Editorial
Poisonings in Spain: looking the other way
Intoxicaciones en España: mirando hacia otro lado
Jordi Puiguriguer
Corresponding author
Unitat de Toxicología Clínica. Hospital Universitari Son Espases, Palma de Mallorca, Spain
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Hospital Universitari Son Espases, Palma de Mallorca, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Intoxicaciones en España: mirando hacia otro lado" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Readers will probably judge the title as scientifically dubious, but after reviewing the state of poisonings in Spain and examining the reality of the situation, greater optimism than suggested by the title is unwarranted. I hope not to jeopardize the trust placed in me by the editor in charge of this prestigious journal, which would end up confirming my inevitable failure as a writer.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Thanks to the achievements of Bartomeu Orfila in the 19th century, toxicology ceased to be a realm of magic and instead became a science, although this illustrious Minorcan had to flee his country to the Paris of Napoleon. Since then, there have been numerous advances in this field, especially since the 1970s. By the 1990s, toxicology had been consolidated as a science and medical specialty in much of the Western world.</p><p id="par0015" class="elsevierStylePara elsevierViewall">As the result of this progress, the treatment of acutely poisoned individuals reached technical, educational (both university and specialized training) and professional levels similar to that of other disciplines. Examples include the various consensus documents by international scientific societies and published reviews since 2000 on highly specific therapeutic aspects of toxicology (agreements on the criteria for renal replacement for patients with poisoning, availability of antidotes and their placement in health centers, digestive decontamination, etc.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a>), as well as specific advances in the diagnostic capacity of laboratories, adapting them to the new reality<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and the successful indication in countries such as France and the US for extracorporeal membrane oxygenation techniques for vital support in cases of toxin-induced cardiogenic shock refractory to conventional treatment.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In parallel to this scientific development, there has been a notable increase in the risk of poisonings due to various factors that will not be contained in the future: growing industrialization, new recreational and leisure time patterns, illicit drug trade, etc.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In standard clinical practice, there are numerous complex clinical conditions in which the etiological diagnosis requires a differential range in which some toxin is usually involved, but due to idiosyncratic training deficiencies, we start from a disadvantageous position to address them as they deserve to be addressed.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In addition to recognizing them, the first step towards correcting these deficiencies should be to quantify them. The study presented by Baeza in this issue is therefore an important contribution.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> There have been various initiatives aimed at promoting poisoning registries. However, these initiatives have almost always arisen from personal professional initiatives, far from any institutional planning, as would be desirable. At least these initiatives have helped analyze local epidemiological aspects (such as that of the study), some multicenter experiences but without temporal continuity<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and more longitudinal series in time but that assess highly specific aspects, such as those promoted by the Spanish Foundation for Clinical Toxicology (chemical poisoning since 1999<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and hospital mortality due to poisoning<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>) and by the toxicology observatory of the Spanish Society of Emergency Pediatrics.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> When we compare the initiatives with those published annually from 1985 in the US, with epidemiological and healthcare information on more than 2 million telephone consultations and visits to poison centers in the US and more than 60 million episodes during this period,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> we understand the urgent need to correct this shortcoming. Faced with the obvious ethical difficulties in conducting clinical trials on toxicology, the epidemiological studies that approach such trials, due to the possibility of estimating the causal effects, are the only valid tools for deepening our understanding of toxicology.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Based on the results of the study by Baeza,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> we should reflect on some of the data. On one hand, we have the high recurrence rate (32%) and the large number of patients discharged without completing their care (5.5%) and the high rate of hospitalized patients (10.5%). These are undoubtedly a repercussion of the entrenched acute and chronic alcohol abuse in Spanish society, the primary toxin in recorded poisonings; however, they also reflect two realities. First, the burden of care for these patients lies mainly on the hospital emergency departments and suggests that these departments represent the only point of contact with healthcare for patients with a highly specific and perfectly identifiable profile. Second, their care is one of the causes for oversaturation of this typically overburdened area, due to these patients’ often extended hospital stay (almost 14% with observations longer than 12 h, without accounting for those who are hospitalized) in the context of an activity for which they were not designed. This impact is particularly significant on hospital emergency departments, due to the lack of specific standardized training in toxicology for most practitioners in Spain.</p><p id="par0040" class="elsevierStylePara elsevierViewall">What is clear from the results of the study by Baeza et al.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> is the impact of leisure and recreational activities on poisonings. According to the conclusions of the annual report of the European Monitoring Center for Drugs and Drug Addiction, Spain leads Europe in the confiscation and consumption of cannabis and cocaine.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> In a country where tourism plays a predominant role in its economics, there is nothing to suggest that this type of poisoning will decrease in the future.</p><p id="par0045" class="elsevierStylePara elsevierViewall">We therefore need to take advantage of the inertia of this initiative to extend its example and establish a unified registry that helps identify and measure the current problem of poisonings in Spain. From there, we need to prioritize the appropriate measures to improve care for poisonings and thereby start to definitively refute the title of this editorial.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Puiguriguer J. Intoxicaciones en España: mirando hacia otro lado. Rev Clin Esp. 2020;220:248–249.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Position paper update: gastric lavage for gastrointestinal decontamination" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Benson" 1 => "K. Hoppu" 2 => "W. Troutman" 3 => "R. 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| 2023 March | 3 | 5 | 8 |
