Variations in Poisoning Epidemiology and Management During the Initial COVID-19 Outbreak in a Taiwanese Emergency Department.

Abstract

Purpose: The COVID-19 pandemic significantly impacted the epidemiology of emergency department (ED) presentations, including those for self-harm and poisoning. Taiwan, with its strict border controls and quarantine measures, experienced a delayed COVID-19 outbreak in late April 2022. We evaluated epidemiological changes in ED poisoning cases and assessed whether their management was affected during the early stages of the COVID-19 outbreak.

Patients and methods: We conducted a retrospective cohort study of ED poisoning cases during the early phase of the COVID-19 outbreak (May 1-July 31, 2022) and the corresponding pre-COVID-19 periods (May 1-July 31, 2018, and 2019) at a tertiary medical center. Demographic data, poisoning characteristics, treatment efficiency, and clinical outcomes were compared between the two periods.

Results: In total, 145 poisoning cases (48.3 per month) were identified during the pandemic, compared to 572 (95.3 per month) in the pre-pandemic period. Poisoned patients were significantly older (median age: 48 vs 40.5 years, p = 0.009) during the pandemic compared to the pre-pandemic periods, with a significant decline in pediatric poisoning cases. Although an increase in prescription drug exposures and a slight decrease in other poisoning categories was observed, these differences were not statistically significant. The proportion of severe poisoning cases (poisoning severity score 3 or 4) was significantly higher during the pandemic than in the pre-pandemic period (14.5% vs 7.9%, p = 0.021), and was accompanied by increased rates of intubation and intensive care unit admissions. ED stays were significantly prolonged during the pandemic, particularly among patients at risk of concurrent COVID-19 infection. Mortality rates remained comparable between the two periods.

Conclusion: The epidemiology, disease severity, and management efficiency of poisoning cases were significantly affected during the early phase of the nationwide COVID-19 outbreak. Further large-scale studies are needed to validate these findings and inform future interventions.