Changes in Diagnosis of Poisoning in Patients in the Emergency Room Using Systematic Toxicological Analysis with the National Forensic Service

Lee, Je Seop; Sung, Yong; Yeon, Seonghoon; Kim, Tae Youn; Lee, Yoon-Suk; Choi, Jin Geul; Cha, Kyoung‐Chul; Lee, Kang Hyun; Kim, Hyun

doi:10.3346/jkms.2021.36.e118

Cited by 8 publications

(12 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[14][15][16][17] Furthermore, patients with acute poisoning may present uncooperative and aggressive behavior, disturbance of consciousness, intoxication with alcohol, or suffering from mental illness. [6,18,19] The identification and treatment of poisoned people can be extremely difficult in the absence of clinical experience. [6,[20][21][22] Regional poison centers have been set up in a number of nations to address this problem and provide poisoned patients with expert care.…”

Section: Discussionmentioning

confidence: 99%

“…[4] Due to the wide range and similarities of clinical manifestations among patients affected by poisoning, a thorough history of exposure, whether provided by the patient or by others (including relatives, friends, healthcare workers, or other bystanders), is an essential part of the diagnostic process for poisoning. [5][6][7] Nonetheless, clinicians may encounter challenges in obtaining precise exposure histories from certain patients. [6][7][8] There are no epidemiological data on these patients in China; however, a study in South Korea found that 21.7% (97/446) of patients visited the ED for unknown poisoning.…”

Section: Introductionmentioning

confidence: 99%

“…[5][6][7] Nonetheless, clinicians may encounter challenges in obtaining precise exposure histories from certain patients. [6][7][8] There are no epidemiological data on these patients in China; however, a study in South Korea found that 21.7% (97/446) of patients visited the ED for unknown poisoning. [6] Toxicological analysis plays a crucial role in diagnosis and treatment, particularly in patients with suspected poisoning and uncertain exposure history.…”

Section: Introductionmentioning

confidence: 99%

“…[6][7][8] There are no epidemiological data on these patients in China; however, a study in South Korea found that 21.7% (97/446) of patients visited the ED for unknown poisoning. [6] Toxicological analysis plays a crucial role in diagnosis and treatment, particularly in patients with suspected poisoning and uncertain exposure history. [6,[9][10][11] Nevertheless, the utilization of toxicological analysis in clinical practice remains uncommon due to a number of issues, including the high expense of testing, the difficulty of accessing testing facilities, the length of time required for the testing procedure, and the low number of samples that are submitted for analysis.…”

Section: Introductionmentioning

confidence: 99%

“…[6] Toxicological analysis plays a crucial role in diagnosis and treatment, particularly in patients with suspected poisoning and uncertain exposure history. [6,[9][10][11] Nevertheless, the utilization of toxicological analysis in clinical practice remains uncommon due to a number of issues, including the high expense of testing, the difficulty of accessing testing facilities, the length of time required for the testing procedure, and the low number of samples that are submitted for analysis. [10,11] At present, establishing a dedicated toxicological analysis laboratory in each hospital is not feasible.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

The value of toxicological analysis in acute poisoning patients with uncertain exposure histories: a retrospective and descriptive study from an institute of poisoning

Shi,

Ba,

Xia

et al. 2024

World Journal of Emergency Medicine

View full text Add to dashboard Cite

BACKGROUND:In clinical practice, some patients might not be able or unwilling to provide a thorough history of medication and poison exposure. The aim of this study was to use toxicological analysis to examine the clinical characteristics of patients with acute poisoning whose exposure history was uncertain from a toxicological analysis perspective.METHODS: This was a retrospective and descriptive study from an institute of poisoning. Patient registration information and test reports spanning the period from April 1, 2020 to March 31, 2022, were obtained. Patients with uncertain exposure histories and who underwent toxicological analysis were included. Clinical manifestations and categories of toxics were analyzed.RESULTS: Among the 195 patients with positive toxicological analysis results, the main causes of uncertain exposure history was disturbance of consciousness (62.6%), unawareness (23.6%) and unwillingness or lack of cooperation (13.8%). The predominant clinical manifestations were disturbed consciousness (62.6%), followed by vomiting and nausea (14.4%) and liver function abnormalities (8.7%). A comparison of clinical manifestations between patients with positive and negative (n=99) toxicological analyses results revealed significantly different proportions of disturbances in consciousness (63% vs. 21%), dizziness (1.5% vs. 5.1%), multi-organ failure (1.5% vs. 7.1%), and local pain (0 vs 4%). The main categories of substances involved were psychiatric medications (23.1%), sedatives (20.5%), insecticides (13.8%), and herbicides (12.8%). CONCLUSION:The clinical manifestations of acute poisoning in patients with an uncertain exposure history are diverse and nonspecific, and toxicological analysis plays a pivotal role in the diagnosis and differential diagnosis of such patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The value of toxicological analysis in acute poisoning patients with uncertain exposure histories: a retrospective and descriptive study from an institute of poisoning

Shi,

Ba,

Xia

et al. 2024

World Journal of Emergency Medicine

View full text Add to dashboard Cite

show abstract

Simultaneous multi-targeted forensic toxicological screening in biological matrices by MRM-IDA-EPI mode

Franzin,

Di Lenardo,

Ruoso

et al. 2024

Arch Toxicol

View full text Add to dashboard Cite

The toxicologist ascertains drug assumptions in case of paediatric intoxications and death for overdose. The analytical approach consists of initially screening and consequently confirming drug positivity. We developed a toxicological screening method and validated its use comparing the results with a LC–MS/MS analysis. The method identifies 751 drugs and metabolites (704 in positive and 47 in negative mode). Chromatographic separation was achieved eluting mobile phase A (10 mM ammonium formate) and B (0.05% formic acid in methanol) in gradient on Kinetex Phenyl-Hexyl (50 × 4.6 mm, 2.6 μm) with 0.7 mL/min flow rate for 11 min. Multiple Reaction Monitoring (MRM) was adopted as survey scan and, after an Information-Dependent Analysis (IDA) (threshold of 30,000 for positive and 1000 cps for negative mode), the Enhanced Product Ion (scan range: 50–700 amu) was triggered. The MS/MS spectrum generated was compared with one of the libraries for identification. Data processing was optimised through creation of rules. Sample preparation, mainly consisting of deproteinization and enzymatic hydrolysis, was set up for different matrices (blood, urine, vitreous humor, synovial fluid, cadaveric tissues and larvae). Cut-off for most analytes resulted in the lowest concentration tested. When the results from the screening and LC–MS/MS analysis were compared, an optimal percentage of agreement (100%) was assessed for all matrices. Method applicability was evaluated on real paediatric intoxications and forensic cases. In conclusion, we proposed a multi-targeted, fast, sensitive and specific MRM-IDA-EPI screening having an extensive use in different toxicological fields.

show abstract

A four-way patient search method for the retrospective identification of poisoning patients

Uslin,

Hällberg,

Lukkarinen

et al. 2024

Sci Rep

View full text Add to dashboard Cite

When studying emergency department (ED) visits, electronic health record systems of hospitals provide a good basis for retrospective studies. However, many intoxication patients presenting to the ED, may not be identified retrospectively if only a single search method is applied. In this study, a new four-way combined patient search method was used to retrospectively identify intoxication patients presenting to the ED. The search included reason for admission to the ED, laboratory results related to intoxication diagnostics, ICD-10 codes, and a novel free word search (FWS) of patient records. After the automated search, the researcher read the medical records of potential substance abuse patients to form comprehensive profiles and remove irrelevant cases. The addition of a free word search identified 36% more substance abuse patients than the combination of the other three methods mentioned above. Patients identified by the FWS search alone were generally admitted to the ED for trauma or mental health problems and were often found to be heavily under the influence of alcohol and/or drugs. The main intoxicants were ethanol and benzodiazepines. The free word search was highly complementary to traditional patient search methods, highlighting the importance of the combined patient search method in retrospective data collection.

show abstract

Changes in Diagnosis of Poisoning in Patients in the Emergency Room Using Systematic Toxicological Analysis with the National Forensic Service

Cited by 8 publications

References 27 publications

The value of toxicological analysis in acute poisoning patients with uncertain exposure histories: a retrospective and descriptive study from an institute of poisoning

The value of toxicological analysis in acute poisoning patients with uncertain exposure histories: a retrospective and descriptive study from an institute of poisoning

Simultaneous multi-targeted forensic toxicological screening in biological matrices by MRM-IDA-EPI mode

A four-way patient search method for the retrospective identification of poisoning patients

Contact Info

Product

Resources

About