Ranking the acute poisoning etiologies in Iran: A systematic review and meta-analysis

Objective: Acute poisoning is a major health problem and one of the most common causes of emergency visits worldwide. Since most poisoning subjects present with a decreased level of consciousness and due to unreliable disease history, recognizing the etiological cause of the poisoning represents a critical part in arranging the treatment strategy. This study aimed at examining the prevalence of etiological causes of poisoning in Iran in a systematic review and meta-analysis. Method: This systematic review and meta-analysis investigated the cross-sectional studies published from 1990 to 2020, reporting specific poisoning agents among acute poisoning cases in Iran. Persian and English articles on this subject were collected by searching the Scientific Information Database (SID), ScienceDirect, PubMed, Medlib, IranMedex, Scopus, Magiran, and Google Scholar databases. The heterogeneity of the studies was investigated using the I2 index and the probability of bias in the publication was assessed by the Begg and Mazumdar test with a significance level of 0.1. Data analysis was performed by Comprehensive Meta-analysis software version 3 (Biostat, Englewood, NJ, USA). Results: In our review, 19 studies appraising 143,251 cases of poisoning were included. The ranking of the OR of each agent was done; Opium poisoning was the most prevalent poisoning case followed by benzodiazepine, acetaminophen, antipsychotic medications, organophosphates, aluminum phosphide, amphetamine, pesticide, tricyclic antidepressant (TCA), alcohol, chemicals, carbon monoxide (CO), nonsteroidal anti-inflammatory drugs (NSAIDs), and selective serotonin reuptake inhibitors (SSRIs). Conclusion: While proper judgment on the cause of poisoning and selection of suitable treatment manners could be followed by a very good prognosis in patients with acute poisoning; this demands an epidemiological perception of the prevalence of the etiological poisoning agents. Our study ranked the most likely agents leading to the poisoning, to be at the top of the list of differential diagnoses of physicians.