A Comparative Clinical Diagnostic Examination of Deceased Poisoned Patients in Baharloo Hospital Through Autopsy and Toxicology at Tehran’s Medico-Legal Organization During 2014-2015
Acute poisoning is nowadays a common medical emergency. The important point about admitting patients with acute poisoning is its timely and early diagnosis. However, the rate of consistency between clinical diagnosis and autopsy of patients with acute lethal poisoning has not been investigated broadly. The goal of this study was to compare the clinical symptoms of poisoned deceased patients through autopsy and toxicology at Tehran’s Medico-Legal Organization. A cross-sectional study was conducted on all the admitted poisoning cases at Baharloo Hospital in 2014 to 2015 who passed away and were referred to Kahrizak Autopsy Hall. Through investigating the medical records of the Hospital and Autopsy Hall, the researcher examined and compared the existent files. The collected data were entered into SPSS 16. Data were analyzed using Cohen’s kappa coefficient. In all, 98 people who had died from acute poisoning were investigated. The most common causes of poisoning were drugs (49%), followed by pesticides (39%). The least common cause of poisoning was alcohol (1%). The most common poisonous drugs were opioids. The most common causes of death based on hospital records and autopsy results were rice tablets and high-dose opioid poisoning. Using Cohen’s kappa coefficient, the rate of agreement between the causes of death in hospital records and autopsy results was estimated at 0.744. Bearing in mind the consistency of clinical diagnosis with postmortem autopsy results, we may begin life-saving management of patients of acute poisoning in the shortest possible time.
Murray CJL, Lopez AD. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Global burden of disease and injury series, vol. 1 of 10. Harvard School of Public Health, 1996.
Krug EG, Sharma GK, Lozano R. The global burden of injuries. American journal of public health. 2000 Apr;90(4):523.
Islambulchilar M, Islambulchilar Z, Kargar-Maher MH. Acute adult poisoning cases admitted to a university hospital in Tabriz, Iran. Hum Exp Toxicol 2009;28:185-190.
Cengiz M, Baysal Z, Ganidagli S, Altindag A. Characteristics of poisoning cases in adult intensive care unit in Sanliurfa, Turkey. Saudi Med J.2006;27(4):497-502.
Baydin A, Yardan T, Aygun D, Doganay Z, Nargis C, Incealtin O. Retrospective evaluation of emergency service patients with poisoning: a 3-year study. Adv. Ther. 2005 Nov 1;22(6):650-8.
WHO in collaboration with UNEP. Public health impact of pesticidesused in agriculture. Geneva: World Health Organization,1990.
Litovitz TL, Felberg L, White S, Klein-Schwartz W. 2000 annual report of the American Association of Poison Control Centerstoxic exposure surveillance system. Am J Emerg Med 2001;19:337 – 395
Lai MW, Klein-Schwartz W, Rodgers GC, Abrams JY, Haber DA, Bronstein AC. 2005 Annual Report of the American Association of Poison Control Centers' national poisoning and exposure database. Clin Toxicol.2006 Jan 1;44(6-7):803-932.
Shadnia S, Esmaily H, Sasanian G, Pajoumand A, Hassanian-Moghaddam H, Abdollahi M. Pattern of acute poisoning in Tehran-Iran in 2003. Hum Exp Toxicol 2007;26:753-756.
Hassanian-Moghaddam H, Zamani N, Rahimi M, Shadnia S, Pajoumand A, Sarjami S. Acute Adult and Adolescent Poisoning in Tehran, Iran; the Epidemiologic Trend between 2006 and 2011. Arch Iran Med 2014;17(8):534 – 538.
Peshin SS, Srivastava A, Halder N, Gupta YK. Pesticide poisoning trend analysis of 13 years: A retrospective study based on telephone calls at the National Poisons Information Centre, All India Institute of Medical Sciences, New Delhi. J Forensic Leg Med 2014;22:57-61.
Raizada A, Kalra OP, Khaira A, Yadav A. Profile of hospital admissions following acute poisoning from a major teaching hospital in North India. Trop Doct 2012 Apr 1;42(2):70-3.
Cha ES, Chang SS, Gunnell D, Eddleston M, Khang YH, Lee WJ. Impact of paraquat regulation on suicide in South Korea. International journal of epidemiology. 2016 Apr 1;45(2):470-9.
Eddleston M. Progress with reducing mortality from organophosphorus insecticide poisoning. Anuradhapura Medical Journal. 2014 Mar 30;8(1).
Roberts DM, Karunarathna A, Buckley NA, Manuweera G, Sheriff MHR, Eddleston M. Influence of pesticide regulation on acute poisoning deaths in Sri Lanka. Bull World Health Organ 2003; 81:789-98.
Proudfoot AT. Aluminium and zinc phosphide poisoning. Clin. Toxicol. 2009 Feb 1;47(2):89-100.
A Hosseinian, N Pakravan, A Rafiei; SMFeyzbaksh; Aluminum phosphide poisoningknown as rice tablet: A common toxicity in NorthIran; Indian J Med Sci 2011;4:143 150.
urjar, Mohan; Azim, Afzal; Baronia, Arvindk; Sharma, Kalpana. "Managing aluminum phosphide poisonings". Journal of Emergencies, Trauma, and Shock. 2011; 4 (3): 378–84.
Goel, A; Aggarwal, P. "Pesticide poisoning". Natl Med J India. 2007; 20 (4): 182–91.
Soltaninejad K, Nelson LS, Bahreini SA, Shadnia S. Fatal aluminum phosphide poisoning in Tehran-Iran from 2007 to 2010. Indian J Med Sci. 2012;66(3-4):66-70.
Chaudhry MQ. A Review of the mechanismsinvolved in the action of phosphine as aninsecticide and phosphine resistance in storedproductinsects. Pestic Sci 1997;49: 213-28.
Chaudhry MQ. Review A Review of the Mechanisms Involved in the Action of Phosphine as an Insecticide and Phosphine Resistance in Stored‐Product Insects. Pest Manag. Sci. 1997 Mar 1;49(3):213-28.
Moghadamnia AA. An update on toxicology of aluminum phosphide. DARU journal of Pharmaceutical Sciences. 2012 Dec;20(1):25.
Khodabande F, Kahane A, Soleimani G. The prevalence of complications leading to death in poisoning with rice tablet. J Forensic Med 2014;20 (2), 27-36.
Mehrpour O, Jafarzadeh M, Abdollahi M. A systematic review of aluminium phosphide poisoning. Archives of Industrial Hygiene and Toxicology. 2012 Mar 1;63(1):61-73.
Soltaninejad K, Nelson LS, Bahreini SA, Shadnia S.Fatal aluminum phosphide poisoning in Tehran-Iran from 2007 to 2010. Indian J Med Sci. 2012;66(3-4):66-70.
Rahbar Taramsari M, Teimourpour P, Jahanbakhsh R. The results of pathology at autopsy poisoned rice with tablets (aluminum phosphide). Journal of Guilan University of Medical Sciences 2011;19(76):56-63
Tofighi H. Medico-legal investigation of narcotics & other drug involved deaths. Tehran Univ Med J 1994 Mar 15;52(1):43-55.
Izadi-Mood N, Tavahen N, Masoumi GR, Gheshlaghi F, Siadat ZD, Setareh M, et al. Demographic factors, length of stay, cost of hospitalization and death in patients treated with amphetamines and drugs. Journal of Isfahan Medical School 2012;29(146).
Moghadamnia AA, Abdollahi M. Anepidemiological study of poisoning in northernIslamic Republic of Iran. East Mediterr Health J 2002;8(1):88-94.
Ahmadi A, Pakravan N, Ghazizadeh Z. Pattern of acute food, drug, and chemical poisoning in Sari City, Northern Iran. Human & experimental toxicology. 2010 Sep;29(9):731-8.
Ala A, Vahdati SS, Moosavi L, Sadeghi H. Studying the Relationship Between Age, Gender and Other Demographic Factors with the Type of Agent Used for Self-Poisoning at a Poisoning Referral Center in North West Iran/Kuzey Bati Iran'da Bir Zehirlenme Referans Merkezinde Kendini Zehirlemek için Kullanilan Ajan Tipi ile Yas, Cinsiyet ve Diger Demografik Faktörlerin Iliskisinin Arastirilmasi. Journal of Academic Emergency Medicine. 2011 Sep 1;10(3):100.
Rahbar Tarmasari M, Orangipour R, Zerkami T, Palizkar M, Mousavian Roshan Zamir A. Investigating patients with rice pills poisoned. Journal of Guilan University of Medical Sciences. , 2006 Jan. 15; 14 (56): 42-7.