Do pre-hospital poisoning deaths differ from in-hospital deaths? A retrospective analysis

Lauri Koskela, Lasse Raatiniemi, Håkon Kvåle Bakke, Tero Ala-Kokko, Janne Liisanantti

Most fatal poisonings occur outside the hospital and the victims found dead. The purpose of this study was to determine the general pattern and patient demographics of fatal poisonings in Northern Finland. In particular, we wanted to analyze differences between pre-hospital and in-hospital deaths. All fatal poisonings that occurred in Northern Finland in 2007-2011 were retrieved from the Cause of Death Registry provided by Statistics Finland. We noted the patient demographics, causal agents, and other characteristics of the poisoning events. A total of 689 fatal poisonings occurred during the study period, of which only 42 (6.1%) reached the hospital alive. Those who died pre-hospital were significantly younger (50 vs. 56 years, p = 0.04) and more likely to be male (77% vs. 57%, p = 0.003). Cardiopulmonary resuscitation was attempted less often in pre-hospital cases (9.9% vs. 47.6%, p < 0.001). Ethanol was more frequently the main toxic agent in pre-hospital deaths (58.4% vs. 26.2%, p < 0.001), and multiple ingestions were more common (52.2% vs. 35.7%, p < 0.001) in pre-hospital deaths. Most of the pre-hospital fatal poisoning victims are found dead and the majority of in-hospital victims are admitted to hospital in an already serious condition. According to results of this and former studies, prevention seems to be the most important factor in reducing deaths due to poisoning. The majority of poisoning-related deaths occur pre-hospital and are related to alcohol intoxication and multiple ingestions.