Demographics of toxic exposures presenting to three public hospital emergency departments in Singapore 2001–2003

BACKGROUND The demographics of poisoned patients and the circumstances of toxic exposure have not been evaluated in Singapore for the last 10 years. AIM This study aims to give an estimate of the burden of poisoning in Singapore from the emergency department's (ED) perspective. METHOD A retrospective study of toxic exposure was conducted over a period of 3 years from 2001 to 2003 at the ED of three public hospitals, one being a paediatric hospital. RESULTS There were 9,212 cases of toxic exposures during the study period, which constituted 0.94% of total ED attendances. The poison exposure rate was 1.7 per 1,000 population and the estimated case fatality rate was 0.8 per 1,000 ED attendances for poisoning. The mean age of patients was 29 years and the majority were male (63.3%). Non-accidental injuries constituted 60% of the cohort. Alcohol was the commonest toxin involved (26%), but paracetamol (acetaminophen) was the most common pharmaceutical agent (33%). The mean time of exposure to ED presentation was 3.3 h. About one third of the patients were admitted of whom 157 patients (4.7% of admitted cases) required intensive care management. CONCLUSION The patients were predominantly young adults. This may suggest a need for poison prevention and chemical safety education to reduce the impact on this high-risk group. Although poisoning accounts for only 1% of the total ED attendance, a sizable proportion of them required inpatient care (36.1%) with a significant proportion requiring intensive care management. However, it was also noted that a third of those who were admitted stayed for less than 24 h, and hence a short-stay ward in the ED might be a cost-effective strategy to consider.