural analgesia regime is favourable. It has been easy to administer and monitor. Pain relief was excellent, side-effects were few and picked up by the established routines followed by the ward staff except in the 2 trauma patients who developed epidural abscesses. The staff on the surgical wards were motivated for this kind of work. Education and strict surveillance routines are mandatory in order to secure prompt action when warning signs develops (e.g. lower limb paralysis).
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