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Clinical and economic characteristics of emergency department visits due to acetaminophen toxicity in the USA

OBJECTIVES: To estimate the number of acetaminophen (APAP) toxicity-related emergency department (ED) visits, and to assess their associated clinical and economic burden in the USA from 2006 to 2010. DESIGN: Cross-sectional, retrospective, large-scale database study. SETTING: Non-federal, non-rehabi...

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Autores principales: Altyar, Ahmed, Kordi, Lama, Skrepnek, Grant
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4567677/
https://www.ncbi.nlm.nih.gov/pubmed/26353865
http://dx.doi.org/10.1136/bmjopen-2014-007368
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author Altyar, Ahmed
Kordi, Lama
Skrepnek, Grant
author_facet Altyar, Ahmed
Kordi, Lama
Skrepnek, Grant
author_sort Altyar, Ahmed
collection PubMed
description OBJECTIVES: To estimate the number of acetaminophen (APAP) toxicity-related emergency department (ED) visits, and to assess their associated clinical and economic burden in the USA from 2006 to 2010. DESIGN: Cross-sectional, retrospective, large-scale database study. SETTING: Non-federal, non-rehabilitation, community EDs in the USA. PARTICIPANTS: Inclusion criteria included any listed diagnosis identifying poisoning by aromatic analgesics paracetamol/APAP or associated supplementary code. Generalised linear models were used to investigate the association between outcomes of inpatient admission, mortality, requirement of invasive mechanical ventilation, charges and inpatient lengths of stay based on patient, hospital and clinical characteristics. RESULTS: Across the 625.2 million ED visits in the USA from 2006 to 2010, 411 811 APAP-related toxicity ED visits were observed, with 45.5% resulting in inpatient admission, 4.7% requiring invasive mechanical ventilation and 0.6% involving death. Overall, the incidence proportion was 27.10 per 100 000 US population, exceeding 70 per 100 000 at age 2 years and ages 16–18 years. The total national bill was $1.06 billion per year (US$ 2014), and predominantly involved females (65.5%) and intentional self-harm (58.4%), which were notably higher within the 12–20 years age category (female(12–20 years)=74.8%, intentional self-harm(12–20 years)=71.4%). Behavioural and mental health comorbidities were relatively common and associated with an increased relative risk of admission and likelihood of charges almost entirely across all age categories of ≥12 years within the multivariable analyses. The number of ED visits did not appreciably change over time, decreasing by <2% from 2006 to 2010 (n=1351). Multivariable results also suggested no consistent change in outcomes across the study's time horizon. CONCLUSIONS: A substantial public health impact of APAP toxicity-related cases was observed in the US from 2006 to 2010, with incidence proportions peaking at age 2 years and ages 16–18 years. After controlling for numerous factors, no consistent change was observed over the 5-year time horizon concerning outcomes of admission, mortality, invasive mechanical ventilation, charges or length of stay.
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spelling pubmed-45676772015-09-17 Clinical and economic characteristics of emergency department visits due to acetaminophen toxicity in the USA Altyar, Ahmed Kordi, Lama Skrepnek, Grant BMJ Open Health Services Research OBJECTIVES: To estimate the number of acetaminophen (APAP) toxicity-related emergency department (ED) visits, and to assess their associated clinical and economic burden in the USA from 2006 to 2010. DESIGN: Cross-sectional, retrospective, large-scale database study. SETTING: Non-federal, non-rehabilitation, community EDs in the USA. PARTICIPANTS: Inclusion criteria included any listed diagnosis identifying poisoning by aromatic analgesics paracetamol/APAP or associated supplementary code. Generalised linear models were used to investigate the association between outcomes of inpatient admission, mortality, requirement of invasive mechanical ventilation, charges and inpatient lengths of stay based on patient, hospital and clinical characteristics. RESULTS: Across the 625.2 million ED visits in the USA from 2006 to 2010, 411 811 APAP-related toxicity ED visits were observed, with 45.5% resulting in inpatient admission, 4.7% requiring invasive mechanical ventilation and 0.6% involving death. Overall, the incidence proportion was 27.10 per 100 000 US population, exceeding 70 per 100 000 at age 2 years and ages 16–18 years. The total national bill was $1.06 billion per year (US$ 2014), and predominantly involved females (65.5%) and intentional self-harm (58.4%), which were notably higher within the 12–20 years age category (female(12–20 years)=74.8%, intentional self-harm(12–20 years)=71.4%). Behavioural and mental health comorbidities were relatively common and associated with an increased relative risk of admission and likelihood of charges almost entirely across all age categories of ≥12 years within the multivariable analyses. The number of ED visits did not appreciably change over time, decreasing by <2% from 2006 to 2010 (n=1351). Multivariable results also suggested no consistent change in outcomes across the study's time horizon. CONCLUSIONS: A substantial public health impact of APAP toxicity-related cases was observed in the US from 2006 to 2010, with incidence proportions peaking at age 2 years and ages 16–18 years. After controlling for numerous factors, no consistent change was observed over the 5-year time horizon concerning outcomes of admission, mortality, invasive mechanical ventilation, charges or length of stay. BMJ Publishing Group 2015-09-09 /pmc/articles/PMC4567677/ /pubmed/26353865 http://dx.doi.org/10.1136/bmjopen-2014-007368 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Health Services Research
Altyar, Ahmed
Kordi, Lama
Skrepnek, Grant
Clinical and economic characteristics of emergency department visits due to acetaminophen toxicity in the USA
title Clinical and economic characteristics of emergency department visits due to acetaminophen toxicity in the USA
title_full Clinical and economic characteristics of emergency department visits due to acetaminophen toxicity in the USA
title_fullStr Clinical and economic characteristics of emergency department visits due to acetaminophen toxicity in the USA
title_full_unstemmed Clinical and economic characteristics of emergency department visits due to acetaminophen toxicity in the USA
title_short Clinical and economic characteristics of emergency department visits due to acetaminophen toxicity in the USA
title_sort clinical and economic characteristics of emergency department visits due to acetaminophen toxicity in the usa
topic Health Services Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4567677/
https://www.ncbi.nlm.nih.gov/pubmed/26353865
http://dx.doi.org/10.1136/bmjopen-2014-007368
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