Poisonings in Singapore: A Poison Center Perspective

Abstract

The Drug and Poison Information Center (DPIC) in Singapore was run as a pilot project over 4 years from April 2004 to March 2008. The center provided a hotline service for toxic exposure assessment and management to healthcare professionals and the general public. The aim of this study was to review poisonings through the perspective of this poison center.
Method
A retrospective review of records in the DPIC call database was made covering the 4 years of its operation. Drug information and ad verse effects calls were excluded from the study.
Results
There was a total of 15227 calls to the DPIC over the study period. Of these, 1817 calls (11.9%) were on acute toxic exposures involving patients. Healthcare personnel working in public restructured hospitals were the most frequent users (71.4%) of the service with the majority of these calls originating from the emergency departments (86%). Public inquiries accounted for 16.6% of the call volume. The cohort of poisoning cases showed a bimodal distribution of age groups with peaks in the less than 5 age group and the 20 to 40 year age group. The racial distribution followed local population demographics but with almost equal gender representation (50.3%males). Most exposures were accidental (67.4%) and occurred at home (69%). The number of agents involved in each exposure ranged from one (84.5%) to a maximum of 6 (<1%) agents. The common exposures involved analgesics (13.5%), antidepressants and sedatives (10.6%), industrial chemicals (5.7%) and bites and stings (8.4%). The calls were evenly distributed by month of the year with no significant seasonal variation although the daily distribution showed a peak in the late evening. The DPIC was able to complete immediate definitive advice within 15 minutes of the call in most situations (96.5%). Majority of public calls (69.2%) ended with reassurance and advice to observe for relevant symptoms. A similar disposition was observed even when the calls were from physicians.
Conclusion
In summary, poisonings were mostly accidental and affected the younger population suggesting that they are potentially preventable. Furthermore, the DPIC appears to have played a significant triaging role in toxic exposures; providing reassurance for minor poisoning cases while facilitating the appropriate referral of the more severe ones.