Emergency department management and outcome for self-poisoning: a cohort study
Emergency department management and outcome for self-poisoning: a cohort study
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DOI：
10.1016/j.genhosppsych.2003.06.002
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发表时间：
2004-01-01
影响因子：
7
通讯作者：
House, A
中科院分区：
文献类型：
--
作者：
Kapur, N;Cooper, J;House, A
成年人的自我中毒是一个重要的公共卫生问题，但缺乏指导心理管理的证据。在当前的队列研究中，我们希望调查急诊科常规管理的各个方面，例如接受心理社会评估或转诊接受专家随访，是否会影响自我中毒的重复率。该研究在英国大曼彻斯特的四家内城医院进行，为期5个月。我们使用医院的信息系统，并审查了每一个病人到急诊室的病例记录，以确定前瞻性的所有成年病人故意自我中毒。收集了每次事件的急诊科管理数据。曼彻斯特和索尔福德的自我伤害数据库被用来确定在他们的指数事件发生后6个月内继续重复自我中毒的人数。在招募期间，658人出现了自我中毒。传统的重复风险因素，如物质依赖，精神接触，和以前的自我中毒与更大的可能性接受心理社会评估或被转介到专家的后续行动。96例患者（14.6%）在其索引发作的6个月内重复自我中毒。在调整基线人口统计学和临床特征以及住院时间后，接受心理社会评估与重复率降低无关，但转诊进行专家随访[重复率的调整风险比（95% CI）：0.49（0.25至0.84），P= 0.01]。我们发现，在自我中毒后进行积极的随访与重复风险降低有关。这一发现的影响进行了讨论。采用队列和随机对照研究设计的进一步研究将有助于为中毒患者提供管理策略。(C)2004年爱思唯尔公司All rights reserved.
Self-poisoning in adults is an important public health problem across the world, but evidence to guide psychological management is lacking. In the current cohort study we wished to investigate whether aspects of routine Emergency Department management such as receiving a psycho-social assessment, or being referred for specialist follow up, affected the rate of repetition of self-poisoning. The study was carried out in four inner city hospitals in Greater Manchester, United Kingdom, over a 5-month period. We used hospital information systems and reviewed the case notes of every patient presenting to the Emergency Department to identify prospectively all adult patients presenting with deliberate self-poisoning. Data regarding the Emergency Department management of each episode were collected. The Manchester and Salford self-harm database was used to determine the number of individuals who went on to repeat self-poisoning within 6 months of their index episode. During the recruitment period 658 individuals presented with self-poisoning. Traditional risk factors for repetition such as substance dependence, psychiatric contact, and previous self-poisoning were associated with a greater likelihood of receiving a psycho-social assessment or being referred for specialist follow-up. Ninety-six patients (14.6%) repeated self-poisoning within 6 months of their index episode. After adjustment for baseline demographic and clinical characteristics and hospital, receiving a psycho-social assessment was not associated with reduced repetition but being referred for specialist follow-up was [adjusted hazard ratio for repetition (95% Cl): 0.49 (0.25 to 0.84), P=.01]. We found that being referred for active follow-up after self-poisoning was associated with a reduced risk of repetition. The implications of this finding are discussed. Further studies using both cohort and randomized controlled study designs will help inform management strategies for patients who poison themselves. (C) 2004 Elsevier Inc. All rights reserved.