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Objective: Aims were (1) to assess the characteristics, associated factors and compliance of patients with acute poisoning advised by the Belgian Poison Centre (BPC) to go (conditionally) to the hospital, (2) to assess the compliance and potential health-economic impact.Methods: Three types of referrals to the hospital of patients who called the BPC between 1 January and 30 June 2018 were analysed: referrals in case of deterioration in the patient's condition (Hosp-watchful-wait), referrals (Hosp-referral) or urgent referrals (Hosp-urgent-referral). Factors associated with type of recommendation were registered. A survey was conducted on a second dataset of patients who called the BPC between 1 March and 15 May 2019 and referred (conditionally) to the hospital.Results: 5476 referrals were included: 72.4% accidental poisoning, 25.3% intentional self-harm, 1.2% substance abuse and 1.1% unclear intentionality. There were 2368 (43.2%) Hosp-watchful-wait cases, 2677 (48.9%) Hosp-referrals and 431 (7.9%) Hosp-urgent-referrals. In Hosp-watchful-wait cases, soaps and detergents were represented most (20.5%). In Hosp-referrals and Hosp-urgent-referrals, benzodiazepines (12.7% and 15.1%, respectively) predominated. Factors associated with hospitalisation type were number of symptoms, intentionality, type of agent(s) involved and advising antidotes. The survey showed that 7.8% of Hosp-watchful-wait patients went to the hospital versus 57.3% of Hosp-referrals and 59.6% of Hosp-urgent-referrals. The mean cost for Hosp-watchful-wait patients, Hosp-referrals and Hosp-urgent-referrals was estimated at €127, €767 and €796, respectively.Conclusion: Only a small proportion of patients followed the advice of the BPC to go (conditionally) to the hospital. A systematic follow-up of cases is warranted to examine the appropriateness of referrals and the compliance of patients. [ABSTRACT FROM AUTHOR]

Abstract Background Overuse of emergency departments (ED) is of concern in Western society and it is often referred to as 'inappropriate' use. This phenomenon may compromise efficient use of health care personnel, infrastructure and financial resources of the ED. To redirect patients, an extensive knowledge of the experiences and attitudes of patients and their choice behaviour is necessary. The aim of this study is to quantify the patients and socio-economical determinants for choosing the general practitioner (GP) on call or the ED. Methods Data collection was conducted simultaneously in 4 large cities in Belgium. All patients who visited EDs or used the services of the GP on call during two weekends in January 2005 were enrolled in the study in a prospective manner. We used semi-structured questionnaires to interview patients from both services. Results 1611 patient contacts were suitable for further analysis. 640 patients visited the GP and 971 went to the ED. Determinants that associated with the choice of the ED are: being male, having visited the ED during the past 12 months at least once, speaking another language than Dutch or French, being of African (sub-Saharan as well as North African) nationality and no medical insurance. We also found that young men are more likely to seek help at the ED for minor trauma, compared to women. Conclusions Patients tend to seek help at the service they are acquainted with. Two populations that distinctively seek help at the ED for minor medical problems are people of foreign origin and men suffering minor trauma. Aiming at a redirection of patients, special attention should go to these patients. Informing them about the health services' specific tasks and the needlessness of technical examinations for minor trauma, might be a useful intervention.

Objective: Aims were to (1) analyse the direct cost charged by a university hospital to the government and the patient in case of an admission for acute poisoning, (2) identify the factors associated with the cost, and (3) compare the cost in the hospital studied with national data from the government. Methods: Patient records and invoices of all poisoning-related episodes of patients 14 years or older admitted to the Emergency Department (ED) of Ghent University Hospital (GUH) in 2017 were analysed. A generalised linear model with gamma loglink was applied to assess the variables associated with the cost. Our GUH data collected in 2017 were compared with national data 2016 for all Belgian hospitals on the one hand, and for the subgroup of GUH 2016 data on the other hand. To do this, we used data provided by the Technical Unit of the Federal Public Service Health, containing All Patient Refined Diagnosis Related Groups 812 (poisoning by medicinal agents) and 816 (toxic effects by non-medicinal substances). Results: The total direct cost for the treatment of 1,175 poisoned patients amounted to $1,830,870. Median direct cost per patient was $512 per episode, with $199 for ambulatory patients, $1,575 for patients admitted to the ED-observation-unit, $3,398 for hospitalised patients and $4,859 for patients treated in the intensive care unit. Factors associated with the cost were gender, degree of severity, type of hospitalisation, intentionality, and involvement of ethanol, paracetamol, antidepressants or amphetamines. Median hospitalisation cost per admission in GUH for medicinal agents was 70.5% higher than the cost reported in national hospitalisation data. Median cost per admission in case of non-medicinal agents was 54.5% higher than the national median 2016. Conclusion: The type of hospitalisation has a high impact on the cost, a.o. primarily due to the length of hospital stay, with accommodation accounting for a large proportion of the costs. It is important to benchmark individual hospital data with (inter)national data to evaluate its own cost management in the context of continuous improvement. [ABSTRACT FROM AUTHOR]

ContextCyanide poisoning may be caused by acetonitrile, a common industrial organic solvent and laboratory agent.ObjectiveTo describe the potential use of disulfiram in treating acetonitrile poisoning in a human clinical case and to further study its effect in human liver microsomesin vitro.Case detailsA 30-year-old man initially presented with a cholinergic toxic syndrome following ingestion of aldicarb. Toxicological analysis revealed coingestion of ethanol. He subsequently developed severe metabolic acidosis caused by the cyanogenic compound acetonitrile which was erroneously interpreted as acetone in the chromatogram. After three treatments with hydroxocobalamin (5 g i.v.) and sodium thiosulfate (12.5 g i.v.) on days 2, 3, and 5, he had transient improvement but recurrent lactic acidosis. Treatment with disulfiram was associated on day 7 with resolution of metabolic acidosis and slowing of the decrease in acetonitrile concentration. He recovered from acetonitrile toxicity completely. The time course of acetonitrile, thiocyanate, and cyanide concentrations suggested that disulfiram inhibited cyanide formation.ResultsIn vitro experiments with human liver microsomes showed the cyanide concentration was significantly lower after incubation with acetonitrile and disulfiram than acetonitrile alone (a mean 60% reduction in cyanide level).DiscussionAlthough disulfiram was given late in the course of the poisoning it is possible that it contributed to the recovery. [ABSTRACT FROM AUTHOR]