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      Intoxicaciones agudas por productos químicos: análisis de los primeros 15 años del Sistema Español de Toxicovigilancia (SETv) Translated title: Acute poisoning by chemical products: analysis of the first 15 years of the Spanish Toxic Surveillance System (SETv)

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          RESUMEN

          Fundamentos:

          Existen pocos estudios epidemiológicos, sobre todo de tipo multicéntrico, sobre las intoxicaciones agudas a causa de productos químicos agroindustriales y del hogar en España. El objetivo de este trabajo fue describir el perfil epidemiológico y clínico de estas intoxicaciones en nuestro país, y analizar su evolución temporal.

          Métodos:

          El Sistema Español de Toxicovigilancia (SETv) es un registro prospectivo que incluye a 32 Servicios de Urgencias y Unidades de Cuidados intensivos de España. Se realizó un estudio descriptivo observacional de las intoxicaciones agudas por agentes químicos (excluyendo drogas y fármacos) en sus primeros 15 años de funcionamiento (1999-2014). Las comparaciones de proporciones se realizaron mediante las pruebas de Chi-cuadrado o exacta de Fisher, y entre pares de grupos independientes con la prueba de Mann-Whitney. Se consideraron significativos los valores de probabilidad menores de 0,05.

          Resultados:

          Los 10.548 casos estudiados presentaban una edad media de 38,41 (±22,07) años, siendo significativamente superior en las mujeres (p=0,0001). El 67,7% de las intoxicaciones ocurrieron en el hogar, y las vías de entrada más frecuentes fueron la respiratoria (48,3%), la digestiva (35,3%) y la ocular (13,1%). Los grupos tóxicos más frecuentes fueron los gases tóxicos (31%), los cáusticos (25,6%) y los gases irritantes (12,1%). Un 76,2% de los casos requirieron tratamiento (27,2% con antídotos). Ingresó en un centro hospitalario un 20,6% de las personas, con una estancia media de 32 (±151,94) días, con diferencias significativas para los plaguicidas y disolventes (p=0,02). Presentaron secuelas al alta un 2,1%. La mortalidad fue del 1,4% (146 pacientes), con una edad media de 62,08 años (±19,58; p=0,0001).

          Conclusiones:

          En las intoxicaciones por productos químicos, las medidas preventivas deben centrarse fundamentalmente en el ámbito doméstico, controlando las fuentes de exposición al monóxido de carbono y la manipulación de los productos de limpieza, fundamentalmente los líquidos cáusticos y la generación de gases irritantes al mezclarlos.

          ABSTRACT

          Background:

          There are few epidemiological studies on acute poisonings from pesticides, industrials and household products in Spain. The objective of this work is to describe the epidemiological and clinical profile of acute poisonings by chemical products in our country, and analyze their annual evolution.

          Methods:

          The Spanish Toxicovigilance System (SETv) is a prospective registry that includes 32 Emergency Departments and Intensive Care Units in Spain. An observational descriptive study of acute poisoning by chemical agents (excluding pharmacological products and illicit drugs) was carried out, within 1999-2014. Statistical analysis was performed using Chi-square or exact Fisher’s tests. Non-parametric continuous variables were compared using the Mann-Whitney U test. P-value less than 0.05 were considered significant.

          Results:

          The 10,548 cases studied had a mean age of 38.41 (±22.07) years, being significantly higher in women (p=0.0001). 67.7% of the poisonings occurred at home, and the most frequent routes of exposure were respiratory (48.3%), digestive (35.3%) and ocular (13.1%). The most frequent toxic groups were toxic gases (31%), caustics (25.6%) and irritant gases (12.1%). Of the patients that required treatment (76.2%), antidotes were used in 27.2%. 20.6% of the patients were admitted at Hospital, with a median stay of 32 (±151.94) days, with significant differences for pesticides and solvents (p=0.02). Sequelae were presented at discharge in 2.1% of patients. Mortality was 1.4% (146 patients) with a mean age of 62.08 years (±19.58) (p=0.0001).

          Conclusions:

          The reduction of chemical poisonings should be prevented in the domestic environment, taking into account the sources of exposure to carbon monoxide and the handling of household cleaning products, both causic liquids and the generation of irritating gases when mixed .

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          Most cited references29

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          2013 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 31st Annual Report

          ABSTRACT Background: This is the 31st Annual Report of the American Association of Poison Control Centers’ (AAPCC) National Poison Data System (NPDS). As of January 1, 2013, 57 of the nation's poison centers (PCs) uploaded case data automatically to NPDS. The upload interval was 8.08 [7.10, 11.63] (median [25%, 75%]) minutes, creating a near real-time national exposure and information database and surveillance system. Methodology: We analyzed the case data tabulating specific indices from NPDS. The methodology was similar to that of previous years. Where changes were introduced, the differences are identified. Poison center (PC) cases with medical outcomes of death were evaluated by a team of 38 medical and clinical toxicologist reviewers using an ordinal scale of 1–6 to assess the Relative Contribution to Fatality (RCF) of the exposure to the death. Results: In 2013, 3,060,122 closed encounters were logged by NPDS: 2,188,013 human exposures, 59,496 animal exposures, 806,347 information calls, 6,116 human-confirmed nonexposures, and 150 animal-confirmed nonexposures. Total encounters showed a 9.3% decline from 2012, while health care facility human exposure calls were essentially flat, decreasing by 0.1%.All information calls decreased 21.4% and health care facility (HCF) information calls decreased 8.5%, medication identification requests (drug ID) decreased 26.8%, and human exposures reported to US PCs decreased 3.8%. Human exposures with less serious outcomes have decreased 3.7% per year since 2008 while those with more serious outcomes (moderate, major or death) have increased by 4.7% per year since 2000. The top five substance classes most frequently involved in all human exposures were analgesics (11.5%), cosmetics/personal care products (7.7%), household cleaning substances (7.6%), sedatives/hypnotics/antipsychotics (5.9%), and antidepressants (4.2%). Sedative/hypnotics/antipsychotics exposures as a class increased most rapidly (2,559 calls/year) over the last 13 years for cases showing more serious outcomes. The top five most common exposures in children of 5 years or less were cosmetics/personal care products (13.8%), household cleaning substances (10.4%), analgesics (9.8%), foreign bodies/toys/miscellaneous (6.9%), and topical preparations (6.1%). Drug identification requests comprised 50.7% of all information calls. NPDS documented 2,477 human exposures resulting in death with 2,113 human fatalities judged related (RCF of 1, undoubtedly responsible; 2, probably responsible; or 3, contributory). Conclusions: These data support the continued value of PC expertise and need for specialized medical toxicology information to manage the more severe exposures, despite a decrease in calls involving less severe exposures. Unintentional and intentional exposures continue to be a significant cause of morbidity and mortality in the United States. The near real-time, always current status of NPDS represents a national public health resource to collect and monitor US exposure cases and information calls. The continuing mission of NPDS is to provide a nationwide infrastructure for public health surveillance for all types of exposures, public health event identification, resilience response and situational awareness tracking. NPDS is a model system for the nation and global public health.
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            National multicentre study of acute intoxication in emergency departments of Spain.

            No studies have been published on global acute intoxication in Spanish emergency departments. We therefore designed a multicentre study to identify the epidemiology and management of intoxicated patients in Spain. We prospectively recorded cases from 14 emergency departments during 14 randomized days between February and April 2000. We included all age groups and all kinds of acute intoxication patients (including alcohol), except food-related cases, inert foreign bodies and deaths before arrival at the emergency department. Phone calls to poison control centres and inpatients were not followed. A total of 419 cases were recorded, 0.66% of emergency department visits. The incidence of intoxication was higher at weekends and on Mondays (P<0.001). The mean age was 33 years (STD+/-18.10); males represented 56%, and 34.2% of patients arrived at the emergency department within the first 2 h. A total of 80% of patients were treated as outpatients, 3.7% were admitted to the intensive care unit, 6.7% were hospitalized, and 0.2% died. We recorded a slightly lower incidence than other European countries with the same epidemiological profile, except for a low incidence of acetaminophen cases. If we apply the European Association of Poisons Centres and Clinical Toxicologists gastric lavage criteria, there were an important number of unnecessary gut decontamination techniques in drug poisoning. Most patients were treated in emergency departments, without hospital admission.
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              The Toxicology Investigators Consortium (ToxIC) Registry

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                Author and article information

                Journal
                Rev Esp Salud Publica
                Rev Esp Salud Publica
                resp
                Revista Española de Salud Pública
                Ministerio de Sanidad, Consumo y Bienestar social
                1135-5727
                2173-9110
                02 November 2020
                2020
                : 94
                : 202001007
                Affiliations
                [1 ] originalServicio de Urgencias. Hospital Universitario de Canarias. Tenerife. España. orgnameHospital Universitario de Canarias orgdiv1Servicio de Urgencias Tenerife, España
                [2 ] originalUniversidad de La Laguna. Tenerife. España. orgnameUniversidad de La Laguna Tenerife, España
                [3 ] originalFundación Española de Toxicología Clínica. Zaragoza. España. orgnameFundación Española de Toxicología Clínica Canarias Zaragoza, España
                [4 ] originalUnidad de Toxicología Clínica. Hospital Clínico Lozano Blesa. Zaragoza. España. orgnameHospital Clínico Lozano Blesa orgdiv1Unidad de Toxicología Clínica Zaragoza, España
                [5 ] originalUniversidad de Zaragoza. Zaragoza. España. orgnameUniversidad de Zaragoza Zaragoza, España
                [6 ] originalServicio de Urgencias y Unidad de Toxicología Clínica. Hospital Son Espases. Palma de Mallorca. España. orgnameHospital Son Espases orgdiv1Servicio de Urgencias y Unidad de Toxicología Clínica Palma de Mallorca, España
                [7 ] originalUnidad de Toxicología Clínica. Servicio de Urgencias. Hospital Clìnic. Barcelona. España. orgnameHospital Clìnic orgdiv1Servicio de Urgencias orgdiv2Unidad de Toxicología Clínica Barcelona, España
                [8 ] originalUniversidad de Barcelona. Barcelona. España. orgnameUniversitat de Barcelona Barcelona, España
                [9 ] originalUnidad Regional de Toxicología Clínica. Hospital Universitario del Río Ortega. Valladolid. España. orgnameHospital Universitario del Río Ortega orgdiv1Unidad Regional de Toxicología Clínica Valladolid, España
                [10 ] originalUniversidad de Valladolid. Valladolid. España. orgnameUniversidad de Valladolid Valladolid, España
                Author notes
                Correspondencia: Guillermo Burillo Putze. Servicio de Urgencias. Hospital Universitario de Canarias. Ofra, s/n, 38320 La Laguna, Santa Cruz de Tenerife, España. gburillo@ 123456telefonica.net

                Los autores declaran que no existe ningún conflicto de interés.

                Article
                e202001007
                11567618
                2f6006c5-da85-475b-9db5-68c224880669

                Este es un artículo publicado en acceso abierto bajo una licencia Creative Commons

                History
                : 13 August 2019
                : 19 September 2019
                : 16 January 2020
                Page count
                Figures: 2, Tables: 1, Equations: 0, References: 19
                Categories
                Originales Breves

                vigilancia epidemiológica,envenenamiento,productos domésticos,intoxicación por gas,cáusticos,epidemiological monitoring,poisoning,household products,gas poisoning,corrosives

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