Is activated charcoal properly indicated in emergency departments from Girona?: a cross-sectional study

Abstract

INTRODUCTION: acute oral drug overdose is the toxicological urgency attended most frequently in emergency departments. In the management of these patients, gastrointestinal decontamination plays an important role. Specifically, activated charcoal is the most widely used type of gastrointestinal decontamination. However, according to current recommendations, activated charcoal is used in excess in the management of these patients and this attitude could lead to higher risk of iatrogenic harm. Consequently, Emergency and Pharmacy departments of Hospital Universitari Doctor Josep Trueta (HJT) worked together with the aim to elaborate an intoxication protocol in order to standardize the management of acute intoxications, reduce the high variability of attitudes towards the management of these patients and make easier to take fast decisions in a field where time is crucial. JUSTIFICATION: the intoxication protocol of the HJT was implemented in 2013 but has never been evaluated. For this reason, this study aims to evaluate if the implementation of this protocol is associated with higher percentage of correct indications of activated charcoal administration. OBJECTIVE: to evaluate if the implementation of the HJT’s intoxication protocol is associated with higher percentage of correct indications of activated charcoal administration in patients with acute oral drug overdose attended in the emergency department of this hospital compared with them attended in the emergency department of Parc Hospitalari Martí i Julià (PHMJ). METHODOLOGY: this study will be an observational cross-sectional study that will be carried out in the emergency departments of HJT and PHMJ. The sample will be formed by two groups with minimum 180 patients each group with acute oral drug overdose. One group will be formed by patients with acute oral drug overdose attended in the emergency department of HJT (protocol group) and the other group will be formed by patients attended in the emergency department of PHMJ, where there is not an own intoxication protocol (control group). Then, we will compare the percentage of correct indications of activated charcoal administration between the two groups to see if there are differences. KEY WORDS: activated charcoal, gastrointestinal decontamination, acute intoxication, acute oral drug overdose, poisoning