Can mortality from agricultural pesticide poisoning be predicted in the emergency department? Findings from a hospital-based study in eastern Taiwan

Chi-Feng Hsu^a, Ming-Jen Tsai^{a, b}, Kun-Chuan Chen^a, Ren-Chieh Wu^a, Sheng-Chuan Hu^a

^a Department of Emergency Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
^b Ph.D. Program in Pharmacology and Toxicology, School of Medicine, Tzu Chi University, Hualien, Taiwan

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Abstract
Objectives

Pesticides are the leading toxicants resulting in emergency department (ED) admission. Factors which help emergency physicians predict mortality from pesticide poisoning have rarely been elucidated. There is also a lack in epidemiologic data on pesticide exposure in eastern Taiwan. This study describes the characteristics of patients with pesticide poisoning in eastern Taiwan and identifies available ED predictors for mortality from pesticide poisoning.

Materials and Methods

Patients with pesticide exposure who presented to the ED in the only medical center in eastern Taiwan between July 2001 and July 2008 were reviewed retrospectively. Clinical information was collected for comparison between survivors and nonsurvivors. Logistic regression was conducted to identify the predictors for poisoning-related mortality.

Results

During the study period, a total of 573 patients with pesticide exposure presented to our ED. There were 145 poisoning-related fatalities (25.31%) with a mean survival of 3.63 days. Paraquat (37.5%) was the leading pesticide involved, followed by glyphosate (23.0%) and organophosphates (13.4%). The significant predictors for mortality from pesticide poisoning were paraquat intoxication [odds ratio (OR) = 83.39; p < 0.001], organophosphate intoxication (OR = 10.88; p = 0.009), suicide attempt (OR = 15.98; p < 0.001), and abnormal body temperature (OR = 2.76; p = 0.043). In paraquat poisoning cases, age over 60 years (OR = 4.64; p = 0.003), suicide attempt (OR = 9.27; p < 0.001) and abnormal body temperature (OR = 2.63; p = 0.038), especially hypothermia, were risk factors for death. In nonparaquat poisoning cases, suicide attempt (OR > 999; p < 0.001) and initial respiratory distress (OR = 23.25; p = 0.001) were predictors for mortality.

Conclusion

Paraquat and organophosphates are the pesticides most associated with mortality. In paraquat exposure, elderly patients, those with suicidal intent and those presenting with an abnormal body temperature are at high risk for death. With nonparaquat pesticides, patients with suicidal intent and respiratory distress are at high risk for mortality.

Keywords
Agricultural chemicals; Herbicides; Mortality; Pesticides; Poisoning