Diapositive 1 - Hôpital du Valais

Institut Central (ICHV)
Zentral Institut (IZIWS)
TOXICOLOGY IN EMERGENCY ROOM IN THE VALAIS HOSPITAL
Nicolas Donzé1, Luc Fornerod2, Arnaud Chiolero2, René Bonvin2, Michel F. Rossier1, Marc Augsburger3
1Central
Institute (ICHV), Grand Champsec 86, 1950 Sion, www.hopitalvs.ch
2Valais Health Observatory (OVS), Grand Champsec 86, 1950 Sion, www.ovs.ch
3University Center of Legal Medicine, Lausanne-Geneva, Rue du Bugnon 21, 1011 Lausanne, www.curml.ch
METHODS
INTRODUCTION
Inspired by the Drug Abuse Warning Network, which presents an estimation of drug-related visits to
hospital emergency departments (EDs) in USA, we assessed the number of drug-related visits to hospital
emergency departments in one canton of Switzerland, in Valais.
The Valais Hospital (8 connected local, medium-sized hospitals, including 5 with an Emergency
Department) has been created for the implementation of cantonal hospital planning in Valais. The Valais
is a mountain canton in the south of Switzerland, whose most important industries are wine production,
agriculture, hydroelectric power production (Europe's tallest gravity dam is located at Grande Dixence in Valais)
chemistry factories, aluminum factories and tourism. People (about 300’000 people) in Valais speaks an
old German in the part called Oberwallis and French in the part called Bas-Valais.
All the patients entered into the Emergency Department (ED) since 2007 to 2011, in the Valais
Hospital’s sites of Brig, Visp, Sierre, Sion (pediatric and general ED) and Martigny (see map 3) were
considered.
Two kinds of requested toxicological analyses were realised: screenings of drugs of abuse (DOA:
acetaminophen; amphetamine; metamphetamine; barbiturates; benzodiazepines; cannabinoids;
cocaine; methadone; opiates; PCP; TCA) by immunological test (Triage; Biosite) in urine and
measure of ethanol in serum with colorimetric method (Cobas 6000 Roche® in Sion and Cobas 400
Roche® in the others sites). The results for DOA test were qualitative (positive or not detected) and
the results for alcohol were quantitative (g/kg) (LOQ = 0.15 g/kg).
AIMS
This study presents drug-related visits to Valais Hospital emergency departments (EDs) between 2007
and 2011, based on data from the Central institute laboratory and from the Valais Health Observatory
(OVS).
This study was realized in accordance to the model of the “Drug Abuse Warning Network, 2009
(DAWN)[1]” which presents US national estimates of drug-related visits to hospital emergency
departments for the period going from 2004 to 2009.
Map 3 : Organisation of the Valais Hospital
Map 2 : The Valais
MAP 1 : Switzerland
EMERGENCY DEPARTMENTS
2007
2008
2009
2010
2011
RESULTS
BRIG
3’725
3’254
2’524
2’156
2’364
VISP
11’842
12’862
13’329
13’660
14’238
SIERRE
SION
8’464
8’975
8’954
8’820
9’333
The total number of ED visits between 2007 and 2011; increased from 64’725 to 69’867 (8 %. Table 1).
The number of requests for DOA or/and alcohol increased from 1922 to 2381 (24 %) as well. It has
been observed that the percentage of requests for DOA or/and alcohol among ED visits presents a
small increase (3.0 % to 3.4 %). The number of requests for DOA only presents an increase of 71 %
between 2007 and 2011 (Table 2).
ED
23’973
24’298
24’109
24’132
24’874
PEDIATRIC UNIT
5’121
4’948
5’596
5’797
6’300
BLOOD ALCOHOL
MARTIGNY
11’600
12’040
12’732
11’968
12’758
U-DOA
TOTAL VALAIS HOSPITAL
64’725
66’377
67’244
66’533
69’867
Table 1
TOTAL
: numbers of visits in ED in differentes sites between 2007 and 2011 in Valais Hospital
2007 ( N = 276)
2008 ( N = 353)
Table 2
2009 ( N = 371)
2008
2009
2010
2011
1’646
1’706
1’615
1’750
1’908
276
353
371
408
473
1’922
2’059
1’986
2’158
2’381
: numbers of analyses of Blood alcohol and U-DOA between 2007 and 2011.
2010 ( N = 408)
2011 ( N = 473)
Drug of abuse (DOA)
< 25 YEARS OLD
Positive results
AMPHETAMINE
METAMPHETAMINE
CANNABINOIDS
COCAÏNE
METHADONE
OPIATES
PHENCYCLIDINE
0
0
15
3
0
3
0
BARBITURATES
BENZODIAZEPINE
PARACETAMOL
TRICYCLIQUE ANTIDEPRESSANTS
0
17
11
0
Table 3
2007
% POS
Positive results
0
0
20
5
5
4
0
5.4
1.1
1.1
0
27
21
0
6.2
4
% POS
5.7
1.4
1.4
1.1
7.6
5.9
Positive results
% POS
Positive results
2
1
24
2
3
2
0
0.5
2
0
28
0
0
4
0
6.5
0.5
0.8
0.5
0
21
16
3
0
21
13
0
5.7
4.3
0.8
% POS
Positive results
% POS
5
3
38
1
1
5
0
1.1
0.6
8
6.9
1
0
23
22
3
5.1
3.2
1.1
4.9
4.7
0.6
: Type of drugs detected between 2007 and 2011 by less than 25 years old. The most important drugs are benzodiazepines and cannabinoids.
2007 ( N = 276)
2008 ( N = 353)
2009 ( N = 371)
2010 ( N = 408)
2011 ( N = 473)
Between 2007 and 2011, the number of visits in ED in
Hospital Valais presents a light increase of about 5’000
people. In the same time the demand of DOA analyses
presents an 197 increase, which represents 70 % more
investigation.
Under 25 years old, benzodiazepines were the most
frequently detected drugs in 2007 and 2008 and since
2009, cannabinoids were the most detected drugs (Table
3). During the period benzodiazepines were often each
year the most detected drug(about 5 % of positives
cases).
> 25 YEARS OLD
Positive results
% POS
Positive results
0
0
19
5
6
10
0
AMPHETAMINE
METAMPHETAMINE
CANNABINOIDS
COCAÏNE
METHADONE
OPIATES
PHENCYCLIDINE
0
1
17
7
3
17
0
0.4
6.2
2.5
1.1
6.2
BARBITURATES
BENZODIAZEPINE
PARACETAMOL
TRICYCLIQUE ANTIDEPRESSANTS
4
63
17
7
1.4
22.8
6.2
2.5
Table 4
2
65
20
8
5.4
1.4
1.7
2.8
0.6
18.4
5.7
2.3
Positive results
% POS
Positive results
2
0
21
6
6
15
0
0.5
0
0
26
9
6
13
0
2
66
27
7
0.5
17.8
7.3
1.9
5.7
1.6
1.6
4
2
90
28
6
% POS
Positive results
% POS
1
0
44
9
12
16
0
0.2
6.4
2.2
1.5
3.2
0.5
22.1
6.9
1.5
0
87
26
3
9.3
1.9
2.5
3.4
2008
2009
Age
Nb
Analyses
Moy [g/kg] (min-max)
Nb
Analyses
Moy [g/kg] (min-max)
Nb
Analyses
12
13
14
15
16
17
18
19
20
21
1
3
5
9
8
25
27
41
30
31
1.59 (1.59 - 1.59)
1.75 ( 0.83 - 2.22)
1.44 (1.04 - 1.98)
1.67 (1.06 - 2.38)
2.15 (1.35 - 2.72)
1.72 (0.27- 2.80)
1.65 (0.30 - 2.58)
2.14 (0.21 - 4.20)
1.74 (0.22 - 3.62)
1.46 (0.23 - 3.26)
1
1
6
21
17
23
25
34
42
37
1.55 (1.55 -1.55)
1.78 (1.78 - 1.78)
1.63 ( 0.26 - 2.45)
1.81 (0.60 - 2.72)
1.80 (0.47 - 3.42)
1.52 (0.17 - 2.69)
1.58 (0.27 - 2.94)
1.88 (0.62 - 3.31)
2.21 (0.21 -5.47)
1.86 (0.20 - 5.17)
0
2
7
12
13
23
29
33
30
35
180
N=
207
Moy [g/kg] (min-max)
1.76 (1.62 - 1.90)
2.04 (1.58 - 2.70)
1.64 (0.53 - 2.35)
1.30 (0.22 - 2.05)
1.52 (0.28 - 2.88)
2.00 (0.31 - 3.84)
1.81 (0.35 - 3.31)
1.56 (0.34 - 2.93)
1.91 (0.18 - 6.06)
184
2010
Nb
Analyses
0
3
8
13
19
18
30
25
18
29
Moy [g/kg] (min-max)
18.4
5.5
0.6
1.64 (1.38 - 1.83)
1.74 (1.20 - 2.43)
1.79 (0.58 - 3.80)
1.67 (0.56 - 2.82)
1.78 (0.48 - 2.96)
1.58 (0.33 - 2.48)
1.71 (.017 - 2.66)
1.73 (0.66 - 2.78)
1.58 ( 0.76 - 3.07)
Alcohol
2011
Nb
Analyses
1
0
7
12
13
24
30
25
43
24
Moy [g/kg] (min-max)
1.16 (1.16 -1.16)
1.50 (0.76 - 2.21)
1.66 (0.26 - 2.21)
1.56 (0.56 - 2.50)
1.82 (0.41 - 4.04)
1.62 (0.37 - 3.11)
1.75 (0.18 - 4.04)
1.70 (0.34 - 3.20)
2.06 (0.14 - 5.21)
163
By adults (more than 25 years old) the most detected
drugs are the benzodiazepines. The number of positive
cases present a tendency to increase. This was also
observed for other drugs, such as cannanbinoids.
About 20 % of adults visiting the ED were positive for
benzodiazepines. (Table 4)
: Type of drugs detected between 2007 and 2011 by more than 25 years old. The most important drugs are benzodiazepines and cannabinoids.
2007
Table 5
% POS
179
Between 2007 and 2011, the proportion of patients under
age of 21 and positive for alcohol represented 15.8 %,
17.2%, 16.4%, 13.8% and 14.1 % of the ED visits,
respectively (Table 5).
Considering the mean blood alcohol concentration (BAC)
of young patients, it is worrying to observe values
between 1.16 and 2.21 g/kg. Moreover, very high BAC
were observed, with a maximal value of 6.06 g/kg for a 21
years old patient. These results suggest a significant
number of cases of alcohol misuse, that would be at risk
to the health of these young patients.
: Type of drugs detected between 2007 and 2011 by more than 25 years old. The most important drugs are benzodiazepines and cannabinoids.
CONCLUSION
In Valais Hospital, it has been observed that the percentage of requests for DOA or/and alcohol among ED visits presents a small increase (3.0 % to 3.4 %). The number of
requests for DOA only presents an increase of 71 % between 2007 and 2011
Alcohol was the drug most frequently detected . Among patients positive for alcohol, one out of ten is under the age of 21. When a request for alcohol is demanded, a positive
result appears in about 70 % of the cases.
The cannabis is the most detected drug of abuse by under 25 years old people. The most detected drug by adults is benzodiazepine.
REFERENCES
[1] Drug Abuse Warning Network, 2009: National Estimates of Drug-Related Emergency Departments Visits. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA, http://DAWNinfo.samhsa.gov) August 2011.