Clinical profile and Prevalence of poisoning patients presenting to the emergency department of a teaching hospital in Kerala: A retrospective comparative study before and during COVID-۱۹ pandemic

Background: Emergency physicians must be updated about the variations in poisoning pattern during Covid۱۹ pandemic. Limited data exist on the incidence and characteristics of patients presenting with poisoning in Indian Emergency Departments (ED) during the COVID ۱۹ pandemic. Hence, we aimed to explore the impact of Covid۱۹ pandemic on poisoning cases presenting to the ED.Methods: This cross-sectional retrospective study was conducted on poisoning patients presenting to ED during the pandemic period (April ۱-October ۳۰, ۲۰۲۰ (period ۲)), and a matching period before the pandemic (September ۱,۲۰۱۹ to March ۳۱, ۲۰۲۰ (period ۱)). The rate of prevalence and clinical profile were compared between period ۱ and ۲ using appropriate statistical test.Results: A total of ۱۱۱ (periods ۱ = ۵۷, and periods ۲ = ۵۴) cases were analysed. Poisoning prevalence rates had slightly increased by ۲.۷% before the pandemic (۵۱.۳۳%) in comparison to during the pandemic (۴۸.۶%) period (p=۰.۳). Females were predominant in both periods, and the mean age of ۳۲.۵ years. The predominant (۵۷%) patient age group was ۱۵-۳۴ years. ۳۶.۹% (n=۴۱) patients consumed multiple poisons, ۱۹.۸% (n=۲۲) consumed paracetamol, and ۱۴.۴% (n=۱۶) patients consumed psychiatric medications. Before lockdown, ۲۷.۰۲% (n=۳۰) patients presented within ۳ hours ingestion, and ۲۱.۶% (n=۲۴) presented after ۳ hours ingestion (p=۰.۱۲). A significant delay in arrival of poisoning cases during lockdown (p= ۰.۱۲) with increased hospital admission (p=۰.۰۳) was observed.  A psychiatric disorder was observed in ۳۶.۰۳% cases. Majority of the cases were admitted in the ICU, and ۰.۹%(n=۱) death was recorded.Conclusions: This is the first Indian study that describes the incidence of poisoning cases and their pattern during the COVID ۱۹pandemic period, study revealed that increased mental health crisis in low resource settings in rural Kerala affects predominantly young population. Study implies the importance of priming the mental health care professionals to initiate their mental health screening programmes.