Poisonings in Spain: looking the other way

Puiguriguer, Jordi

doi:10.1016/j.rceng.2019.09.002

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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" => "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.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.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">1–3</a>), as well as specific advances in the diagnostic capacity of laboratories, adapting them to the new reality<a class="elsevierStyleCrossRef" href="#bib0020">4</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">5</a>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.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.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">6</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">7</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">8</a> and hospital mortality due to poisoning<a class="elsevierStyleCrossRef" href="#bib0045">9</a>) and by the toxicology observatory of the Spanish Society of Emergency Pediatrics.<a class="elsevierStyleCrossRef" href="#bib0050">10</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">11</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.Based on the results of the study by Baeza,<a class="elsevierStyleCrossRef" href="#bib0025">5</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.What is clear from the results of the study by Baeza et al.<a class="elsevierStyleCrossRef" href="#bib0025">5</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">12</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.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." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Puiguriguer J. Intoxicaciones en España: mirando hacia otro lado. 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Revista Clínica Española (English Edition)

ISSN: 2254-8874

Revista Clínica Española published its first issue in 1940 and is the body of expression of the Spanish Society of Internal Medicine (SEMI).
The journal fully endorses the goals of updating knowledge and facilitating the acquisition of key developments in internal medicine applied to clinical practice. Revista Clínica Española is subject to a thorough double blind review of the received articles written in Spanish or English. Ten issues are published each year, including mostly originals, reviews and consensus documents.

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Current Contents / Clinical Medicine , JCR / SCI-Expanded, Index Medicus / Medline y Excerpta Medica / EMBASE

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Impact factor

The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years.

© Clarivate Analytics, Journal Citation Reports 2022

Impact factor 2023

2.3

Citescore

CiteScore measures average citations received per document published.

Citescore 2023

0.7

SJR

SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.

SJR 2023

0.162

SNIP

SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.

SNIP 2023

0.211

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Journal Information

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Vol. 220. Issue 4.

Pages 248-249 (May 2020)

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