Outcomes and Cost Analysis of Patients Admitted to the Intensive Care Unit due to Accidental or Intentional Acute Poisoning
CCCF ePoster library. Fernando S. Oct 3, 2017; 198190; 71
Dr. Shannon Fernando
Dr. Shannon Fernando
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Outcomes and Cost Analysis of Patients Admitted to the Intensive Care Unit due to Accidental or Intentional Acute Poisoning

Shannon M. Fernando, MD, MSc1,2; Peter M. Reardon, MD1,2; Ian M. Ball, MD, MSc3; Sasha Van Katwyk, MSc4; Kednapa Thavorn, PhD4; Peter Tanuseputro, MD, MHSc4,5,6; Erin Rosenberg, MD, MHA1; Kwadwo Kyeremanteng, MD, MHA1,6

 

1. Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON

2. Department of Emergency Medicine, University of Ottawa, Ottawa, ON

3. Division of Critical Care Medicine, Department of Medicine, and Department of Epidemiology and Biostatistics, Western University, London, ON

4. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON

5. Bruyere Research Institute, Ottawa, ON

6. Division of Palliative Medicine, Department of Medicine, University of Ottawa, ON


Background: Acute poisoning (whether intentional or accidental) represents a major cause of morbidity and mortality worldwide. Such patients may be admitted to the Intensive Care Unit (ICU) for a variety of reasons, such as altered level of consciousness (requiring airway protection), shock, and respiratory distress. The ICU is a major source of hospital expenditure and resource utilization. However, very little is known regarding the ICU costs of acute poisoning.    
 
Objectives: We evaluated ICU patient records in order to identify characteristics, outcomes and cost patterns for patients admitted to the ICU due to acute poisoning.   
 
Methods: This retrospective cohort study was performed in two tertiary care hospital ICUs, within The Ottawa Hospital network. Patients were enrolled between January 1, 2011 and December 31, 2014. Patient characteristics and outcomes were gathered from The Ottawa Hospital Data Warehouse. Patients with a primary diagnosis of poisoning were identified and included in the analysis. We excluded patients with allergic reactions/anaphylaxis to medications. Patients were further categorized and analyzed based on the xenobiotic most likely to have caused the toxicity. Primary outcomes were ICU length of stay (LOS) and hospital costs. For cost analysis, the total cost per patient was measured and stored by the hospital Data Warehouse.
 
Results: 8502 patients were admitted to the ICU during the study period, of which 277 had a primary diagnosis of poisoning. 204 cases (73.6%) were intentional. Mean age of poisoning patients was 44.5 years (42.5-46.4), and 53.4% were male. The most common categories of xenobiotics were sedative-hypnotics (n = 56, 20.2%), antidepressants (n = 42, 15.2%) and opioids (n = 29, 10.5%). Overall mortality in the cohort was 5.1%, compared with a mortality rate of 28.0% for non-poisoning patients admitted to the ICU during the same period. Mean ICU LOS for poisoning patients was 4.4 days (3.9-5.0), compared with 8.3 days (8.0-8.5) for non-poisoning patients. Poisoning patients had a mean total cost of $18958 (16305-21610), with a mean cost per day of $3629 (3457-3791). Mean total cost for non-poisoning patients admitted to the ICU during the same period was $60628 (56966-64290), with a mean cost per day of $3365 (3318-3413). The xenobiotics associated with the highest costs were acetaminophen (mean total cost of $18585 [9499-27671] and mean cost per day of $3438 [2888-3988]); toxic alcohols (mean total cost of $16771 [11608-21935] and mean cost per day of $4720 [3909-5530]); and opioids (mean total cost of $17158 [8750-25566] and mean cost per day of $3817 [3246-4388]). 
 
Conclusions: In our cohort, we found that patients admitted to the ICU with a primary diagnosis of poisoning have lower mortality and ICU LOS than non-poisoning patients admitted to the ICU. However, despite this, poisoning patients still account for significant costs, with the highest costs attributed to xenobiotics with known antidotes, such as acetaminophen, toxic alcohols, and opioids.

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