The Clinical Management of Acetaminophen Poisoning in a Community Hospital System: Factors Associated with Hospital Length of Stay

Abstract

Acetaminophen (APAP) overdose is the most common pharmaceutical poisoning. The objective of this study was to examine the management of patients admitted for treatment of APAP overdose. Factors impacting hospital length of stay (LOS) were of particular interest. This was a retrospective cohort study of patients admitted to Kaiser Permanente Northern California hospitals for APAP overdose from July 2003 through December 2007. Medical records were abstracted for patient demographic data, key factors of overdose, California Poison Control System (CPCS) contact, data regarding hospital course, transfer for liver transplantation, and death. Four hundred thirty-five patients were included. The mean hospital LOS was 66.5 h (95% CI 62.1, 71.0). Four patients (0.9%) died. Eight patients (1.8%) were transferred for liver transplantation, but all of these patients later recovered without transplant. Of 289 cases eligible for placement on the RumackMatthew nomogram (acute ingestion with known time of ingestion <24 h and normal liver enzymes), 161 (55.7%) had APAP levels above the "200" line and 77 (26.6%) fell below the "150" line. CPCS was contacted in 295 cases (67.8%). Mean LOS in cases with CPCS consultation was 61.9 h (95% CI 57.2, 66.5 h) versus 76.3 h (95% CI 66.6, 86.0 h) in those without. LOS in cases treated with IV NAC was 67.1 h (95% CI 57.7, 76.5 h) versus 66.4 h (95% CI 61.2, 71.5 h) in cases treated with oral NAC. Many patients admitted for APAP overdose had serum APAP levels below the minimum toxicity level. Use of IV NAC did not impact hospital LOS. CPCS consultation appeared to decrease mean hospital LOS.

Effect of a Medical Toxicology Admitting Service on Length of Stay, Cost, and Mortality Among Inpatients Discharged with Poisoning-Related Diagnoses

“…Medical toxicologists also care for children <14 years of age, but some facilities did not routinely admit and care for poisoned children. Given that management advice from poison center staff has previously been associated with more favorable outcomes, a limitation to our study might be that we did not adjust for poison center involvement with inpatient care in the three patient groups [6][7][8][9][10][11][12][13][14][15]. However, our PCC staff very uncommonly makes treatment recommendations for patients under the primary care of medical toxicologists at BGS (group 1).…”

“…Prior studies have shown that PCC involvement in the management of poisoned patients results in health care savings [5][6][7][8][9][10][11][12][13]. It has also been demonstrated that patients managed with PCC telephone consultation utilize the emergency department (ED) less frequently and experience lower rates of hospital admission and shorter lengths of stay (LOS) when hospitalized [7,[14][15][16][17]. However, very limited data exist regarding consultative bedside management of poisoned patients by medical toxicologists, and no studies have reported major quality outcomes in patients admitted to a medical toxicology service where care was primarily delivered by medical toxicologists [18,19].…”

Evaluating the Necessity of a Poison Control Center in Cameroon: The Knowledge and Perception of Health Care Professionals in the Laquintinie Hospital and the Bonassama District Hospital in Douala

“…The absences of data's on poisoning management training and literature or research works in Cameroon are elements still rendering the management of poisoning in Cameroon a very controversial issue thereby making it a serious public health hazard, especially when it comes to managing a poison case without any recorded data's on pass related exposure in a given community [60][61][62][63][64][65]. This made our study the first of its kind to put forward the question on the necessity of a PCC in Cameroon by evaluating the knowledge of HCP on poisoning and PCC in regard to proper poison patient's management in Cameroon [66][67][68][69][70][71].…”

What are the factors associated with the length of hospital stay after acetaminophen overdose?

“…These are some points that the authors have not noticed and mentioned in their study and can affect the length of hospital stay. 4 Therefore, it would be better if the authors mentioned these factors before considering the clinical and demographic factors in these patients as well as the effect of early treatment of acetaminophen overdose. It seems that even without the statistical analysis, it is quite evident that the patients who present with signs and symptoms of acetaminophen overdose have ingested a large amount of acetaminophen, have an acetaminophen level above the possible toxicity treatment line according to the standard Rumack-Matthew nomogram, and are treated with IV-NAC will have a longer course of hospital stay in comparison to the others.…”