Clinical Analysis of Acute Sedative/Hypnotic Intoxication by Route of Emergency Department Access

ABSTRACT

PURPOSE: The prevalence of intoxication and toxidromes, such as altered mental status, from Sedatives/hypnotics is high. Many patients have been transferred to a higher-level emergency center. This study was designed to analyze the clinical features of these patients and to compare patients transferred from a regional hospital with patients who directly visited a higher-level emergency center. METHODS: A retrospective study was conducted on 298 sedative/hypnotic intoxication patients examined from January 2008 to December 2012. After excluding patients intoxicated from other category medications and missing data on medical records, 158 acute intoxication patients were enrolled in the study and divided into transferred and direct-visit groups. Gastric lavage patients (n=108) were also subdivided into two groups by irrigation site. Clinical features, treatments, and complications were investigated. RESULTS: There were no significant differences between the two groups in initial clinical manifestations, laboratory data, and toxicological information, except for charcoal treatment and complications from pneumonia. The use of charcoal was significantly lower in the group transferred from a regional medical center. The transferred group showed a higher incidence of pneumonia than the direct-visit group (10/54(18.5%) vs. 5/104(4.8%), respectively, p=0.007). In the subgroup analysis of gastric lavage patients, there was also a higher incidence of pneumonia in the regional hospital lavage group compared to the higher-level emergency center lavage group (8/32(25.0%) vs. 5/76(6.6%), respectively, p=0.011). From a comparative analysis of pneumonic complications and mental status, pneumonia patients showed a higher incidence of painful responses and unresponsive mentality (6(40.0%) and 4(26.7%), respectively, p<0.001). CONCLUSION: In acute sedative/hypnotic intoxication patients, transferred patients, including regional hospital gastric lavage patients, showed a higher incidence of pneumonia. Pneumonic complication patients showed a higher incidence of a decreased mentality. Therefore, for patients transferred or treated for an altered mental status, precautions for complications from pneumonia must be considered.