Purpose: There is a lack of data concerning
the evaluation of scientific research productivity in paracetamol poisoning
from the world. The purposes of this study were to analyse the worldwide
research output related to paracetamol poisoning and to examine the authorship
pattern and the citations retrieved from the Scopus database for over a decade.
Methods: Data were searched for documents with specific words
regarding paracetamol poisoning as ‘keywords’ in the title or/and abstract.
Scientific output was evaluated based on a methodology developed and used in
other bibliometric studies. Research productivity was adjusted to the national
population and nominal gross domestic product (GDP) per capita.
Results: There were 1721 publications that met the criteria
during study period from the world. All retrieved documents were published from
72 countries. The largest number of articles related to paracetamol poisoning
was from the United States (US; 30.39%), followed by India (10.75%) and the
United Kingdom (UK; 9.36%). The total number of citations at the time of data
analysis was 21,109, with an average of 12.3 citations per each documents and
median (interquartile range) of 4 (1–14). The h-index of the retrieved
documents was 57. After adjusting for economy and population power, India
(124.2), Nigeria (18.6) and the US (10.5) had the highest research
productivity. Countries with large economies, such as the UK, Australia, Japan,
China and France, tended to rank relatively low after adjustment for GDP over
the entire study period.
Conclusion: Our study demonstrates evidence that research
productivity related to paracetamol poisoning has increased rapidly during the
recent years. The US obviously dominated in research productivity. However,
certain smaller country such as Nigeria has high scientific output relative to
their population size and GDP. A highly noticeable increase in the
contributions of Asia-Pacific and Middle East regions to scientific literature
related to paracetamol poisoning was also observed.
Purpose The present study examines the relationship between the dose of
acetaminophen reported to have been ingested by patients and the occurrence of
serum acetaminophen levels above the ‘possible toxicity’ line in patients
presenting at the hospital after acetaminophen overdose. The prognostic value
of patient-reported dosage cut-offs of 8, 10 and 12 g was determined.
Methods This
retrospective cohort study included patients admitted to the emergency department
or hospital within 24 hours of acetaminophen ingestion. Serum acetaminophen
concentrations were considered to be the gold standard, and specificity,
sensitivity and positive/negative predictive values were calculated from the
reported ingested dose, to predict toxicity using the Rumack–Matthew nomogram
(i.e. the ‘possible toxicity’ treatment line) and standard equations.
Results Of
305 patients identified, 291 met the study inclusion criteria, and 121 (41.6%)
had serum acetaminophen concentrations above the ‘possible toxicity’ treatment
line. The range of patient-reported acetaminophen ingested was 1–75 g, with 185
patients (63.6%) reporting ≥8 g. One hundred eighteen patients (97.5%) who
reported ingesting ≥8 g had serum acetaminophen concentrations above the
‘150-line’, compared with only three patients (2.5%) who reported ingesting
<8 g (p < 0.001). The positive predictive value of a
patient-reported dose ≥8 g for predicting serum acetaminophen concentrations
above the ‘possible toxicity’ treatment line was 63.78%, with a negative
predictive value of 97.17%. The sensitivity of patient-reported doses ≥8 g was
high (97.52%) but with low specificity (60.59%). The sensitivity of
patient-reported doses ≥10 g also was high (89.26%) with low specificity
(65.29%), whereas the sensitivity of ≥12 g dose was low (61.16%) with high
specificity (86.47%).
Conclusions Patient-reported
doses of acetaminophen are good risk indicators for acetaminophen overdose
patients in Malaysia. Patient-reported ingestion of ≥8 g (as a cut-off dose)
had a higher sensitivity than ≥10 g or ≥12 g. The results of this study have
important implications for toxicity risk evaluations in areas with poor serum
acetaminophen assay availability.
Background: Acetaminophen is one of the most commonly encountered medications in self-poisoning, with a high rate of morbidity. The prevalence and characteristics of acetaminophen intoxication associated with long hospital stay in patients are not well defined. Objectives: This study aims to identify the clinical and demographic factors associated with the length of in-hospital stay (LOS), and to evaluate the effect of early treatment of acetaminophen overdose patients (≤8 hours) by intravenous N-acetylcysteine (IV-NAC) on hospital stay. Methods: This is a retrospective cohort study of hospital admissions for acetaminophen overdose conducted over a period of 5 years from 1 January 2004 to 31 December 2008. Patients were divided into two groups: LS group patients had a long hospital stay (> median hours stay in hospital) and SS group patients had a short hospital stay (≤ median hours stay in hospital). Variables were abstracted from medical records for comparison between the two groups. A total of 20 variables were identified for comparison. Parametric and non-parametric tests were used to test differences between groups depending on the normality of the data. SPSS 15 was used for data analysis. Results: Of the 305 patients, 11 factors were identified in the univariate analysis as associated with LS. Three independent factors were found to be significant predictors of LS in the multivariate analysis. The factors associated with LS were seen among patients with a history of abdominal pain after ingestion of acetaminophen (p = 0.04), who were on IV-NAC administration (p < 0.001) and had an acutely depressed mood (p = 0.003). Late time to NAC infusion of more than 8 hours was associated with LS rather than SS (96 patients [57%] and 6 [24%], respectively; p = 0.003). Conclusion: Patients with long hospital stay have different clinical characteristics compared to patients with short hospital stay. We identified time to IV-NAC administration is a potentially modifiable factor that may lead to prolonged hospital stay. When risk assessment indicates that NAC is required, it is highly recommended that NAC be started in the first hours of admission to reduce the LOS.
Purpose The present study examines the relationship between the dose of acetaminophen reported to have been ingested by patients and the occurrence of serum acetaminophen levels above the ‘possible toxicity’ line in patients presenting at the hospital after acetaminophen overdose. The prognostic value of patient-reported dosage cut-offs of 8, 10 and 12 g was determined.
Methods This retrospective cohort study included patients admitted to the emergency department or hospital within 24 hours of acetaminophen ingestion. Serum acetaminophen concentrations were considered to be the gold standard, and specificity, sensitivity and positive/negative predictive values were calculated from the reported ingested dose, to predict toxicity using the Rumack–Matthew nomogram (i.e. the ‘possible toxicity’ treatment line) and standard equations.
Results Of 305 patients identified, 291 met the study inclusion criteria, and 121 (41.6%) had serum acetaminophen concentrations above the ‘possible toxicity’ treatment line. The range of patient-reported acetaminophen ingested was 1–75 g, with 185 patients (63.6%) reporting ≥8 g. One hundred eighteen patients (97.5%) who reported ingesting ≥8 g had serum acetaminophen concentrations above the ‘150-line’, compared with only three patients (2.5%) who reported ingesting <8 g (p < 0.001). The positive predictive value of a patient-reported dose ≥8 g for predicting serum acetaminophen concentrations above the ‘possible toxicity’ treatment line was 63.78%, with a negative predictive value of 97.17%. The sensitivity of patient-reported doses ≥8 g was high (97.52%) but with low specificity (60.59%). The sensitivity of patient-reported doses ≥10 g also was high (89.26%) with low specificity (65.29%), whereas the sensitivity of ≥12 g dose was low (61.16%) with high specificity (86.47%).
Conclusions Patient-reported doses of acetaminophen are good risk indicators for acetaminophen overdose patients in Malaysia. Patient-reported ingestion of ≥8 g (as a cut-off dose) had a higher sensitivity than ≥10 g or ≥12 g. The results of this study have important implications for toxicity risk evaluations in areas with poor serum acetaminophen assay availability.
Background: Acetaminophen overdose may be accompanied by electrolyte disturbances. The basis for electrolyte change appears to be due to increased fractional urinary electrolyte excretion.
Purpose: This study investigated the impact of serum acetaminophen concentration on changes in serum potassium, creatinine and urea concentrations in patients with acetaminophen overdose.
Methods: This was a retrospective cohort study which included patients admitted to the emergency department and hospital within 24 h of acetaminophen ingestion. The study was conducted over a period of 5 years from 1 January 2004 to 31 December 2008. Data are presented as mean ± SD and as medians (interquartile range) and groups were compared using independent two-tailed Student t-test. Statistical Package for Social Sciences (SPSS) 15 was used for data analysis.
Results: Two hundred and eighty-three patients were studied (44 males and 239 females), mean age 23 ± 7.5 years. Patients who had a serum acetaminophen concentration above a ‘possible toxicity’ treatment line were associated with an elevation in serum creatinine concentration (p = 0.044) and a reduction in the serum potassium concentration (p < 0.001) but were not associated with a reduction in serum urea concentration (p > 0.99). During the study period, 63.3% (179 patients) had serum potassium concentrations less than the normal concentration (3.5 mmol/l) and 31.4% (89 patients) had serum urea concentrations less than the normal concentration (2.5 mmol/l). The serum creatinine concentration in all patients was within the normal range.
Conclusions: Acetaminophen appears to cause a concentration-dependent reduction of potassium concentrations and an elevation of creatinine concentrations of short duration (<24 h) after overdose.
Background: Acetaminophen is one of the most commonly encountered medications in self-poisoning, with a high rate of morbidity. The prevalence and characteristics of acetaminophen intoxication associated with long hospital stay in patients are not well defined.
Objectives: This study aims to identify the clinical and demographic factors associated with the length of in-hospital stay (LOS), and to evaluate the effect of early treatment of acetaminophen overdose patients (≤8 hours) by intravenous N-acetylcysteine (IV-NAC) on hospital stay.
Methods: This is a retrospective cohort study of hospital admissions for acetaminophen overdose conducted over a period of 5 years from 1 January 2004 to 31 December 2008. Patients were divided into two groups: LS group patients had a long hospital stay (> median hours stay in hospital) and SS group patients had a short hospital stay (≤ median hours stay in hospital). Variables were abstracted from medical records for comparison between the two groups. A total of 20 variables were identified for comparison. Parametric and non-parametric tests were used to test differences between groups depending on the normality of the data. SPSS 15 was used for data analysis.
Results: Of the 305 patients, 11 factors were identified in the univariate analysis as associated with LS. Three independent factors were found to be significant predictors of LS in the multivariate analysis. The factors associated with LS were seen among patients with a history of abdominal pain after ingestion of acetaminophen (p = 0.04), who were on IV-NAC administration (p < 0.001) and had an acutely depressed mood (p = 0.003). Late time to NAC infusion of more than 8 hours was associated with LS rather than SS (96 patients [57%] and 6 [24%], respectively; p = 0.003).
Conclusion: Patients with long hospital stay have different clinical characteristics compared to patients with short hospital stay. We identified time to IV-NAC administration is a potentially modifiable factor that may lead to prolonged hospital stay. When risk assessment indicates that NAC is required, it is highly recommended that NAC be started in the first hours of admission to reduce the LOS
Intravenous N-acetylcysteine (IV-NAC) is usually regarded as a safe antidote to acetaminophen overdose. However, during infusion of the loading dose, adverse drug reactions such as a headache may occur. The objectives of this study were to investigate the prevalence of headache in patients presenting to hospital after acetaminophen overdose and to determine which clinical findings are most predictive of headache among these patients. This is a retrospective cohort study of hospital admissions for acute acetaminophen overdose that was conducted over a period of 4 years from January 1, 2005 to December 31, 2008. Demographic data, clinical characteristics, and predictors of headache were analyzed. spss 15 was used for data analysis. Two-hundred and fifty-five patients were studied; their mean age was 23.1 ± 1.6; 83.9% of them were women and 14.9% had a headache during hospitalization. Headache among patients was significantly associated with IV-NAC administration (P = 0.001), intentional ingestion of drug (P = 0.04), acetaminophen concentration above ‘possible toxicity’ treatment line (P = 0.04), a high acetaminophen concentration (P = 0.04), and a long hospital stay (P = 0.03). Multiple logistic regression showed a significant risk factor for headache in patients administered IV-NAC (P = 0.04). We recorded a high frequency of headache in patients with acute acetaminophen overdose in our geographical area. This study suggests that among those patients, the use of IV-NAC is associated with an increased risk of headache.
Background and objectives: Intravenous
N-acetylcysteine (IV-NAC) is widely recognized as the antidote of choice for
acetaminophen overdose [1]. However, its use is not without adverse drug
reactions (ADR) which might affect therapeutic outcome or lead to treatment
delay [2, 3]. The aims of this study were to investigate the type and incidence
of ADR induced by IV-NAC in patients treated for acetaminophen overdose and to
assess the causality of individual ADR to IV-NACusing Naranjo's algorithm [4].
Methods:
This is a retrospective study of patients admitted to the hospital for acute
acetaminophen overdose over a period of 5 years (January 1, 2004 to December
31, 2008). The primary outcome of interest in this study was the occurrence of
ADR during NAC administration. The probability of an ADR was assessed using the
Naranjo algorithm, which consists of 10 questions), and has been used to
determine the likelihood that an ADR was related to a specific medication [4].
Results:
During the study period, 305 patients with a diagnosis of overdose of
paracetamol-containing compounds were admitted to the hospital for monitoring
and treatment. Different types of ADR occurred in 137 patients (137/305;
44.9%). Of those patients who had an ADR, 98 (98/137; 71.5%) had been treated
with IV-NAC and 39 (39/137; 28.5%) had not(p < 0.001). Comparison of
different ADR in all patients showed that the following ADR were significantly
associated with IV-NAC administration: nausea (p = 0.004), vomiting (p <
0.001), flushing (p < 0.001), rash (P < 0.001), pruritus (p < 0.001),
chest pain (p = 0.001), bronchospasm (p = 0.015), coughing (p = 0.017),
headache (p < 0.001), dizziness (p < 0.001), convulsion (p = 0.035) and
hypotension (p = 0.001). Based on Naranjo’s algorithm, 226 events were judged
to be NAC-related – 31.1% probably and 67.9% possibly drug-related. None of the
events were definitely drug-related. Conclusion: Adverse drug reactions
to IV-NAC were common among patients with acetaminophen overdose but mostly
minor, and that all reported adverse reactions were easily managed.
Purpose: The present study examines the relationship between
the dose of acetaminophen reported to have been ingested by patients and the
occurrence of serum acetaminophen levels above the ‘possible toxicity’ line in
patients presenting at the hospital after acetaminophen overdose. The
prognostic value of patient-reported dosage cut-offs of 8, 10 and 12 g was
determined.
Methods: This retrospective cohort study included patients admitted to the
emergency department or hospital within 24 hours of acetaminophen ingestion.
Serum acetaminophen concentrations were considered to be the gold standard, and
specificity, sensitivity and positive/negative predictive values were calculated
from the reported ingested dose, to predict toxicity using the Rumack–Matthew
nomogram (i.e. the ‘possible toxicity’ treatment line) and standard equations.
Results Of 305 patients identified, 291 met the study inclusion criteria, and
121 (41.6%) had serum acetaminophen concentrations above the ‘possible
toxicity’ treatment line. The range of patient-reported acetaminophen ingested
was 1–75 g, with 185 patients (63.6%) reporting ≥8 g. One hundred eighteen
patients (97.5%) who reported ingesting ≥8 g had serum acetaminophen
concentrations above the ‘150-line’, compared with only three patients (2.5%)
who reported ingesting <8 g (p < 0.001). The positive
predictive value of a patient-reported dose ≥8 g for predicting serum
acetaminophen concentrations above the ‘possible toxicity’ treatment line was
63.78%, with a negative predictive value of 97.17%. The sensitivity of
patient-reported doses ≥8 g was high (97.52%) but with low specificity
(60.59%). The sensitivity of patient-reported doses ≥10 g also was high
(89.26%) with low specificity (65.29%), whereas the sensitivity of ≥12 g dose
was low (61.16%) with high specificity (86.47%).
Conclusions: Patient-reported doses of
acetaminophen are good risk indicators for acetaminophen overdose patients in
Malaysia. Patient-reported ingestion of ≥8 g (as a cut-off dose) had a higher
sensitivity than ≥10 g or ≥12 g. The results of this study have important
implications for toxicity risk evaluations in areas with poor serum
acetaminophen assay availability.