key: cord-0953444-0mmris42 authors: Al-Mousa, Fawaz A.; Gado, Ali M.; Attia, Afaf M.; Tammam, Hany G. title: Medical toxicology experience: Poisoning consultations cases registry in Saudi Ministry of Health -2020 annual report date: 2021-08-02 journal: Toxicol Rep DOI: 10.1016/j.toxrep.2021.07.024 sha: e225687304d50f9a7e5dd174871d93735bbc106e doc_id: 953444 cord_uid: 0mmris42 INTRODUCTION: Saudi poison control centers provide surveillance data that should be used to determine the magnitude of poisoning exposures and the level of public awareness that is to evaluate control measures. This work aimed to review and assess the characteristics of toxic events received by toxicological information center's hotline all over Saudi Arabia during 2020. PATIENTS AND METHODS: Data were collected from the poison control centers in Saudi Arabia. Cases of poisonings were studied during the period from 1st January to 31st December 2020. RESULTS AND DISCUSSION: The poison control center received 20,513 calls in the year 2020. Most of calls were from Riyadh city (40.9 %) and from public places (92.9 %). Regarding the patients, most of the cases were less than 6 years old and more than half of them were males. The majority of toxic exposures were accidental oral poisoning. About 84 % of patients (84.3 %) called for help within one hour from poisons exposure. Household substances toxic exposure represented about one third of toxic cases. Chemicals and alcohol sanitizers' poisoning were the highest among house hold substances toxicities (39.3 % and 17.7 % respectively of all household substances toxicity). In addition, the most frequently ingested drugs were vitamins poisoning. CONCLUSION: Household chemicals represented the highest risk in exposures among children below 6 years. Finally, we recommended widespread awareness of the poisons risk and the importance of poison control that play a great role in time management and saving lives. Acute poisoning is a common reason for seeking medical help and being admitted to the emergency room. They are a real public health issue whose causes and consequences must be fully recognized [1] . The bulk of drug and chemical poisoning is classified as an imminent threat to one's health, life, property, or environment, and it affects both young boys and females. The majority of these poisonings require immediate attention to avoid a deterioration of the situation, particularly those caused primarily by self-poisoning with pesticides and corrosives [2] . Poisons' control Centre is a specialized unit providing information on prevention, early diagnosis, and treatment of poisoning and hazard management [3, 4] . One of the main activities of poison control centers' is telephone consultation, which they offer to the general public, emergency medical services staff, health care professionals, and public health organizations. These programs rely on clinical toxicologists, medical toxicologists, experts in subspecialty areas, and poison specialists to manage calls rapidly and efficiently [5] . In the case of poisoning exposures, services given to the public include assessment of the nature and severity of toxicity, advice for athome treatment when appropriate, reassurance to the caller, and referral to a health care provider when necessary. Callbacks are given as appropriate to ensure that the episode is resolved satisfactorily. To avoid repeat poisoning episodes, preventative measures such as removing certain objects from the home or putting them out of reach of children are recommended. When callers are referred to a medical facility, the facility is notified, and information about the case as well as the toxicology of the poison involved is made available [6, 7] . Poison control centers often respond to public complaints regarding toxins, chemical exposures at work or at home. They ask for an evaluation of symptoms they think related to poisoning, as well as questions about environmental contamination, plants, herbal remedies, medication interactions, or envenomation, and general knowledge about poisoning subjects (e.g., first aid). Since people call the poison control center when they don't know who else to call, the range of topics is wide. For potential food poisoning, such calls can be referred to more relevant departments, such as the local public health department [6] . Toxicology research, which focuses on poison control center clinical services and contribution of centers in researching and treating poisonings are very precious in improving their services [7, 8] . Therefore, the present study aims to review and assess the characteristics of toxic events received by the toxicological information center's hotline all over Saudi Arabia during 2020. A retrospective study was performed on 20,513 cases of poisoning. The information was collected from the poison control centers hotline service all over Saudi Arabia. Cases of poisonings were studied during the period from January to December 2020 divided into four quarters (1st from January to March, 2nd from April to June, 3rd from July to September and 4th from October to December). These parameters were studied: city as the call was received, origin of the call and all the followings regarding the case; age, gender, occupation, mode, place and route of poisoning, clinical manifestations, investigations, recommendations and type of poisoning. All data were analyzed using the Statistical Package for Social Science software (SPSS- Version 14) . The data entered was then checked for accuracy. For each item, the frequency and percentage of assessment items were presented. Most of the consultation calls were from public areas (92.9 %) while, the other calls were received from hospitals (7.1 %) (Fig. 2) . Regarding the patients, 11,205 were males and 9308 were females. Most of the patients were in age group from <6 years (78 %) and in the pre-school stage (77.8 %) as shown in Table 1 . As shown in Table 2 , the accidental mode of poisonings was the most among cases (97.8 %) while; the intentional mode of poisonings was 1.3 %. Regarding the place of poisoning, most of the cases were poisoned at home (98.6 %). The oral route of poisoning was represented the most among the cases (94.1 %) (Fig. 3) . About 84 % of patients (84.3 %) called for help within one hour from poisoning while about five percent of patients (4.9 %) asking for help after 2− 4 hours. Most of the cases presented with no clinical (Table 3) . As regards type of poisoning (Table 4) , household substances toxicities represented 6419 cases (31.3 %) while non-narcotic analgesic and other medications toxicity were 2657 cases (13 %) and 4790 cases (23.4 %), respectively in frequency. Chemicals then alcohol sanitizers poisoning were the highest (39.3 % and 17.7 % respectively) among household substances toxicities. Vitamins poisoning was the highest among other medications toxicities (31.1 % of all other medications). Poison control centers are a rich source of data and knowledge for food protection and toxicity analysis. These data have been used in hundreds of analysis papers. These data are often used for research into better patient care, antidote assessment, epidemiology, and policy creation [9] . The aim of the present study is to review and assess the characteristics of toxic events received by toxicological information center's hotline all over Saudi Arabia during the year 2020. The results of that paper revealed that poison control centers received 20,513 calls in the year 2020 (5339, 6793, 4851 and 3530 in 1 st, 2nd, 3rd, and 4th quarter respectively). Most of the calls were from Riyadh City (40.9 %) and that because it is the largest Saudi city regarding number of populations. The numbers of calls increased during 1 st and 2nd quarters of year 2020, this could be explained by increasing the hazards of COVID 19 and people were frightened to get out of their houses and go to hospitals. This considered a great benefit of the poison control service as keeping patients out of the emergency department saves lives during the pandemic of COVID 19. In consistent with our scope, Zaloshnja et al. and Bunn et al. as they stated that the important value of poison control calls is their significant impact on reducing health-care costs [10, 11] . The primary driver of these health-care economic savings was through reduction of health-care expenses and this can be achieved by: Firstly, reduced emergency department (ED) visits for poisoning and secondly reduced length of patients' admission in hospitals. Besides, most of the consultation calls in the current work were from public areas (92.9 %) while, the other calls were received from hospitals (7.1 %). In agreement with our results, previously documented reports of the poison control centers provided information to the public about poisoning exposures and respond to requests for poison information [12, 13] . As a result, everyone can call the poisoning hotline for assistance. Moreover, and regarding the patients, 11,205 were males and 9308 were females. Most of the patients were in age group <6 years (78 %) and most of them in pre-school stage (77.8 %). The accidental mode of poisonings was the highest mode (97.8 %). Regarding the place of poisoning, most of the cases poisoned at home (98.6 %). The oral route of poisoning represented the most among cases (94.1 %). The preponderance of male to female patients in our study is in accordance with Al-Shehri [8] . Similarly, the involvement of children in the age group <6 year in this study agrees with Saddique [12] . We can explain that that children "in this age group" have curious and explorative behavior as well as being hyperactive, making them vulnerable to poisoning at home, where almost every substance is thrown into the mouth. It is important to note that careless storage of products and drugs is a very important factor in the poisoning of children. About eighty-four percent of patients (84.3 %) called for assistance within one hour of being poisoned and this behavior reflected good awareness of the population regarding the poisoning and the benefit of poison center-hotline service in saving the poisoned patient's life. Due to early seeking for help by calling the hotline, most of the cases presented with no clinical manifestation during call (90.3 %). Many investigative tools were ordered occasionally, but the majority of cases needed no investigations (14,252 cases). Toxicologists recommended much advice to patients. Regarding the public calls, toxicologists recommended management at home in most of the cases (66.7 %). While regarding the hospital calls, we recommended put patients under observations in most of the cases (49.2 %). Determining which of these poisoned patients may manage at home not only reduced ED visits and hospital admissions but also, limited microbial transmission and the hazards of infection during the Covid19 pandemic. As regards the type of poisoning, household substances toxicities represented a remarkable category of poisoning about one third of cases then other medications toxicity in frequency (31.3 % and 23.4 % respectively). Chemicals then alcohol sanitizers' poisonings were the highest among household substances toxicities (39.3 % and 17.7 % respectively from household substances). Vitamins poisoning was the highest among other medications toxicities (31.1 % of all other medications). We can explain that by the availability of disinfectants and antiseptics in all homes during Covid 19 outbreak, also the availability of vitamins and analgesics due to its use in Covid 19 treatment protocols. These results were in agreement with the findings in some developing countries, where ingestion of household products like chlorine bleach (Clorox), pesticides, disinfectants and unidentified products ranked first [14] . Previous studies have shown that accidental poisoning in children is related to the lifestyle of the household, and some environmental factors [8] . In addition, Al-Shehri in his study showed that 95 % of poisoning occurred in the child's own home where a collection of drugs, household cleaning agents and personal products are very often improperly stored [8] . Home medications were a common type of children poisoning due to its availability in an easy to reach storage cabinet [16] and attractive packaging of these medications that get children's attention [17] . Some other studies showed that acetaminophen was the most common drug poison in children [15, 16] . On other hand, Al-Shehri found that toilet bowel cleaners were the most common household products swallowed accidentally, followed by fingernail polish remover, soap powder and Clorox [17] . In conclusion, most of poison control's calls were from Riyadh City and were received from public places. Regarding the patients, the largest were males in the age group <6 years. The accidental mode of poisonings was the most of cases that poisoned at home by oral route of poisoning. About 84 % of patients called for help within one hour from poisoning. The household substances toxicities represented the first in frequency of all types of toxicities, whereas chemicals were the highest then alcohol sanitizers. Medication's toxicities represented the second of all types of toxicities in frequency whereas vitamins toxicity was the highest. This study reinforced the importance of parental supervision, control, and prevention of poisoning of children.Because of lack of safe storage of poisonous drugs and household products, we recommend as a preventive strategy, that parents must ensure that all medicates, household chemicals and toxic products are kept in a safe place out of the reach of children. Child-resistant containers for household agents and dispensed medications should be used firmly. Finally, the establishment of drug and poisoning information centers in every region through a network is highly recommended. In addition, we recommended widespread awareness of the importance of poison control hotline service and use a simple unique phone number to be easily remembered by the public. This statement to certify that all authors have seen and approved the final version of the manuscript being submitted. They warrant that the article is the authors' original work, hasn't received prior publication and isn't under consideration for publication elsewhere. The authors report no declarations of interest. Acute paracetamol poisonings received at the Oran University Hospital Pattern of food, drug and chemical poisoning in Qassim region, Saudi Arabia from Annual report of the american association of poison control centers toxic exposure e surveillance system Emergency department poisoning visits in children younger than 6 years: comparing referrals by a regional poison control center to referrals by other sources A risk assessment based approach to the management of acute poisoning Forging a poison prevention and control system: report of an Institute of Medicine committee Pattern of childhood poisoning in Abha City-Southwestern Saudi Arabia The value and evolving role of the US poison control center system The potential impact of poison control centers on rural hospitalization rates for poisoning The effect of poison control center consultation on accidental poisoning inpatient hospitalizations with preexisting medical conditions Poisoning in Saudi Arabia: ten-year experience in king khaled university hospital Poison control in the United States Clinical profile and outcome of poisoning in Najran Pattern of drug overdose and chemical poisoning among patients attending an emergency department, western Saudi Arabia Updated guidelines for the management of paracetamol poisoning in Australia and New Zealand The clinical value of routine acetaminophen level screening in pediatric patients presenting to the emergency department Volatile 29 75 94 52 250 Corrosives 431 386 170 66 1053 Chemicals 636 991 661 233 2521 Insecticides 101 139 109 71 420 Rodenticides 134 154 47 15