Hostname: page-component-76fb5796d-qxdb6 Total loading time: 0 Render date: 2024-04-29T23:42:34.089Z Has data issue: false hasContentIssue false
  • English
  • Français

Emergency department visits for acetaminophen overdose: a Canadian population-based epidemiologic study (1997–2002)

Published online by Cambridge University Press:  21 May 2015

Robert P. Myers ,
Bing Li  and
Abdel Aziz M. Shaheen
Robert P. Myers*
Affiliation:
Liver Unit, Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alta. Department of Community Health Sciences, University of Calgary, Calgary, Alta.
Bing Li
Affiliation:
Department of Community Health Sciences, University of Calgary, Calgary, Alta.
Abdel Aziz M. Shaheen
Affiliation:
Liver Unit, Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alta.
*
Liver Unit, University of Calgary, G126, 3330 Hospital Dr. N.W., Calgary AB T2N 4N1; rpmyers@ucalgary.ca

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

We describe the epidemiology of emergency department (ED) visits for acetaminophen overdose in a large Canadian health region, with a focus on sociodemographic risk factors and temporal trends.

Methods:

Patients presenting to an ED in the Calgary Health Region (population ~ 1.1 million) for acetaminophen overdose between 1997 and 2002 were identified using regional administrative data.

Results:

A total of 2699 patients made 3015 ED visits for acetaminophen overdose between 1997 and 2002, corresponding to an age- and sex-adjusted incidence of 45.7 per 100 000 population. Alcohol-related disorders were common (19%) and overdose rates were higher in females, younger patients, Aboriginals and social assistance recipients. The incidence decreased from 52.6 per 100 000 in 1997 to 35.1 per 100 000 in 2002 (34% relative reduction; p < 0.0005). When classified according to suicidal intent, the rates of intentional and unintentional overdose (69% and 25% of all overdoses, respectively) showed similar temporal trends. A marked seasonality was observed, with a peak in spring and early summer.

Conclusions:

ED visit rates for acetaminophen overdose fell between 1997 and 2002. High-risk groups, including young females and marginalized populations, may benefit from preventive and educational initiatives.

Keywords

acetaminophendatabaseepidemiologyparacetamolself-injurious behaviour
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 9 , Issue 4 , July 2007 , pp. 267 - 274
Copyright
Copyright © Canadian Association of Emergency Physicians 2007

References

1.Prior, MJ, Cooper, K, Cummins, P, et al. Acetaminophen availability increases in Canada with no increase in the incidence of reports of inpatient hospitalizations with acetaminophen overdose and acute liver toxicity. Am J Ther 2004;11:443–52.Google Scholar
2.Rumack, BH. Acetaminophen hepatotoxicity: the first 35 years. J Toxicol Clin Toxicol 2002;40:3–20.Google Scholar
3.Larson, AM, Polson, J, Fontana, RJ, et al. Acetaminophen-induced acute liver failure: results of a United States multicenter, prospective study. Hepatology 2005;42:1364–72.Google Scholar
4.Ostapowicz, G, Fontana, RJ, Schiodt, FV, et al. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med 2002;137:947–54.Google Scholar
5.Makin, AJ, Wendon, J, Williams, R. A 7-year experience of severe acetaminophen-induced hepatotoxicity (1987–1993). Gastroenterology 1995;109:1907–16.Google Scholar
6.Schiodt, FV, Rochling, FA, Casey, DL, et al. Acetaminophen toxicity in an urban county hospital. N Engl J Med 1997;337:1112–7.CrossRefGoogle Scholar
7.Schiodt, FV, Lee, WM, Bondesen, S, et al. Influence of acute and chronic alcohol intake on the clinical course and outcome in acetaminophen overdose. Aliment Pharmacol Ther 2002;16:707–15.Google Scholar
8.Schmidt, LE, Dalhoff, K, Poulsen, HE. Acute versus chronic alcohol consumption in acetaminophen-induced hepatotoxicity. Hepatology 2002;35:876–82.CrossRefGoogle ScholarPubMed
9.Ayonrinde, OT, Phelps, GJ, Hurley, JC, et al. Paracetamol overdose and hepatotoxicity at a regional Australian hospital: a 4-year experience. Intern Med J 2005;35:655–60.Google Scholar
10.Lee, WM. Acetaminophen and the U.S. Acute Liver Failure Study Group: lowering the risks of hepatic failure. Hepatology 2004;40:6–9.CrossRefGoogle Scholar
11.Turvill, JL, Burroughs, AK, Moore, KP. Change in occurrence of paracetamol overdose in UK after introduction of blister packs. Lancet 2000;355:2048–9.Google Scholar
12.Bond, GR, Novak, JE. The human and economic cost of paracetamol (acetaminophen) overdose. Pharmacoeconomics 1995;8:177–81.Google Scholar
13.Nourjah, P, Ahmad, SR, Karwoski, C, et al. Estimates of acetaminophen (paracetomal)-associated overdoses in the United States. Pharmacoepidemiol Drug Saf 2005.Google Scholar
14.Bateman, DN, Bain, M, Gorman, D, et al. Changes in paracetamol, antidepressants and opioid poisoning in Scotland during the 1990s. QJM 2003;96:125–32.Google Scholar
15.Prince, MI, Thomas, SH, James, OF, et al. Reduction in incidence of severe paracetamol poisoning. Lancet 2000;355:2047–8.Google Scholar
16.Robinson, D, Smith, AM, Johnston, GD. Severity of overdose after restriction of paracetamol availability: retrospective study. BMJ 2000;321:926–7.Google Scholar
17.Bond, GR, Hite, LK. Population-based incidence and outcome of acetaminophen poisoning by type of ingestion. Acad Emerg Med 1999;6:1115–20.Google Scholar
18.Fagan, E, Wannan, G. Reducing paracetamol overdoses. BMJ 1996;313:1417–8.Google Scholar
19.Committee on Safety of Medicines. Paracetamol and aspirin. Curr Prob Pharmacovigilance 1997;23:9.Google Scholar
20.Morgan, O, Majeed, A. Restricting paracetamol in the United Kingdom to reduce poisoning: a systematic review. J PublicHealth (Oxf) 2005;27:12–8.Google Scholar
21. Data disclosure handbook. Part VI. Data resources at Alberta Health and Wellness. Government of Alberta. Available: http://www.health.gov.ab.ca (accessed 2006 March 6).Google Scholar
22.Colman, I, Dryden, DM, Thompson, AH, et al. Utilization of the emergency department after self-inflicted injury. Acad Emerg Med 2004;11:136–42.Google ScholarPubMed
23.International Classificiation of Diseases. 9th revision, Clinical Modification (ICD-9-CM). Los Angeles (CA): Practice Management Information Corporation; 2001.Google Scholar
24.International Statistical Classifications of Diseases and Related Health Problems. 10th revision (ICD-10). 2nd edition. Geneva(CH): World Health Organization; 2005.Google Scholar
25.Status. Most often asked questions. Indian and Northern Affairs Canada. 2004. Available:http://www.ainc-inac.gc.ca/pr/pub/ywtk/index_e.html (accessed 2006 Mar 6).Google Scholar
26.Adams, WL, Yuan, Z, Barboriak, JJ, et al. Alcohol-related hospi-talizations of elderly people. Prevalence and geographic variation in the United States. JAMA 1993;270:1222–5.CrossRefGoogle ScholarPubMed
27.Saitz, R, Ghali, WA, Moskowitz, MA. The impact of alcohol-related diagnoses on pneumonia outcomes. Arch Intern Med 1997;157:1446–52.Google Scholar
28.Cameron, AC, Trivedi, PK. Regression analysis of count data. New York (NY): Cambridge University Press; 1998.Google Scholar
29.Langlois, S, Morrison, P. Suicide deaths and suicide attempts. Health Rep 2002;13:9–22.Google Scholar
30.Trends in suicide in England and Wales, 1982–1996. UK Office for National Statistics. 1998. Available: http://www.statistics .gov.uk/articles/population_trends/suicide_pt92.pdf (accessed 2006 April 25).Google Scholar
31.Colman, I, Yiannakoulias, N, Schopflocher, D, et al. Population based study of medically treated self-inflicted injuries. Can J Emerg Med 2004;6:313–20.Google Scholar
33.Clayer, JR, Czechowicz, AS. Suicide by aboriginal people in South Australia: comparison with suicide deaths in the total urban and rural populations. Med J Aust 1991;154:683–5.Google Scholar
34.Rumack, BH, Matthew, H. Acetaminophen poisoning and toxic-ity. Pediatrics 1975;55:871–6.CrossRefGoogle Scholar
35.Makin, A, Williams, R. Paracetamol hepatotoxicity and alcohol consumption in deliberate and accidental overdose. QJM 2000;93:341–9.Google Scholar
36.Rhodes, AE, Links, PS, Streiner, DL, et al. Do hospital E-codes consistently capture suicidal behaviour? Chronic Dis Can 2002;23:139–45.Google Scholar
37.Iribarren, C, Sidney, S, Jacobs, DR Jr, et al. Hospitalization for suicide attempt and completed suicide: epidemiological features in a managed care population. Soc Psychiatry Psychiatr Epidemiol 2000;35:288–96.Google Scholar
38.LeMier, M, Cummings, P, West, TA. Accuracy of external cause of injury codes reported in Washington State hospital discharge records. Inj Prev 2001;7:334–8.CrossRefGoogle ScholarPubMed
39.Gyamlani, GG, Parikh, CR. Acetaminophen toxicity: suicidal vs. accidental. Crit Care 2002;6:155–9.Google Scholar
40.Barker, A, Hawton, K, Fagg, J, et al. Seasonal and weather factors in parasuicide.Br J Psychiatry 1994;165:375–80.Google Scholar
41.MacMahon, K. Short-term temporal cycles in the frequency of suicide. United States, 1972–1978. Am J Epidemiol 1983;117: 744–50.Google Scholar
42.Masterton, G. Monthly and seasonal variation in parasuicide. A sex difference. Br J Psychiatry 1991;158:155–7.CrossRefGoogle ScholarPubMed
43.Petridou, E, Papadopoulos, FC, Frangakis, CE, et al. A role of sunshine in the triggering of suicide. Epidemiology 2002;13:106–9.Google Scholar
44.Meehan, PJ, Lamb, JA, Saltzman, LE, et al. Attempted suicide among young adults: progress toward a meaningful estimate of prevalence. Am J Psychiatry 1992;149:41–4.Google Scholar