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2019 &#40;per&#237;odo prepandemia&#41;&#44; 2020 &#40;per&#237;odo de confinamiento e inicio de la desescalada&#41; y 2021 &#40;per&#237;odo reactivaci&#243;n actividades sociales&#41;&#46; Este estudio cont&#243; con la aprobaci&#243;n del Comit&#233; de &#201;tica de la Investigaci&#243;n de las Islas Baleares &#40;n&#46;&#176; de expediente IB 4679&#47;21 PI&#44; con fecha del 27&#47;10&#47;2021&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El an&#225;lisis estad&#237;stico se llev&#243; a cabo mediante un an&#225;lisis descriptivo&#160;univariante&#160;de las variables incluidas en el estudio &#40;sexo&#44; edad y origen del intoxicado&#44; motivaci&#243;n de la intoxicaci&#243;n&#44; tipo de t&#243;xico&#44; realizaci&#243;n de medidas de descontaminaci&#243;n digestiva&#44; empleo de ant&#237;dotos&#44; indicaci&#243;n de medidas contenci&#243;n&#44; destino&#44; estancia y muerte&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Para el an&#225;lisis bivariante se emple&#243; la prueba de la t de&#160;Student-Fisher&#44; y para evaluar la relaci&#243;n entre variables categ&#243;ricas se aplic&#243;&#160;la prueba de Chi-cuadrado &#40;y sus correspondientes pruebas no param&#233;tricas cuando no se cumpl&#237;an las condiciones de aplicaci&#243;n&#41;&#44; calculando los correspondientes intervalos de confianza&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0040" class="elsevierStylePara elsevierViewall">Se incluyeron 1&#46;182 pacientes intoxicados&#46; Como se muestra en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#44; en relaci&#243;n con la etapa prepand&#233;mica&#44; el n&#250;mero de intoxicaciones agudas disminuy&#243; a partir del a&#241;o 2019 de forma significativa principalmente el a&#241;o 2020 &#40;2019&#58; 1&#44;9 vs&#46; 2020&#58; 1&#44;5&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; mientras que la ratio var&#243;n&#47;mujer aument&#243; &#40;2&#44;0 vs&#46; 1&#44;4&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41;&#44; as&#237; como lo hizo la edad media de los intoxicados &#40;31&#44;4 vs&#46; 41&#44;3&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Las intoxicaciones suicidas crecieron tambi&#233;n durante la pandemia &#40;8&#44;71 vs&#46; 21&#44;0&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; as&#237; como las medicamentosas &#40;14&#44;20 vs&#46; 28&#44;76&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; y&#44; como consecuencia de ello&#44; la proporci&#243;n de intoxicados que precisaron medidas de descontaminaci&#243;n digestiva &#40;0&#44;95 vs&#46; 4&#44;7&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;00&#41;&#44; y necesidad de ingreso hospitalario &#40;2&#44;46 vs&#46; 5&#44;35&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Por el contrario&#44; las intoxicaciones con drogas recreativas disminuyeron notablemente &#40;76&#44;1 vs&#46; 62&#44;0&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; as&#237; como los pacientes de origen extranjero &#40;50&#44;6 vs&#46; 4&#44;7&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;00&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Los resultados del &#250;ltimo per&#237;odo &#40;verano 2021&#41;&#44; comparados con el a&#241;o anterior a la pandemia &#40;2019&#41;&#44; confirman alguna de estas tendencias&#44; persistiendo el incremento de las intoxicaciones con motivaci&#243;n suicida &#40;2019&#58; 8&#44;7 vs&#46; 2021&#58; 16&#44;3&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;00&#41;&#44; medicamentosas &#40;14&#44;2 vs&#46; 26&#44;2&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;00&#41; y las que requirieron ingreso &#40;2&#44;5 vs&#46; 5&#44;9&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Las intoxicaciones en mujeres volvieron a incrementarse porcentualmente &#40;33&#44;1 vs&#46; 41&#44;4&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;04&#41;&#59; y&#44; tras la relajaci&#243;n de las medidas restrictivas durante el verano de 2021&#44; reaparecen las intoxicaciones recreativas por drogas de abuso &#40;14&#44;0 vs&#46; 32&#44;7&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;00&#41; y los intoxicados de origen extranjero &#40;11&#44;4 vs&#46; 31&#44;8&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;00&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0055" class="elsevierStylePara elsevierViewall">La mayor parte de los resultados epidemiol&#243;gicos de los intoxicados atendidos en estos per&#237;odos difieren de los obtenidos en estudios previos publicados&#44; como la serie de Baeza en 3 hospitales p&#250;blicos del sur de Espa&#241;a&#44; en la que la prevalencia de las intoxicaciones se manten&#237;a constante&#44; a&#241;o tras a&#241;o&#44; influenciada fundamentalmente en aquel estudio por la localizaci&#243;n de hospital &#40;&#225;rea urbana o rural&#41; y por una variabilidad estacional<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">En nuestra serie&#44; hemos evidenciado un cambio en la estabilidad anual del n&#250;mero de intoxicados atendidos&#44; con datos asistenciales en cierto modo paralelos a los diferentes escenarios pand&#233;micos y de confinamiento que hemos vivido&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">En la l&#237;nea de lo descrito recientemente por Gunnell et al&#46; que ya alertaba del incremento de los problemas psicol&#243;gicos y del riesgo suicida durante la pandemia<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">10</span></a>&#44; nuestros resultados coinciden en mostrar un crecimiento de las intoxicaciones con intencionalidad suicida&#44; doblando los porcentajes relativos de estas intoxicaciones en los a&#241;os 2020 y 2021&#44; en relaci&#243;n con la etapa prepand&#233;mica&#46; Este dato conlleva&#44; adem&#225;s&#44; un cambio en el tipo de t&#243;xico responsable empleado en estos gestos suicidas&#44; con un notorio incremento de las intoxicaciones medicamentosas&#44; que se asocian habitualmente a una mayor gravedad&#44; un aumento en la necesidad de terapias propias de las intoxicaciones &#40;descontaminaci&#243;n digestiva y uso de ant&#237;dotos&#41;&#44; m&#225;s ingresos y mayor duraci&#243;n de la estancia media&#46; Parad&#243;jicamente no detectamos el incremento de mortalidad descrito en otros estudios&#44; en los que describ&#237;an un aumento de mortalidad en las intoxicaciones suicidas en relaci&#243;n al resto de intoxicaciones<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Por otro lado&#44; tal como han sugerido recientemente F&#233;rnandez-L&#225;zaro et al&#46;&#44; hay un incremento inicial de la ratio var&#243;n&#47;mujer&#44; que tiende a normalizarse en el &#250;ltimo per&#237;odo &#40;2021&#41;&#44; y un descenso de la edad media de los intoxicados&#44; al detectarse un preocupante incremento de las intoxicaciones suicidas en edad juvenil<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">7</span></a>&#46; En esta l&#237;nea&#44; consideramos de suma importancia que se intensifiquen los esfuerzos por parte de la administraci&#243;n para cuidar la salud mental y prevenir las conductas suicidas&#46; Ejemplo de ello es el Plan de Acci&#243;n 2021-2024 Salud Mental y COVID-19<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">11</span></a>&#44; que viene a complementar la Estrategia de Salud Mental aprobada en el a&#241;o 2006&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">La disparidad de las medidas restrictivas en los diferentes pa&#237;ses de Europa influy&#243; en la limitaci&#243;n del resurgimiento de las intoxicaciones recreativas por drogas de abuso&#44; cuyos protagonistas en nuestro hospital&#44; situado en una zona de alta influencia tur&#237;stica&#44; sol&#237;an ser ciudadanos extranjeros&#44; principalmente brit&#225;nicos&#44; situ&#225;ndonos a&#250;n lejanos a los n&#250;meros de la situaci&#243;n prepand&#233;mica que conoc&#237;amos&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">En Reino Unido&#44; durante los 2 meses del estudio del 2021&#44; se obligaba a mantener cuarentenas a sus habitantes cuando retornaban de nuestro pa&#237;s<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">12</span></a>&#44; lo que influy&#243; en la afluencia tur&#237;stica de este origen&#44; que representaba casi un tercio de los intoxicados en el 2019&#46; No debemos olvidar que durante el verano del 2021 se cancelaron&#44; adem&#225;s&#44; la mayor parte de actividades de ocio nocturno &#40;discotecas&#44; etc&#46;&#41; y fiestas populares&#44; lo que ayud&#243; a controlar parcialmente los excesos que se produc&#237;an en ambos entornos&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">La idiosincrasia del entorno tur&#237;stico en el que se encuentra situado nuestro hospital supone una limitaci&#243;n del presente estudio&#44; al condicionar los resultados obtenidos y dificultar su extrapolaci&#243;n a otras &#225;reas con menor influencia tur&#237;stica&#46; Pero&#44; por el contrario&#44; proliferaron convocatorias multitudinarias&#44; macrobotellones&#44; mediante las redes sociales que&#44; temporalmente&#44; relevaron a las anteriores<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; la pandemia por COVID-19 ha generado cambios cl&#237;nicos y epidemiol&#243;gicos en el tipo de paciente intoxicado que ha sido atendido en un SU hospitalario durante sus distintas fases&#46; Todo apunta a que&#44; en esta nueva normalidad&#44; en el &#225;mbito estrictamente toxicol&#243;gico&#44; no va a suponer una mejora en el perfil sociodemogr&#225;fico y cl&#237;nico en relaci&#243;n con el pasado&#44; ya que&#44; a tenor de nuestros resultados&#44; se espera confluyan la progresi&#243;n detectada en las intoxicaciones suicidas&#44; con las intoxicaciones derivadas de la reactivaci&#243;n de las actividades recreativas y de ocio&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">En este escenario se crean las condiciones &#243;ptimas durante el pr&#243;ximo verano para una &#171;tormenta perfecta&#187; que afectar&#225; principalmente a la gente joven&#44; para lo cual&#44; tal como conclu&#237;amos en una carta cient&#237;fica previa<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">6</span></a>&#44; no nos queda m&#225;s remedio que alertar de estas previsiones a los responsables de la gesti&#243;n sanitaria&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicto de intereses</span><p id="par0100" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de inter&#233;s&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Financiaci&#243;n</span><p id="par0105" class="elsevierStylePara elsevierViewall">Este art&#237;culo es un proyecto de investigaci&#243;n no financiado&#46;</p></span></span>"
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            1 => "Intoxicaciones agudas"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La pandemia por COVID-19 ha provocado cambios globales que afectan a la vida diaria de la poblaci&#243;n mundial&#44; con un impacto directo sobre la salud f&#237;sica y mental de los individuos&#44; as&#237; como en sus h&#225;bitos sociales y recreativos&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis retrospectivo de aspectos demogr&#225;ficos y cl&#237;nicos de los pacientes atendidos por intoxicaciones agudas en un servicio de urgencias hospitalario durante 3 per&#237;odos distintos&#58; prepandemia &#40;2019&#41;&#44; tras el confinamiento domiciliario &#40;2020&#41; y en el per&#237;odo pospand&#233;mico &#40;2021&#41;&#44; analizando en cada uno los meses de junio y julio&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 1&#46;182 intoxicaciones agudas&#46; En relaci&#243;n con la etapa prepand&#233;mica&#44; el n&#250;mero de intoxicados disminuy&#243; durante el confinamiento &#40;2019&#58; 1&#44;9 vs&#46; 2020&#58; 1&#44;5&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; increment&#225;ndose la ratio var&#243;n&#47;mujer &#40;2&#44;0 vs&#46; 1&#44;4&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41; y la edad media &#40;2019&#58; 31&#44;4 vs&#46; 2020&#58; 41&#44;3&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; tendencia que se mantuvo en el a&#241;o 2021 &#40;38&#44;3&#41;&#46; La intoxicaci&#243;n con motivaci&#243;n suicida tambi&#233;n aument&#243; en dicho per&#237;odo &#40;2019&#58; 8&#44;71 vs&#46; 2020&#58; 21&#44;0&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; mientras que las l&#250;dicas decrecieron &#40;2019&#58; 76&#44;1 vs&#46; 2020&#58; 62&#44;0&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; con un aumento no significativo en el &#250;ltimo a&#241;o 2021 &#40;69&#44;0&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;07&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La pandemia por COVID-19 ha generado cambios cl&#237;nicos y epidemiol&#243;gicos en las intoxicaciones agudas atendidas en un servicio de urgencias hospitalario durante las distintas fases de la pandemia&#46;</p></span>"
        "secciones" => array:4 [
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The COVID-19 pandemic has caused global changes that affect the daily life of the world&#39;s population&#44; with a direct impact on individuals&#8217; physical and mental health as well as on their social and recreational habits&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">This study aimed to retrospectively analyze the demographic and clinical characteristics of patients attended to for acute poisoning in a hospital emergency department &#40;ED&#41; at three different periods of time&#58; pre-pandemic &#40;2019&#41;&#44; after strict lockdown of the population in Spain &#40;2020&#41;&#44; and post-pandemic &#40;2021&#41;&#46; We analyzed 2 months &#40;June and July&#41; in each period&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A total of 1&#44;182 cases of acute poisoning were included&#46; Compared to the pre-pandemic period&#44; during lockdown&#44; the number of patients with acute poisoning decreased &#40;2019&#58; 1&#46;9&#37; vs&#46; 2020&#58; 1&#46;5&#37;&#59; <span class="elsevierStyleItalic">p</span>&#60;&#46;01&#41;&#59; the ratio of men to women increased &#40;2&#46;0 vs&#46; 1&#46;4&#59; <span class="elsevierStyleItalic">p</span>&#61;&#46;02&#41;&#59; and the mean age of patients increased &#40;2019&#58; 31&#46;4 vs&#46; 2020&#58; 41&#46;3&#59; <span class="elsevierStyleItalic">p</span>&#60;&#46;001&#41;&#44; a trend which continued in 2021 &#40;38&#46;3&#41;&#46; Poisoning with suicidal intention also increased during the pandemic &#40;2019&#58; 8&#46;71&#37; vs&#46; 2020&#58; 21&#46;0&#37;&#59; <span class="elsevierStyleItalic">p</span>&#60;&#46;01&#41; whereas poisonings with a recreational intention declined &#40;2019&#58; 76&#46;1&#37; vs&#46; 2020&#58; 62&#46;0&#37;&#59; <span class="elsevierStyleItalic">p</span>&#60;&#46;01&#41; with a non-significant increase in 2021 &#40;69&#46;0&#37;&#44; <span class="elsevierStyleItalic">p&#61;</span>&#46;07&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The COVID-19 pandemic generated clinical and epidemiological changes in the acute poisonings attended to in a hospital emergency department during the various phases of the pandemic&#46;</p></span>"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">DE&#58; desviaci&#243;n est&#225;ndar&#59; IC&#58; intervalo de confianza&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2019</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2020</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Valor de p&#40;20&#47;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2021</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Valor de p&#40;21&#47;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Valor de p&#40;21&#47;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37; &#40;IC 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37; &#40;IC 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37; &#40;IC 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Intoxicados&#47;urgencias totales</span><span class="elsevierStyleItalic">N&#46;&#176; total de urgencias</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">52827&#46;782&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#44;9 &#40;1&#44;74-2&#44;06&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">29919&#46;930&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;5 &#40;1&#44;33-1&#44;67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35525&#46;351&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;4 &#40;1&#44;26-1&#44;54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="10" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Var&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">309&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">58&#44;5 &#40;53&#44;4-63&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">200&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#44;9 &#40;61&#44;56-72&#44;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;02&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">208&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#44;6 &#40;53&#44;47-63&#44;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Media &#40;&#177;<span class="elsevierStyleHsp" style=""></span>DE&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">31&#44;4 &#40;&#177;<span class="elsevierStyleHsp" style=""></span>16&#44;9&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#44;3 &#40;&#177;<span class="elsevierStyleHsp" style=""></span>16&#44;3&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">38&#44;3 &#40;&#177;<span class="elsevierStyleHsp" style=""></span>18&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Origen</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Espa&#241;ol&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">265&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">68&#44;2 &#40;63&#44;32-73&#44;01&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Datos de los resultados demogr&#225;ficos y asistenciales de los intoxicados atendidos en un servicio de urgencias de un hospital universitario en los meses de junio y julio de los a&#241;os 2019&#44; 2020 y 2021&#44; comparando estad&#237;sticamente los resultados entre los per&#237;odos 2020 vs&#46; 2019&#44; 2021 vs&#46; 2020 y 2021 vs&#46; 2019</p>"
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Original Breve
Intoxicaciones agudas atendidas en un servicio de urgencias. De la prepandemia a la nueva normalidad
Acute poisoning among patients attended to in an emergency department: From the pre-pandemic period to the new normality
A.F. Caballero-Bermejoa, J. Ortega-Pérezb, G. Frontera-Juanc, C. Homar-Amengualb, B. Barceló-Martínb, J. Puiguriguer-Ferrandob,
Autor para correspondencia
jordi.puiguriguer@ssib.es

Autor para correspondencia.
a Servicio de Farmacología Clínica, Hospital Universitario Puerta de Hierro-Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Majadahonda, Madrid, España
b Unidad de Toxicología Clínica, Servicio de Urgencias, Hospital Universitario Son Espases, Palma de Mallorca, España
c Departamento de Soporte Metodológico del Instituto de Investigación, Hospital Universitario Son Espases, Palma de Mallorca, España
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el Gobierno espa&#241;ol decret&#243; el 14 de marzo de 2020 el estado de alarma en todo el territorio&#44; con un confinamiento domiciliario estricto de la poblaci&#243;n &#40;salvo para los trabajadores esenciales&#41; durante pr&#225;cticamente 99 d&#237;as&#44; hasta el d&#237;a 21 de junio de 2020<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">3</span></a>&#46; Estas medidas restrictivas&#44; de confinamiento domiciliario&#44; comportaron una disminuci&#243;n en la afluencia a los servicios de urgencias &#40;SU&#41; de adultos<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">4</span></a> y un incremento en las consultas telef&#243;nicas a los centros de regulaci&#243;n de urgencias y emergencias extrahospitalarias<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En relaci&#243;n con las urgencias atendidas por intoxicaci&#243;n aguda&#44; tambi&#233;n disminuyeron de forma significativa&#44; especialmente las que aparecen en los entornos recreativos&#44; aunque no completamente tal como cabr&#237;a esperar tras dichas medidas dictadas precisamente para impedir cualquier relaci&#243;n social<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">6</span></a>&#46; Datos similares se han obtenido en estudios muy recientes que ata&#241;en a la poblaci&#243;n atendida en SU pedi&#225;tricos&#44; donde se constata el preocupante incremento de las intoxicaciones con motivaci&#243;n suicida en estas tempranas edades<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Tras el primer a&#241;o de pandemia&#44; lleg&#243; el verano del 2021 en el que se relajaron las medidas de limitaci&#243;n de la movilidad&#44; recuperando parcialmente algunas actividades de ocio y sociales&#44; sin que se haya analizado de forma espec&#237;fica la repercusi&#243;n de esta desescalada sobre las intoxicaciones&#46; Adelant&#225;ndonos por primera vez a otros pa&#237;ses con un mayor arraigo en el estudio epidemiol&#243;gico de las intoxicaciones<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">8</span></a>&#44; surge este estudio&#44; cuyo objetivo es analizar la evoluci&#243;n de las intoxicaciones atendidas en 3 per&#237;odos distintos de la pandemia&#44; y del impacto que hubiera podido tener sobre las intoxicaciones las distintas medidas de control pand&#233;mico dictadas&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Se realiz&#243; un estudio observacional retrospectivo&#44; mediante la revisi&#243;n de la historia cl&#237;nica electr&#243;nica&#44; incluyendo a todos los pacientes atendidos por una intoxicaci&#243;n aguda en el SU del Hospital Universitario Son Espases en los meses de junio y julio de 3 a&#241;os consecutivos &#40;61 d&#237;as cada a&#241;o&#41;&#58; 2019 &#40;per&#237;odo prepandemia&#41;&#44; 2020 &#40;per&#237;odo de confinamiento e inicio de la desescalada&#41; y 2021 &#40;per&#237;odo reactivaci&#243;n actividades sociales&#41;&#46; Este estudio cont&#243; con la aprobaci&#243;n del Comit&#233; de &#201;tica de la Investigaci&#243;n de las Islas Baleares &#40;n&#46;&#176; de expediente IB 4679&#47;21 PI&#44; con fecha del 27&#47;10&#47;2021&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El an&#225;lisis estad&#237;stico se llev&#243; a cabo mediante un an&#225;lisis descriptivo&#160;univariante&#160;de las variables incluidas en el estudio &#40;sexo&#44; edad y origen del intoxicado&#44; motivaci&#243;n de la intoxicaci&#243;n&#44; tipo de t&#243;xico&#44; realizaci&#243;n de medidas de descontaminaci&#243;n digestiva&#44; empleo de ant&#237;dotos&#44; indicaci&#243;n de medidas contenci&#243;n&#44; destino&#44; estancia y muerte&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Para el an&#225;lisis bivariante se emple&#243; la prueba de la t de&#160;Student-Fisher&#44; y para evaluar la relaci&#243;n entre variables categ&#243;ricas se aplic&#243;&#160;la prueba de Chi-cuadrado &#40;y sus correspondientes pruebas no param&#233;tricas cuando no se cumpl&#237;an las condiciones de aplicaci&#243;n&#41;&#44; calculando los correspondientes intervalos de confianza&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0040" class="elsevierStylePara elsevierViewall">Se incluyeron 1&#46;182 pacientes intoxicados&#46; Como se muestra en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#44; en relaci&#243;n con la etapa prepand&#233;mica&#44; el n&#250;mero de intoxicaciones agudas disminuy&#243; a partir del a&#241;o 2019 de forma significativa principalmente el a&#241;o 2020 &#40;2019&#58; 1&#44;9 vs&#46; 2020&#58; 1&#44;5&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; mientras que la ratio var&#243;n&#47;mujer aument&#243; &#40;2&#44;0 vs&#46; 1&#44;4&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41;&#44; as&#237; como lo hizo la edad media de los intoxicados &#40;31&#44;4 vs&#46; 41&#44;3&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Las intoxicaciones suicidas crecieron tambi&#233;n durante la pandemia &#40;8&#44;71 vs&#46; 21&#44;0&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; as&#237; como las medicamentosas &#40;14&#44;20 vs&#46; 28&#44;76&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; y&#44; como consecuencia de ello&#44; la proporci&#243;n de intoxicados que precisaron medidas de descontaminaci&#243;n digestiva &#40;0&#44;95 vs&#46; 4&#44;7&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;00&#41;&#44; y necesidad de ingreso hospitalario &#40;2&#44;46 vs&#46; 5&#44;35&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Por el contrario&#44; las intoxicaciones con drogas recreativas disminuyeron notablemente &#40;76&#44;1 vs&#46; 62&#44;0&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; as&#237; como los pacientes de origen extranjero &#40;50&#44;6 vs&#46; 4&#44;7&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;00&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Los resultados del &#250;ltimo per&#237;odo &#40;verano 2021&#41;&#44; comparados con el a&#241;o anterior a la pandemia &#40;2019&#41;&#44; confirman alguna de estas tendencias&#44; persistiendo el incremento de las intoxicaciones con motivaci&#243;n suicida &#40;2019&#58; 8&#44;7 vs&#46; 2021&#58; 16&#44;3&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;00&#41;&#44; medicamentosas &#40;14&#44;2 vs&#46; 26&#44;2&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;00&#41; y las que requirieron ingreso &#40;2&#44;5 vs&#46; 5&#44;9&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Las intoxicaciones en mujeres volvieron a incrementarse porcentualmente &#40;33&#44;1 vs&#46; 41&#44;4&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;04&#41;&#59; y&#44; tras la relajaci&#243;n de las medidas restrictivas durante el verano de 2021&#44; reaparecen las intoxicaciones recreativas por drogas de abuso &#40;14&#44;0 vs&#46; 32&#44;7&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;00&#41; y los intoxicados de origen extranjero &#40;11&#44;4 vs&#46; 31&#44;8&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;00&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0055" class="elsevierStylePara elsevierViewall">La mayor parte de los resultados epidemiol&#243;gicos de los intoxicados atendidos en estos per&#237;odos difieren de los obtenidos en estudios previos publicados&#44; como la serie de Baeza en 3 hospitales p&#250;blicos del sur de Espa&#241;a&#44; en la que la prevalencia de las intoxicaciones se manten&#237;a constante&#44; a&#241;o tras a&#241;o&#44; influenciada fundamentalmente en aquel estudio por la localizaci&#243;n de hospital &#40;&#225;rea urbana o rural&#41; y por una variabilidad estacional<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">En nuestra serie&#44; hemos evidenciado un cambio en la estabilidad anual del n&#250;mero de intoxicados atendidos&#44; con datos asistenciales en cierto modo paralelos a los diferentes escenarios pand&#233;micos y de confinamiento que hemos vivido&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">En la l&#237;nea de lo descrito recientemente por Gunnell et al&#46; que ya alertaba del incremento de los problemas psicol&#243;gicos y del riesgo suicida durante la pandemia<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">10</span></a>&#44; nuestros resultados coinciden en mostrar un crecimiento de las intoxicaciones con intencionalidad suicida&#44; doblando los porcentajes relativos de estas intoxicaciones en los a&#241;os 2020 y 2021&#44; en relaci&#243;n con la etapa prepand&#233;mica&#46; Este dato conlleva&#44; adem&#225;s&#44; un cambio en el tipo de t&#243;xico responsable empleado en estos gestos suicidas&#44; con un notorio incremento de las intoxicaciones medicamentosas&#44; que se asocian habitualmente a una mayor gravedad&#44; un aumento en la necesidad de terapias propias de las intoxicaciones &#40;descontaminaci&#243;n digestiva y uso de ant&#237;dotos&#41;&#44; m&#225;s ingresos y mayor duraci&#243;n de la estancia media&#46; Parad&#243;jicamente no detectamos el incremento de mortalidad descrito en otros estudios&#44; en los que describ&#237;an un aumento de mortalidad en las intoxicaciones suicidas en relaci&#243;n al resto de intoxicaciones<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Por otro lado&#44; tal como han sugerido recientemente F&#233;rnandez-L&#225;zaro et al&#46;&#44; hay un incremento inicial de la ratio var&#243;n&#47;mujer&#44; que tiende a normalizarse en el &#250;ltimo per&#237;odo &#40;2021&#41;&#44; y un descenso de la edad media de los intoxicados&#44; al detectarse un preocupante incremento de las intoxicaciones suicidas en edad juvenil<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">7</span></a>&#46; En esta l&#237;nea&#44; consideramos de suma importancia que se intensifiquen los esfuerzos por parte de la administraci&#243;n para cuidar la salud mental y prevenir las conductas suicidas&#46; Ejemplo de ello es el Plan de Acci&#243;n 2021-2024 Salud Mental y COVID-19<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">11</span></a>&#44; que viene a complementar la Estrategia de Salud Mental aprobada en el a&#241;o 2006&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">La disparidad de las medidas restrictivas en los diferentes pa&#237;ses de Europa influy&#243; en la limitaci&#243;n del resurgimiento de las intoxicaciones recreativas por drogas de abuso&#44; cuyos protagonistas en nuestro hospital&#44; situado en una zona de alta influencia tur&#237;stica&#44; sol&#237;an ser ciudadanos extranjeros&#44; principalmente brit&#225;nicos&#44; situ&#225;ndonos a&#250;n lejanos a los n&#250;meros de la situaci&#243;n prepand&#233;mica que conoc&#237;amos&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">En Reino Unido&#44; durante los 2 meses del estudio del 2021&#44; se obligaba a mantener cuarentenas a sus habitantes cuando retornaban de nuestro pa&#237;s<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">12</span></a>&#44; lo que influy&#243; en la afluencia tur&#237;stica de este origen&#44; que representaba casi un tercio de los intoxicados en el 2019&#46; No debemos olvidar que durante el verano del 2021 se cancelaron&#44; adem&#225;s&#44; la mayor parte de actividades de ocio nocturno &#40;discotecas&#44; etc&#46;&#41; y fiestas populares&#44; lo que ayud&#243; a controlar parcialmente los excesos que se produc&#237;an en ambos entornos&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">La idiosincrasia del entorno tur&#237;stico en el que se encuentra situado nuestro hospital supone una limitaci&#243;n del presente estudio&#44; al condicionar los resultados obtenidos y dificultar su extrapolaci&#243;n a otras &#225;reas con menor influencia tur&#237;stica&#46; Pero&#44; por el contrario&#44; proliferaron convocatorias multitudinarias&#44; macrobotellones&#44; mediante las redes sociales que&#44; temporalmente&#44; relevaron a las anteriores<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; la pandemia por COVID-19 ha generado cambios cl&#237;nicos y epidemiol&#243;gicos en el tipo de paciente intoxicado que ha sido atendido en un SU hospitalario durante sus distintas fases&#46; Todo apunta a que&#44; en esta nueva normalidad&#44; en el &#225;mbito estrictamente toxicol&#243;gico&#44; no va a suponer una mejora en el perfil sociodemogr&#225;fico y cl&#237;nico en relaci&#243;n con el pasado&#44; ya que&#44; a tenor de nuestros resultados&#44; se espera confluyan la progresi&#243;n detectada en las intoxicaciones suicidas&#44; con las intoxicaciones derivadas de la reactivaci&#243;n de las actividades recreativas y de ocio&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">En este escenario se crean las condiciones &#243;ptimas durante el pr&#243;ximo verano para una &#171;tormenta perfecta&#187; que afectar&#225; principalmente a la gente joven&#44; para lo cual&#44; tal como conclu&#237;amos en una carta cient&#237;fica previa<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">6</span></a>&#44; no nos queda m&#225;s remedio que alertar de estas previsiones a los responsables de la gesti&#243;n sanitaria&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicto de intereses</span><p id="par0100" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de inter&#233;s&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Financiaci&#243;n</span><p id="par0105" class="elsevierStylePara elsevierViewall">Este art&#237;culo es un proyecto de investigaci&#243;n no financiado&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La pandemia por COVID-19 ha provocado cambios globales que afectan a la vida diaria de la poblaci&#243;n mundial&#44; con un impacto directo sobre la salud f&#237;sica y mental de los individuos&#44; as&#237; como en sus h&#225;bitos sociales y recreativos&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis retrospectivo de aspectos demogr&#225;ficos y cl&#237;nicos de los pacientes atendidos por intoxicaciones agudas en un servicio de urgencias hospitalario durante 3 per&#237;odos distintos&#58; prepandemia &#40;2019&#41;&#44; tras el confinamiento domiciliario &#40;2020&#41; y en el per&#237;odo pospand&#233;mico &#40;2021&#41;&#44; analizando en cada uno los meses de junio y julio&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 1&#46;182 intoxicaciones agudas&#46; En relaci&#243;n con la etapa prepand&#233;mica&#44; el n&#250;mero de intoxicados disminuy&#243; durante el confinamiento &#40;2019&#58; 1&#44;9 vs&#46; 2020&#58; 1&#44;5&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; increment&#225;ndose la ratio var&#243;n&#47;mujer &#40;2&#44;0 vs&#46; 1&#44;4&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41; y la edad media &#40;2019&#58; 31&#44;4 vs&#46; 2020&#58; 41&#44;3&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; tendencia que se mantuvo en el a&#241;o 2021 &#40;38&#44;3&#41;&#46; La intoxicaci&#243;n con motivaci&#243;n suicida tambi&#233;n aument&#243; en dicho per&#237;odo &#40;2019&#58; 8&#44;71 vs&#46; 2020&#58; 21&#44;0&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; mientras que las l&#250;dicas decrecieron &#40;2019&#58; 76&#44;1 vs&#46; 2020&#58; 62&#44;0&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; con un aumento no significativo en el &#250;ltimo a&#241;o 2021 &#40;69&#44;0&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;07&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La pandemia por COVID-19 ha generado cambios cl&#237;nicos y epidemiol&#243;gicos en las intoxicaciones agudas atendidas en un servicio de urgencias hospitalario durante las distintas fases de la pandemia&#46;</p></span>"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Resultados"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusiones"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The COVID-19 pandemic has caused global changes that affect the daily life of the world&#39;s population&#44; with a direct impact on individuals&#8217; physical and mental health as well as on their social and recreational habits&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">This study aimed to retrospectively analyze the demographic and clinical characteristics of patients attended to for acute poisoning in a hospital emergency department &#40;ED&#41; at three different periods of time&#58; pre-pandemic &#40;2019&#41;&#44; after strict lockdown of the population in Spain &#40;2020&#41;&#44; and post-pandemic &#40;2021&#41;&#46; We analyzed 2 months &#40;June and July&#41; in each period&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A total of 1&#44;182 cases of acute poisoning were included&#46; Compared to the pre-pandemic period&#44; during lockdown&#44; the number of patients with acute poisoning decreased &#40;2019&#58; 1&#46;9&#37; vs&#46; 2020&#58; 1&#46;5&#37;&#59; <span class="elsevierStyleItalic">p</span>&#60;&#46;01&#41;&#59; the ratio of men to women increased &#40;2&#46;0 vs&#46; 1&#46;4&#59; <span class="elsevierStyleItalic">p</span>&#61;&#46;02&#41;&#59; and the mean age of patients increased &#40;2019&#58; 31&#46;4 vs&#46; 2020&#58; 41&#46;3&#59; <span class="elsevierStyleItalic">p</span>&#60;&#46;001&#41;&#44; a trend which continued in 2021 &#40;38&#46;3&#41;&#46; Poisoning with suicidal intention also increased during the pandemic &#40;2019&#58; 8&#46;71&#37; vs&#46; 2020&#58; 21&#46;0&#37;&#59; <span class="elsevierStyleItalic">p</span>&#60;&#46;01&#41; whereas poisonings with a recreational intention declined &#40;2019&#58; 76&#46;1&#37; vs&#46; 2020&#58; 62&#46;0&#37;&#59; <span class="elsevierStyleItalic">p</span>&#60;&#46;01&#41; with a non-significant increase in 2021 &#40;69&#46;0&#37;&#44; <span class="elsevierStyleItalic">p&#61;</span>&#46;07&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The COVID-19 pandemic generated clinical and epidemiological changes in the acute poisonings attended to in a hospital emergency department during the various phases of the pandemic&#46;</p></span>"
        "secciones" => array:4 [
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            "identificador" => "abst0030"
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            "identificador" => "abst0035"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">DE&#58; desviaci&#243;n est&#225;ndar&#59; IC&#58; intervalo de confianza&#46;</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2019</th><th class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2020</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Valor de p&#40;20&#47;19&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2021</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Valor de p&#40;21&#47;20&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Valor de p&#40;21&#47;19&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37; &#40;IC 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37; &#40;IC 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37; &#40;IC 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Intoxicados&#47;urgencias totales</span><span class="elsevierStyleItalic">N&#46;&#176; total de urgencias</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;9 &#40;1&#44;74-2&#44;06&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">35525&#46;351&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;4 &#40;1&#44;26-1&#44;54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Var&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">309&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">58&#44;5 &#40;53&#44;4-63&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">66&#44;9 &#40;61&#44;56-72&#44;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;02&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">208&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#44;6 &#40;53&#44;47-63&#44;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;04&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Media &#40;&#177;<span class="elsevierStyleHsp" style=""></span>DE&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">31&#44;4 &#40;&#177;<span class="elsevierStyleHsp" style=""></span>16&#44;9&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">38&#44;3 &#40;&#177;<span class="elsevierStyleHsp" style=""></span>18&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="10" align="left" valign="\n
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                  \t\t\t\t">260&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">242&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#44;2 &#40;63&#44;32-73&#44;01&#41;&nbsp;\t\t\t\t\t\t\n
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Información del artículo
ISSN: 00142565
Idioma original: Español
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