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Acute poisoning at local hospitals
Intoxicaciones agudas en hospitales comarcales
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Ibrahim-Achi, M.A. Pérez-Carrillo, M. Expósito-Rodriguez, G. Burillo-Putze" "autores" => array:4 [ 0 => array:3 [ "nombre" => "D." "apellidos" => "Ibrahim-Achi" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 1 => array:3 [ "nombre" => "M.A." "apellidos" => "Pérez-Carrillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Expósito-Rodriguez" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:4 [ "nombre" => "G." "apellidos" => "Burillo-Putze" "email" => array:1 [ 0 => "gburillo@telefonica.net" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Universidad de La Laguna, La Laguna, Santa Cruz de Tenerife, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Universidad Europea de Canarias, La Orotava, Santa Cruz de Tenerife, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Intoxicaciones agudas en hospitales comarcales" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The article by Baeza et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> provides, in our opinion, an important overview of acute poisonings. Most published series in Spain are currently based on data from patients with poisonings treated only in tertiary or reference hospitals, located in large cities, generally the capitals of provinces or of autonomous regions. The study by Baeza et al., in contrast, provides epidemiological data on emergency care in hospital centers at lower care levels, one of which is also a characteristic summer tourist area, with its expected seasonal fluctuations, but not previously.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> Given that it is difficult even for reference hospitals to find emergency care professionals interested in clinical toxicology and involved in epidemiological research, finding them in smaller hospitals with over a period of 5 years is exceptionally commendable.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In the evolution of the incidence of cases, it is noteworthy how the poisoning rate practically triples in the centers with a significantly lower population coverage, compared with urban hospitals where the poisoning rate remained virtually constant over the 5 years analyzed despite a 10% increase in the number of emergencies treated. The authors do not have an explanation for this difference, which could be due to the type of toxic (alcohol) responsible for the Emergency Department visit.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Moreover, there was a notable rate of poisoning in individuals older than 75 years, with differences in the reasons behind the poisoning according to sex, but different to those of other series, where more suicidal poisonings and those resulting in death occurred in this age group.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> With an increasingly aging Spanish population with more and more geriatric emergencies,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> this is another epidemiological element to consider in future epidemiological studies, and therefore for prevention.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In terms of the toxic subtances responsible for poisonings, there is a scarcity of cases related to agricultural products, despite the study's suburban-rural setting, as well as few poisonings due to paracetamol. In contrast, there was a nonnegligible number of cases due to anticoagulants not previously reported and, what is more disconcerting, 109 cases due to opioids, with the inrush (albeit weak) of heroin, which could be undergoing a resurgence in Spain, as it has been clearly happening in other neighboring countries.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> Moreover, it might have been interesting to determine the number of patients diagnosed only by laboratory tests, considering this also leaves out the emerging new psychoactive substances (<span class="elsevierStyleItalic">e.g.</span>, mephedrone, synthetic cannabinoids, piperazine), which for now are undetectable in most Spanish tertiary hospitals and in all secondary hospitals.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">7,8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The high percentage of patients treated in the first 2<span class="elsevierStyleHsp" style=""></span>hours is probably due to the proximity of healthcare centers to the treated population. As rightly stated by the authors, the precocity of care is related to the high resolutive capacity of the analyzed emergency departments. It is also likely that the relatively high hospital admission rate is due to the reduced availability of beds in observation areas of the emergency department.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Lastly, the emergency department can be another tool for the healthcare system, especially in smaller settings and <span class="elsevierStyleItalic">a priori</span> with a closer physician–patient relationship. Prevention programs for frail groups (such as the elderly patients indicated in the series) and strategies to reduce the worrisome alcohol consumption that the study demonstrates can be developed. Initiatives such as that implemented in the autonomous community of Castilla y León have achieved interesting results, although a high degree of commitment is needed from emergency department professionals.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a></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: Ibrahim-Achi D, Pérez-Carrillo MA, Expósito-Rodriguez M, Burillo-Putze G. Intoxicaciones agudas en hospitales comarcales. Rev Clin Esp. 2020;220:388–389.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalencia de las intoxicaciones agudas asistidas en 3 hospitales del sureste español" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Baeza" 1 => "A. Muñoz-Ortega" 2 => "N. 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