Outcome of early emergency intubation and early emergency dialysis in deliberate self-harm with formic acid in a tertiary care center in South India: A retrospective cohort study
Rahul Balasubramanian1
, Jobin Jose Maprani2, Sandra Paulson3, Suresh G4, S Manu Ayyan5, Vimal Rohan K6
1Department of Emergency Medicine, St James Hospital, Chalakudy, Thrissur, Kerala, India
2Department of Emergency Medicine, Amala Institute of Medical Sciences, Thrissur, Kerala, India
3Department of Community Medicine, Amala Institute of Medical Sciences, Thrissur, Kerala, India
4Department of Emergency Medicine, Government Medical College, Kannur, Pariyaram, Kerala, India
5Department of Emergency Medicine & Trauma, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
6Department of Emergency Medicine, Government Medical College Kannur, Pariyaram, Kerala, India
Keywords: Corrosive, dialysis, emergency medicine, formic acid, intubation, mortality
Abstract
OBJECTIVE: The objective is to evaluate the outcome of early emergency intubation and early dialysis in formic acid (FA) poisoning and to determine the clinical features associated with its mortality.
METHODS: It is a retrospective cohort study of 78 patients who presented to the emergency medicine department from July 2008 to June 2015 with alleged history and clinical features of FA poisoning. The outcome of early intubation and early dialysis was studied in terms of 7-day and 30-day mortality. The outcome was compared in severe and not severe groups separately. Severity was graded according to Med-Tu chart used for corrosive poisoning.
RESULTS: In the severe group (n = 53), early dialysis was done in 15 patients. There was 53% (n = 8) 30-day mortality. In the group where early dialysis was not done there was a significant increase in mortality 92.1% (n = 35). This was statistically significant with a P = 0.003. In a similar fashion 7-day mortality was analyzed in the severe group where mortality was higher when early dialysis was not done. In not severe group early dialysis has minimally decreased the mortality. Early intubation in severe group did not demonstrate any mortality benefit. Patients who were intubated early and not intubated early had equally high mortality. In not severe group, intubation could not make any significant difference in mortality.
CONCLUSION: In this retrospective study, we observed that early dialysis in the severe group has a better outcome in terms of 7-day and 30-day mortality.
How to cite this article: Balasubramanian R, Maprani JJ, Paulson S, Suresh G, Ayyan SM, Vimal Rohan K. Outcome of early emergency intubation and early emergency dialysis in deliberate self-harm with formic acid in a tertiary care center in South India: A retrospective cohort study. Turk J Emerg Med 2024;24:111-6.
The study was certified by the Institutional Ethical and Research Committee of Academy of Medical Sciences Pariyaram, Kannur, Kerala, India, as per reference no. 23/2014/ACME dated February 07, 2014.
Not taken due to the retrospective nature of the study, secondary data from the patient’s case sheet were collected on a case-to-case basis from the Academy of Medical Sciences, Pariyaram.
RB: Conceptualization (lead); writing – original draft (lead); formal analysis (lead); writing – review and editing (equal). JM: Methodology (lead); writing – review and editing (equal). SP: Conceptualization (supporting); Writing – original draft (supporting); Writing – review and editing (equal). SG: Conceptualization (supporting); Project Administration (lead). MA: Software (lead); writing – review and editing (equal). VRK: Supervision (lead); Resources and Software (supporting).
None Declared.
None.