Poisoning is a public health problem worldwide [1–9] and is one of the most common reasons for attendance at hospital emergency departments (EDs) [6, 10–12]. Although the incidence of poisoning is difficult to estimate accurately, the wide availability and accessibility of chemicals and their extensive use in a variety of applications including medicine, agriculture and industry has increased the risk of poisoning [1, 2, 13].
Knowledge of the epidemiology of poisoning and its changes is important to both emergency physicians and public health practitioners, but the pattern of poisoning varies from country to country and over time, sometimes rapidly [1, 2, 13–16]. Therefore, regional epidemiological data on poisoning are very helpful in planning rational use of resources for the prevention and management of poisoning and in targeting research. Various epidemiological studies concerning poisoning have been undertaken including single hospital-based, multi-center-based and poison center-based investigations [1, 5, 6, 17, 18].
Poisoning is common in Taiwan but epidemiological studies and surveillance data are limited [2, 19, 20]. According to the Poison Control Center (PCC) the annual incidence of poison exposure in Taiwan ranges from 0.16 to 0.22 exposures per 1000 population . The PCC receives calls on poisoning and poison exposure from all over the country, but for various reasons not all poisoning cases are reported to the PCC [21, 22]; this is considered a major factor contributing to differences in estimates between those reported by the PCC and other epidemiologic studies. There is little current systematic information on the causes, circumstances and clinical course of poisoning in the southwest region of Taiwan.
In developed countries, poisoning exposure has mostly been associated with medicines, alcohol and household chemicals [1, 4, 6], whereas in developing countries the common causal agents are agrochemicals, including pesticides [13, 17, 23–25]. Pesticide exposure and pesticide-related morbidity and fatality have been, and continue to be, a major concern in acute poisonings in Taiwan. A number of studies concerning identification of prognostic factors and assessment of severity have been reported [24, 26–31], but most have focused on prognostic factors for a single type of pesticide, and have evaluated the impact using clinical scoring systems such as the Simplified Acute Physiology Score (SAPS) II and Acute Physiology and Chronic Health Evaluation (APACHE) II and III [26, 30–33]. Factors that help to predict overall poisoning-related fatality formed the basis of the present study, as these have rarely been elucidated.
We speculated that factors generally associated with unfavorable prognosis in clinical settings, such as unstable vital signs (including decreased consciousness, shock status, respiratory distress, abnormal heart rate and abnormal body temperature), history of major disease, and old age are predictors of fatality in cases of poisoning. However, other patient characteristics may also be associated with poisoning-related fatality. The objectives of this study were to describe the demographic and clinical characteristics in poisoning cases, and to compare instances of poisoning-related fatality and survival to identify and evaluate predictors of fatality.