Patterns of hospital transfer for self-poisoned patients in rural Sri Lanka: implications for estimating the incidence of self-poisoning in the developing world
OBJECTIVES: Most data on self-poisoning in rural Asia have come from secondary hospitals. We aimed to: assess how transfers from primary to secondary hospitals affected estimates of case-fatality ratio (CFR); determine whether there was referral bias according to gender or poison; and estimate the a...
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The World Health Organization
2006-01-01
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| Series: | Bulletin of the World Health Organization |
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| Online Access: | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862006000400011 |
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| author | Eddleston Michael Sudarshan K Senthilkumaran M Reginald K Karalliedde Lakshman Senarathna Lalith Silva Dhammika de Rezvi Sheriff MH Buckley Nick A Gunnell David |
| author_facet | Eddleston Michael Sudarshan K Senthilkumaran M Reginald K Karalliedde Lakshman Senarathna Lalith Silva Dhammika de Rezvi Sheriff MH Buckley Nick A Gunnell David |
| author_sort | Eddleston Michael |
| collection | DOAJ |
| description | OBJECTIVES: Most data on self-poisoning in rural Asia have come from secondary hospitals. We aimed to: assess how transfers from primary to secondary hospitals affected estimates of case-fatality ratio (CFR); determine whether there was referral bias according to gender or poison; and estimate the annual incidence of all self-poisoning, and of fatal self-poisoning, in a rural developing-world setting. METHODS: Self-poisoning patients admitted to Anuradhapura General Hospital, Sri Lanka, were reviewed on admission from 1 July to 31 December 2002. We audited medical notes of self-poisoning patients admitted to 17 of the 34 surrounding peripheral hospitals for the same period. FINDINGS: A total of 742 patients were admitted with self-poisoning to the secondary hospital; 81 died (CFR 10.9%). 483 patients were admitted to 17 surrounding peripheral hospitals. Six patients (1.2%) died in peripheral hospitals, 249 were discharged home, and 228 were transferred to the secondary hospital. There was no effect of gender or age on likelihood of transfer; however, patients who had ingested oleander or paraquat were more likely to be transferred than were patients who had taken organophosphorus pesticides or other poisons. Estimated annual incidences of self-poisoning and fatal self-poisoning were 363 and 27 per 100 000 population, respectively, with an overall CFR of 7.4% (95% confidence interval 6.0-9.0). CONCLUSION: Fifty per cent of patients admitted to peripheral hospitals were discharged home, showing that CFRs based on secondary hospital data are inflated. However, while incidence of self-poisoning is similar to that in England, fatal self-poisoning is three times more common in Sri Lanka than fatal self-harm by all methods in England. Population based data are essential for making international comparisons of case fatality and incidence, and for assessing public health interventions. |
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| institution | Directory Open Access Journal |
| issn | 0042-9686 |
| language | English |
| last_indexed | 2024-03-07T17:38:13Z |
| publishDate | 2006-01-01 |
| publisher | The World Health Organization |
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| series | Bulletin of the World Health Organization |
| spelling | doaj.art-b6fe70d99d974ef89859acc50b0fc9c72024-03-02T16:24:56ZengThe World Health OrganizationBulletin of the World Health Organization0042-96862006-01-01844276282Patterns of hospital transfer for self-poisoned patients in rural Sri Lanka: implications for estimating the incidence of self-poisoning in the developing worldEddleston MichaelSudarshan KSenthilkumaran MReginald KKaralliedde LakshmanSenarathna LalithSilva Dhammika deRezvi Sheriff MHBuckley Nick AGunnell DavidOBJECTIVES: Most data on self-poisoning in rural Asia have come from secondary hospitals. We aimed to: assess how transfers from primary to secondary hospitals affected estimates of case-fatality ratio (CFR); determine whether there was referral bias according to gender or poison; and estimate the annual incidence of all self-poisoning, and of fatal self-poisoning, in a rural developing-world setting. METHODS: Self-poisoning patients admitted to Anuradhapura General Hospital, Sri Lanka, were reviewed on admission from 1 July to 31 December 2002. We audited medical notes of self-poisoning patients admitted to 17 of the 34 surrounding peripheral hospitals for the same period. FINDINGS: A total of 742 patients were admitted with self-poisoning to the secondary hospital; 81 died (CFR 10.9%). 483 patients were admitted to 17 surrounding peripheral hospitals. Six patients (1.2%) died in peripheral hospitals, 249 were discharged home, and 228 were transferred to the secondary hospital. There was no effect of gender or age on likelihood of transfer; however, patients who had ingested oleander or paraquat were more likely to be transferred than were patients who had taken organophosphorus pesticides or other poisons. Estimated annual incidences of self-poisoning and fatal self-poisoning were 363 and 27 per 100 000 population, respectively, with an overall CFR of 7.4% (95% confidence interval 6.0-9.0). CONCLUSION: Fifty per cent of patients admitted to peripheral hospitals were discharged home, showing that CFRs based on secondary hospital data are inflated. However, while incidence of self-poisoning is similar to that in England, fatal self-poisoning is three times more common in Sri Lanka than fatal self-harm by all methods in England. Population based data are essential for making international comparisons of case fatality and incidence, and for assessing public health interventions.http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862006000400011Poisoning/epidemiologySuicide, Attempted/trendsReferral and consultationSri Lanka |
| spellingShingle | Eddleston Michael Sudarshan K Senthilkumaran M Reginald K Karalliedde Lakshman Senarathna Lalith Silva Dhammika de Rezvi Sheriff MH Buckley Nick A Gunnell David Patterns of hospital transfer for self-poisoned patients in rural Sri Lanka: implications for estimating the incidence of self-poisoning in the developing world Bulletin of the World Health Organization Poisoning/epidemiology Suicide, Attempted/trends Referral and consultation Sri Lanka |
| title | Patterns of hospital transfer for self-poisoned patients in rural Sri Lanka: implications for estimating the incidence of self-poisoning in the developing world |
| title_full | Patterns of hospital transfer for self-poisoned patients in rural Sri Lanka: implications for estimating the incidence of self-poisoning in the developing world |
| title_fullStr | Patterns of hospital transfer for self-poisoned patients in rural Sri Lanka: implications for estimating the incidence of self-poisoning in the developing world |
| title_full_unstemmed | Patterns of hospital transfer for self-poisoned patients in rural Sri Lanka: implications for estimating the incidence of self-poisoning in the developing world |
| title_short | Patterns of hospital transfer for self-poisoned patients in rural Sri Lanka: implications for estimating the incidence of self-poisoning in the developing world |
| title_sort | patterns of hospital transfer for self poisoned patients in rural sri lanka implications for estimating the incidence of self poisoning in the developing world |
| topic | Poisoning/epidemiology Suicide, Attempted/trends Referral and consultation Sri Lanka |
| url | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862006000400011 |
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