Toxicologic related deaths: A case series from 1970 to 2014

Objectives: Acute poisoning is a leading cause of admittance to health care facilities (HCF) worldwide. Aim of our study is to analyze mortality rate (MR), class and nature of offenders, demography and timing of death in patients admitted in our Toxicology Unit. A comparison with data emerging from international reports and literature is also included. Case series: We retrospectively analyzed toxicological-related deaths occurred in patients admitted for acute poisonings between 1970-2014. A total of 74,563 patients (47,284 M, 27,279 F) were admitted; out of these, 105 patients died (55 F; 50 M). The overall mean age ± SE was 53.7 ± 2.1 years (ys) . Death’s distribution by classes of age (range 2–93 ys) were 2.8% (0 to 5 ys), 5.7% (6 to 19 ys), 32.4% (21 to 50 ys), 36.2% (51 to 70 ys), and 22.9% over 71 ys . Overall MR resulted 0.14% (0.20% F; 0.11% M). As no deaths occurred from 2007 since 2014, accordingly adjusted MR was 0.194%. Data emerging from AAPCC annual reports (1985–2012) indicate overall MR as 0.051 (1). However, the value adjusted according to the number of HCF admittances reached 0.298 in 1999-2012. Related-death offenders were: drugs (n = 42; 44.8 %), mushrooms (Amanita Phalloides) (n = 20; 19 %), caustics (n= 11; 10.5), systemic toxic gases (n = 9; 8.6 %),%), pesticides (n = 9; 8.6 %), hydrocarbons (n = 7; 6.7 %), substances of abuse (n = 6; 5.7%) and animal toxins (n = 1; 0.9%). Average time between admission and death was 5.5 ± 0.63 days (mean±SE) depending by the involved class of agents (caustics 1.8 and pesticides 7.1 days, respectively). Conclusions: Death due to acute poisoning is low; overall MR resulted higher than that emerging in AAPCC reports relatively to total calls, but lower considering patients admitted to HCF; higher MR was observed in 21-50 and 51-70 year old patients; drugs and mushrooms poisonings represent the chief offenders.