acute poisonings treated in hospitals in oslo: a one-year prospective study (i): pattern of...
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Acute poisonings treated in hospitals in Oslo: a one-year prospective study (I): pattern of poisoning. Hovda.Clin Toxicol (Phila).2008
Matthias PICHONDesc réa. Méd. 2009
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Méthodologie
• Étude prospective épidémiologique• Durée de 1 an ( 2003-2004)• Multicentrique• Intoxication aigue• Ville d’Oslo (Norvège)
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Méthodologie
• Les 3 objectifs :
- incidence d’hospitalisation des intox. Aigues / 1 an
- association âge-sexe et agent toxique
- association âge-sexe et motif d’intoxication
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Méthodologie• Critères d’inclusion: - âge ≥ 16 ans - intox. volontaire ou accidentelle • Critères d’exclusion: - intox. chronique - hospitalisation pour autre diag. principal (même si
intox. associée)
• 1 agent toxique retenu = le + toxique
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résultats• 3775 contacts téléphoniques / 3025 intoxications• 947 hospitalisations 31 %• Incidence annuelle / 1000 hab.: - homme:1,9 - femme: 2,1• 54 % femmes• Age médian: 36 ans• 96 % volontaires• 8 % patients admis 2X en 1an / 5 % admis entre 3 et 7X
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Rappel• système de médecine d’urgence d’Oslo - ambulanciers service ambulancier naloxone
1 médicalisé
consultation externe
urgence hospitalière + niveau de soins + surveillance transfert
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Répartition des patients après contact des services de santé pour intoxication
31 %
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Incidence âge-sexe / intox.aigue
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résultats
• Substances: - BZD → 18 % - alcool → 17% - paracétamol → 12 % - opiacés → 7 % - GHB → 7 % ( nouvelle drogue)
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résultats
• Hommes abus drogues + alcool
• Femmes intoxication médicamenteuse prescription TS
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5 principaux agents tox. et âge
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résultats
• 29 % intention suicidaire à l’admission (31 vs 25)
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Validité interne
• Biais de sélection +++ : exclusion des patients avec autre diagnostic
principal ( ex trauma et intox. Alcoolique aigue)
• Biais de suivi: difficulté d’observance de l’étude / comorbidités psy. et abus de substances
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discussion
• Étude épidémiologique prospective: résultats statistiques et observation de certaines =
• Pas d’étude polyintoxication 62,5 %• Agents toxiques non vérifiés systématiquements
par dosage biologique• 69 % intox. PEC par ambulance ou service de
consultations externes• Intox. aux opiacés (cf)• Morbi-mortalité des intox. aigues
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Autres littératures
Acute poisonings treated in hospitals in Oslo: a one-year prospective study (II): clinical outcome. Clin Toxicol (Phila). 2008
étude comparative avec résultats épidémiologiques de 1980
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Autres littératures
Acute child poisonings in Oslo: a 2-year prospective study. Acta Paediatr. 2007
- < 15 ans - 175 épisodes - 50 % → TTT - mortalité / séquelles= 0 - incidence annuelle: 97 / 100000 230 / 100000 ( 1980) - < 8 ans: médicaments + produits ménagers - ≥ 8 ans: alcool + médicaments
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Autres littératures
Pre-hospital treatment of acute poisonings in Oslo. Hovda. BMC Emerg Med. 2008
- Étude prospective épidémiologique- Durée de 1 an (2003-2004)- Multicentrique- Intoxication aigue- Ville d’Oslo (Norvège)- Prise en charge ambulance, service de
consultation externe, urgence hospitalière
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Autres littératures
Pre-hospital treatment of acute poisonings in Oslo. Hovda. BMC Emerg Med. 2008
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Autres littératures
Pre-hospital treatment of acute poisonings in Oslo. Hovda. BMC Emerg Med. 2008
- patient laissé sur place après TTT ambulancier = 40 %
- 70 % → intox. opiacés- 35 % → coma- 37 % → dépression respiratoire- 49 % → naloxone
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Autres littératures
Pre-hospital treatment of acute poisonings in Oslo. Hovda. BMC Emerg Med. 2008
- PEC ambulanciers: 15 décès - 1 patient DCD (overdose aux opiacés): 48h
après PEC ambulancière sans transfert pour intox. aux opiacés
- protocole naloxone: 1 inj. IM avt TTT IV (1/2 vie courte)
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Autres littératuresObservatoire européen des drogues et des toxicomanies
(OEDT). rapport 2008.
- La consommation d'opiacés, qui semblait en diminution, s'est stabilisée en Europe
- L'Union européenne plus la Norvège comptent de 1,3 million à 1,7 million d'usagers problématiques d'opiacés
- 7000 à 8000 décès liés à la drogue en Europe → 80 % opiacés ( ↗ depuis 2004)
- 1 des principales causes de décès chez les jeunes Européens
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Conclusion
- Étude en concordance avec nos idées sur l’intoxication
- prise en charge laxiste des intox. aux opiacés ?