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Poisoning Fatalities

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Critical Care Toxicology

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Abstract

The understanding of the epidemiology of poisoning deaths remains difficult for several reasons. Many comorbid factors contribute to the outcome, including the patient’s age, underlying medical condition, and the delay between exposure and treatment. The literature on poisoning deaths does not reflect the true prevalence. A major discrepancy exists between hospital and nonhospital deaths, and there is a wide variation according to the sources of reporting. The main sources of information in the United States are the data collected by the Toxic Exposure Surveillance System (TESS) of the American Association of Poison Control Centers and by the National Center for Health Statistics (NCHS) [1, 2]. There are marked differences between these two data sets [2]. Fatalities are underreported to poison control centers, and the NCHS data set gives a larger profile of poisoning deaths by reporting more out-of-hospital deaths.

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References

  1. Warner M, Chen LH, Makuc DM, et al. Drug poisoning deaths in the United States, 1980–2008. NCHS Data Brief. 2011;81:1–8.

    Google Scholar 

  2. Mowry JB, Spyker DA, Cantilena Jr LR, et al. 2013 annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 31st annual report. Clin Toxicol (Phila). 2014;52:1032–283.

    Article  Google Scholar 

  3. Hedegaard H, Chen LH, Warner M. Drug-poisoning deaths involving heroin: United States, 2000–2013. NCHS Data Brief. 2015;190:1–8.

    Google Scholar 

  4. Chen LH, Hedegaard H, Warner M. Drug-poisoning deaths involving opioid analgesics: United States, 1999–2011. NCHS Data Brief. 2014;166:1–8.

    Article  Google Scholar 

  5. Hamad AE, Al-Ghadban A, Carvounis CP, et al. Predicting the need for medical intensive care monitoring in drug-overdosed patients. J Intensive Care Med. 2000;15:321–8.

    Article  Google Scholar 

  6. Mühlberg W, Becker K, Heppner HJ, et al. Acute poisoning in old and very old patients: a longitudinal study of 5883 patients in a toxicological intensive care unit. Z Gerontol Geriatr. 2005;38:182–9.

    Article  PubMed  Google Scholar 

  7. Brandenburg R, Brinkman S, de Keizer NF, et al. In-hospital mortality and long-term survival of patients with acute intoxication admitted to the ICU. Crit Care Med. 2014;42:1471–9.

    Article  PubMed  Google Scholar 

  8. Flanagan RJ, Mant TGK. Coma and metabolic acidosis early in severe acute paracetamol poisoning. Hum Toxicol. 1986;5:179–82.

    CAS  PubMed  Google Scholar 

  9. Dean BS, Verdile VP, Krenzelok EP. Coma reversal with cerebral dysfunction recovery after repetitive hyperbaric oxygen therapy for severe carbon monoxide poisoning. Am J Emerg Med. 1993;11:616–8.

    Article  CAS  PubMed  Google Scholar 

  10. Hantson P, Duprez T, Mahieu P. Neurotoxicity to the basal ganglia shown by brain magnetic resonance imaging (MRI) following poisoning by methanol and other substances. J Toxicol Clin Toxicol. 1997;35:151–61.

    Article  CAS  PubMed  Google Scholar 

  11. Morgan BW, Ford MD, Follmer R. Ethylene glycol ingestion resulting in brainstem and midbrain dysfunction. J Toxicol Clin Toxicol. 2000;38:445–51.

    Article  CAS  PubMed  Google Scholar 

  12. Sklienka P, Neiser J, Ševčik P, et al. Successful kidney transplantation from methanol-intoxicated donors. Prog Transplant. 2014;24:199–205.

    Article  PubMed  Google Scholar 

  13. O’Connor A, Cluroe A, Couch R, et al. Death from hyponatremia-induced cerebral oedema associated with MDMA (“Ecstasy”) use. N Z Med J. 1999;112:255–6.

    PubMed  Google Scholar 

  14. Mittal BV, Desai AP, Khade KR. Methyl alcohol poisoning: an autopsy study of 28 cases. J Postgrad Med. 1991;37:9–13.

    CAS  PubMed  Google Scholar 

  15. Lichtenfeld PJ, Rubin BD, Feldman RS. Subarachnoid hemorrhage precipitated by cocaine snorting. Arch Neurol. 1984;41:223–4.

    Article  CAS  PubMed  Google Scholar 

  16. Levine SR, Washington JM, Jefferson MF, et al. “Crack” cocaine-associated stroke. Neurology. 1987;37:1849–53.

    Article  CAS  PubMed  Google Scholar 

  17. Iriye BK, Asrat T, Adashek JA, et al. Intraventricular haemorrhage and maternal brain death associated with antepartum cocaine abuse. Br J Obstet Gynaecol. 1995;102:68–9.

    Article  CAS  PubMed  Google Scholar 

  18. Wojak JC, Flamm ES. Intracranial hemorrhage and cocaine use. Stroke. 1987;18:712–5.

    Article  CAS  PubMed  Google Scholar 

  19. Guérit JM, de Tourtchaninoff M, Hantson P, et al. Multimodality evoked potentials in the differential diagnosis of brain death. In: Machado C, editor. Recent developments in neurology: brain death. Amsterdam: Elsevier; 1995. p. 119–26.

    Google Scholar 

  20. Hantson P, de Tourtchaninoff M, Mahieu P, et al. Prélèvements d’organes consécutifs aux décès par intoxication: expérience et problèmes diagnostiques. Réanim Urgences. 2000;9:197–209.

    Article  Google Scholar 

  21. de Tourtchaninoff M, Hantson P, Mahieu P, et al. Brain death diagnosis in misleading conditions. QJM. 1999;92:407–14.

    Article  PubMed  Google Scholar 

  22. Hantson P, de Tourtchaninoff M, Guérit JM, et al. Multimodality evoked potentials as a valuable technique for brain death diagnosis in poisoned patients. Transplant Proc. 1997;29:3345–6.

    Article  CAS  PubMed  Google Scholar 

  23. Marrache F, Mégarbane B, Pirnay S, et al. Difficulties in assessing brain death in a case of benzodiazepine poisoning with persistent cerebral blood flow. Hum Exp Toxicol. 2004;23:503–5.

    Article  PubMed  Google Scholar 

  24. Schlake HP, Bottger IG, Grotemeyer KH, et al. Determination of cerebral perfusion by means of planar brain scintigraphy and 99mTc-HMPAO in brain death, persistent vegetative state and severe coma. Intensive Care Med. 1992;18:76–81.

    Article  CAS  PubMed  Google Scholar 

  25. Costa DC, Hubank M, Sinha A, et al. Influence of time, temperature, sodium-potassium pump inhibition and glutathione on the 99mTc-HMPAO uptake by cultured astrocytes. Eur J Nucl Med. 1989;15:584.

    Google Scholar 

  26. Nordlander S, Wiklund PE, Åsard PE. Cerebral angioscintigraphy in brain death and in coma due to drug intoxication. J Nucl Med. 1973;14:856–7.

    CAS  PubMed  Google Scholar 

  27. Facco E, Zuchetta P, Munari M, et al. 99mTc-HMPAO SPECT in the diagnosis of brain death. Intensive Care Med. 1998;24:911–7.

    Article  CAS  PubMed  Google Scholar 

  28. Momose T, Nishikawa J, Watanabe T, et al. Clinical application of 18F-FDG-PET in patients with brain death. Kaku-Igaku. 1992;29:1139–42.

    CAS  PubMed  Google Scholar 

  29. Meyer MA. Evaluating brain death with positron emission tomography: case report on dynamic imaging of 18F-fluorodeoxyglucose activity after intravenous bolus injection. J Neuroimaging. 1996;6:117–9.

    Article  CAS  PubMed  Google Scholar 

  30. Bird TD, Plum F. Recovery from barbiturate overdose coma with a prolonged isoelectric electroencephalogram. Neurology. 1968;18:456–60.

    Article  CAS  PubMed  Google Scholar 

  31. Haider I, Oswald I. Electroencephalographic investigation in acute drug poisoning. Electroencephalogr Clin Neurophysiol. 1970;29:105.

    Article  CAS  PubMed  Google Scholar 

  32. Jørgensen EO. The EEG during severe barbiturate intoxication. Acta Neurol Scand. 1970;46 Suppl 43:281.

    Google Scholar 

  33. Kirshbaum RJ, Carollo VJ. Reversible iso-electric EEG in barbiturate coma. JAMA. 1970;212:1215.

    Article  CAS  PubMed  Google Scholar 

  34. Mellerio F, Gaultier M, Fournier E, et al. Contribution of electroencephalography to resuscitation in toxicology. Clin Toxicol. 1973;6:271–85.

    Article  CAS  PubMed  Google Scholar 

  35. Mellerio F. EEG changes during intoxication with trichlorethylene. Electroencephalogr Clin Neurophysiol. 1970;29:101.

    CAS  PubMed  Google Scholar 

  36. Mantz JM, Tempe JD, Jaeger A, et al. Silence électrique cérébral de vingt-quatre heures au cours d’une intoxication massive par 10 g de pentobarbital. Presse Med. 1971;79:1243–6.

    CAS  PubMed  Google Scholar 

  37. Powner DJ. Drug-associated isoelectric EEGs: a hazard in brain-death certification. JAMA. 1976;236:1123.

    Article  CAS  PubMed  Google Scholar 

  38. Haider I, Matthew H, Oswald I. Electroencephalographic changes in acute drug poisoning. Electroencephalogr Clin Neurophysiol. 1971;30:23–31.

    Article  CAS  PubMed  Google Scholar 

  39. García-Larrea L, Fischer C, Artru F. Effet des anesthésiques sur les potentiels évoqués sensoriels. Neurophysiol Clin. 1993;23:141–62.

    Article  PubMed  Google Scholar 

  40. Guérit JM, editor. Les Potentiels Évoqués. Paris: Masson; 1991.

    Google Scholar 

  41. Guérit JM, Mahieu P. Multimodality evoked potentials in the diagnosis of brain death. In: Barko D, Gerstenbrand F, Turkani P, editors. Neurology in Europe—I. London: John Libbey; 1990. p. 373–8.

    Google Scholar 

  42. Guérit JM. Evoked potentials: a safe brain-death confirmatory tool? Eur J Med. 1992;1:233–43.

    PubMed  Google Scholar 

  43. Guérit JM, de Tourtchaninoff M, Soveges L, et al. The prognostic value of three-modality evoked potentials in anoxic and traumatic comas. Neurophysiol Clin. 1993;23:209–26.

    Article  PubMed  Google Scholar 

  44. Hantson P, de Tourtchaninoff M, Simoëns G, et al. Evoked potentials investigation of visual dysfunction after methanol poisoning. Crit Care Med. 1999;27:2707–15.

    Article  CAS  PubMed  Google Scholar 

  45. Guérit JM, Meulders M. Clinical applications of the quantification of the relationship between body temperature and brain-stem auditory evoked potentials. Electroencephalogr Clin Neurophysiol. 1981;52:S39–40.

    Google Scholar 

  46. Guérit JM, Sovèges L, Baele P, et al. Evoked potentials in profound hypothermia for ascending aorta repair. Electroencephalogr Clin Neurophysiol. 1990;77:163–73.

    Article  PubMed  Google Scholar 

  47. Jones SJ. SEPs: Clinical observation and applications. In: Halliday AM, editor. Evoked potentials in clinical testing. 2nd ed. Edinburgh: Churchill Livingstone; 1993. p. 462–5.

    Google Scholar 

  48. Picton TW. Auditory evoked potentials. In: Daly DD, Pedley TA, editors. Current practice of clinical electroencephalography. 2nd ed. New York: Raven; 1990. p. 642–3.

    Google Scholar 

  49. Chiappa KH. BAEP: Methodology. In: Chiappa KH, editor. Evoked potentials in clinical medicine. 2nd ed. New York: Raven; 1990. p. 218–20.

    Google Scholar 

  50. Chiappa KH. Short-latency SEP: methodology. In: Chiappa KH, editor. Evoked potentials in clinical medicine. 2nd ed. New York: Raven; 1990. p. 368–9.

    Google Scholar 

  51. Chiappa KH. BAEP: interpretation. In: Chiappa KH, editor. Evoked potentials in clinical medicine. 2nd ed. New York: Raven; 1990. p. 271–2.

    Google Scholar 

  52. Mauguière F, Garcia-Larrea L, Bertrand O. Utility and uncertainties of evoked potentials monitoring in the intensive care unit. In: Grundi BL, Villani RM, editors. Evoked potentials—intraoperative and ICU monitoring. Wien: Springer; 1988. p. 153–67.

    Google Scholar 

  53. Chatrian GE. Coma, other states of altered responsiveness and brain death. In: Daly DD, Pedley TA, editors. Current practice of clinical electroencephalography. 2nd ed. New York: Raven; 1990. p. 425–87.

    Google Scholar 

  54. Hantson P, Mahieu P, de Tourtchaninoff M, et al. The problem of “brain death” and organ donation in poisoned patients. In: Machado C, editor. Recent developments in neurology: brain death. Amsterdam: Elsevier; 1995. p. 127–34.

    Google Scholar 

  55. Jones AL, Simpson KJ. Drug abusers and poisoned patients: a potential source of organs for transplantation. QJM. 1998;91:589–92.

    Article  CAS  PubMed  Google Scholar 

  56. Klimaszyk D, Lukasic-Glebocka M. Acute poisonings and organ donation – case reports and literature review. Przegl Lek. 2013;70:674–8.

    PubMed  Google Scholar 

  57. Yaprak M, Turan MN, Sezer TÖ, et al. Use of suicidal deaths as kidney donors: a single-center experience. Transplant Proc. 2013;45:872–4.

    Article  CAS  PubMed  Google Scholar 

  58. US Department of Health and Human Sciences and Health Resources and Services Administration. Organ Procurement and Transplantation Network. http://optn.transplant.hrsa.gov/. Accessed June 2015.

  59. Wood DM, Dargan PI, Jones AL. Poisoned patients as potential organ donors: postal survey of transplantation centres and intensive care units. Crit Care. 2003;7:147–54.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Wood DM, Chan WL, Dargan PI. Using drug-intoxicated deaths as potential organ donors: impression of attendees at the American College of Medical Toxicology 2014 Annual Meeting. J Med Toxicol. 2014;10:360–3.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Leikin JB, Heyn-Lamb R, Erickson T, et al. The toxic patient as a potential organ donor. Am J Emerg Med. 1994;12:151–4.

    Article  CAS  PubMed  Google Scholar 

  62. Hantson P, Vekemans MC, Squifflet JP, et al. Successful pancreas-renal transplantation after cyanide poisoning. Clin Transplant. 1991;5:419–21.

    Google Scholar 

  63. Hantson P, Vekemans MC, Squifflet JP, et al. Outcome following organ removal from poisoned donors: experience with 12 cases and a review of the literature. Transpl Int. 1995;8:185–9.

    Article  CAS  PubMed  Google Scholar 

  64. Hantson P, Kremer Y, Lerut J, et al. Successful liver transplantation with a graft coming from a methanol-poisoned donor. Transpl Int. 1996;9:437.

    Article  CAS  PubMed  Google Scholar 

  65. Hantson P, Vekemans MC, Squifflet JP, et al. Organ transplantation from victims of carbon monoxide poisoning. Ann Emerg Med. 1996;27:673–4.

    Article  CAS  PubMed  Google Scholar 

  66. Hantson P, Vekemans MC, Laterre PF, et al. Heart donation after fatal acetaminophen poisoning. J Toxicol Clin Toxicol. 1997;35:325–6.

    Article  CAS  PubMed  Google Scholar 

  67. Hantson P. The poisoned donors. Curr Opin Organ Transpl. 1999;4:125–9.

    Article  Google Scholar 

  68. Hantson P, Mahieu P. Organ donation after fatal poisoning. QJM. 1999;92:415–8.

    Article  CAS  PubMed  Google Scholar 

  69. Evrard P, Hantson P, Ferrant E, et al. Successful double lung transplantation with a graft obtained from a methanol poisoned donor. Chest. 1999;115:1458–9.

    Article  CAS  PubMed  Google Scholar 

  70. Hantson P, Vanormelingen P, Squifflet JP, et al. Methanol poisoning and organ transplantation. Transplantation. 1999;68:165–6.

    Article  CAS  PubMed  Google Scholar 

  71. Hantson P, Vanormelingen P, Lecomte C, et al. Fatal methanol poisoning and organ donation: experience with seven cases in a single center. Transplant Proc. 2000;32:491–2.

    Article  CAS  PubMed  Google Scholar 

  72. Martínez-Mier G, Avila-Pardo SF, Guraieb-Barragan E, et al. Successful renal transplantation from a deceased donor with pesticide intoxication: a case report. Transplant Proc. 2010;42:2397–8.

    Article  PubMed  Google Scholar 

  73. Mariage JL, Gallinat A, Hantson P. Organ donation following fatal organophosphate poisoning. Transpl Int. 2012;25:e71–2.

    Article  PubMed  Google Scholar 

  74. Garcia JH, Coehlo GR, Marques GA, et al. Successful organ transplantation from donors poisoned by a carbamate insecticide. Am J Transplant. 2010;10:1490–2.

    Article  CAS  PubMed  Google Scholar 

  75. Tenderich C, Koerner MK, Posival H, et al. Hemodynamic follow-up of cardiac allografts from poisoned donors. Transplantation. 1998;66:1163–7.

    Article  CAS  PubMed  Google Scholar 

  76. Hanzlick R. Postmortem tricyclic antidepressant concentrations: lethal vs nonlethal levels. Am J Forensic Med Pathol. 1989;10:326–9.

    Article  CAS  PubMed  Google Scholar 

  77. Karlson-Stiber C, Persson H. Ethylene glycol poisoning: experience from an epidemic in Sweden. J Toxicol Clin Toxicol. 1992;30:565–74.

    Article  CAS  PubMed  Google Scholar 

  78. Tazelaar HD, Karch SB, Stephens BG, et al. Cocaine and the heart. Hum Pathol. 1987;18:195–9.

    Article  CAS  PubMed  Google Scholar 

  79. Bai H, Otsu K, Islam MN, et al. Direct cardiotoxic effects of cocaine and cocaethylene on isolated cardiomyocytes. Int J Cardiol. 1996;53:15–23.

    Article  CAS  PubMed  Google Scholar 

  80. Brieke A, Krishnamani R, Rocha MJ, et al. Influence of donor cocaine use on outcome after cardiac transplantation: analysis of the United Network for Organ Sharing Thoracic Registry. J Heart Lung Transplant. 2008;27:1350–2.

    Article  PubMed  Google Scholar 

  81. Koerner MM, Tenderich G, Minami K, et al. Extended donor criteria: use of cardiac allografts after carbon monoxide poisoning. Transplantation. 1997;63:1358–60.

    Article  CAS  PubMed  Google Scholar 

  82. Busche MN, Knobloch K, Herold C, et al. Solid organ procurement from donors with carbon monoxide poisoning and/or burn – a systematic review. Burns. 2011;37:814–22.

    Article  PubMed  Google Scholar 

  83. Martìn-Suàrez S, Mikus E, Pilato E, et al. Cardiac transplantation from a carbon monoxide intoxicated donor. Transplant Proc. 2008;40:1563–5.

    Article  PubMed  Google Scholar 

  84. Sezgin A, Akay TH, Ozkhan D, et al. Successful cardiac transplantation from donor with carbon monoxide intoxication: a case report. Transplant Proc. 2001;40:324–5.

    Article  Google Scholar 

  85. Rodrigus IE, Conraads V, Amsel BJ, et al. Primary cardiac allograft failure after carbon monoxide poisoning treated with biventricular assist device. J Heart Lung Transplant. 2011;20:1345–8.

    Article  Google Scholar 

  86. Fujisaki N, Nakao A, Osako T, et al. Can carbon monoxide-poisoned victims be organ donors? Med Gas Res. 2014;4:13.

    Article  PubMed  PubMed Central  Google Scholar 

  87. Smith JA, Bergin PJ, Williams TJ, et al. Successful heart transplantation with cardiac allografts exposed to carbon monoxide poisoning. J Heart Lung Transplant. 1992;11:698–700.

    CAS  PubMed  Google Scholar 

  88. Tritapepe L, Macchiarelli G, Rocco M, et al. Functional and ultrastructural evidence of myocardial stunning after acute carbon monoxide poisoning. Crit Care Med. 1998;26:797–801.

    Article  CAS  PubMed  Google Scholar 

  89. Bentley MJ, Mullen JC, Lopushinsky SR, et al. Successful cardiac transplantation with methanol or carbon monoxide-poisoined donors. Ann Thorac Surg. 2001;71:1194–7.

    Article  CAS  PubMed  Google Scholar 

  90. Doede T, Bröcker V, Frühauf NR. Organ donation after lethal methanol intoxication. Transpl Int. 2014;27:e48–9.

    Article  PubMed  Google Scholar 

  91. Lopez-Navidad A, Caballero F, Gonzalez-Segura C, et al. Short- and long-term success of organs transplanted from acute methanol poisoned donors. Clin Transplant. 2002;16:151–62.

    Article  CAS  PubMed  Google Scholar 

  92. Barkoukis TJ, Sarbak CA, Lewis D, et al. Multiorgan procurement from a victim of cyanide poisoning: a case report and review of the literature. Transplantation. 1993;55:1434–6.

    Article  CAS  PubMed  Google Scholar 

  93. Vivien B, Deye N, Mégarbane B, et al. Extracorporeal life support in a case of fatal flecainide and betaxolol poisoning allowing successful cardiac allograft. Ann Emerg Med. 2010;56:409–12.

    Article  PubMed  Google Scholar 

  94. Lee TJ, Fox MP, Trivedi J, et al. Donors with a history of cocaine use and lung transplant outcomes. J Heart Lung Transplant. 2012;31:1144–6.

    Article  PubMed  Google Scholar 

  95. Stëhr I, Nagib R, Franke AZ, et al. Bilateral lung transplantation from a donor with fume poisoning. J Heart Lung Transplant. 2007;26:194–5.

    Article  Google Scholar 

  96. Silva JA, Chamarro C, Varela A, et al. Successful bilateral lung transplantation from a methanol-poisoned donor. Transplant Proc. 2004;36:2806–7.

    Article  CAS  PubMed  Google Scholar 

  97. Tobbli JE, Ferder L, Angerosa M, et al. Effects of amlodipine on tubulointerstitial lesions in normotensive oxaluric rats. Hypertension. 1999;34:854–8.

    Article  Google Scholar 

  98. Hylander B, Kjellstrand CM. Prognostic factors and treatment of severe ethylene glycol intoxication. Intensive Care Med. 1996;22:546–52.

    Article  CAS  PubMed  Google Scholar 

  99. Gunka I, Samlik J, Mazur M, et al. Kidney transplantation from donors dying of methanol intoxication. Rozhl Chir. 2013;92:201–4.

    CAS  PubMed  Google Scholar 

  100. Andrews PA, Koffman CG. Kidney donation after paracetamol overdose. BMJ. 1993;306:1129.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  101. Hantson P, Mahieu P. Pancreatic injury following acute methanol poisoning. J Toxicol Clin Toxicol. 2000;38:297–303.

    Article  CAS  PubMed  Google Scholar 

  102. Manara AR, Murphy PG, O’Callaghan G. Donation after circulatory death. Br J Anaesth. 2012;51:108–21.

    Article  Google Scholar 

  103. Gok MA, Gupta A, Olschewski P, et al. Renal transplants from non-heart beating paracetamol overdose donors. Clin Transplant. 2004;18:541–6.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Louvain Centre for Toxicology and Applied Pharmacology, Catholic University of Louvain, Louvain, Belgium

    Philippe Hantson

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  1. Philippe Hantson
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Correspondence to Philippe Hantson .

Editor information

Editors and Affiliations

  1. University of Colorado School of Medicine, Toxicology Associates, Denver, Colorado, USA

    Jeffrey Brent

  2. Office of New Drugs Drug Evaluation and Research, FDA, Silver Spring, Maryland, USA

    Keith Burkhart

  3. Clinical Toxicology, St Thomas' Hospital, London, United Kingdom

    Paul Dargan

  4. University of Colorado School of Medicine, Toxicology Associates, Denver, Colorado, USA

    Benjamin Hatten

  5. Med & Toxicological Intensive Care Unit, Lariboisière Hospital Paris-Diderot University, Paris, France

    Bruno Megarbane

  6. University of Colorado School of Medicine, Toxicology Associates, Denver, Colorado, USA

    Robert Palmer

Grading System for Levels of Evidence Supporting Recommendations in Critical Care Toxicology; 2nd Edition

Grading System for Levels of Evidence Supporting Recommendations in Critical Care Toxicology; 2nd Edition

  1. I

    Evidence obtained from at least one properly randomized controlled trial.

  2. II-1

    Evidence obtained from well-designed controlled trials without randomization.

  3. II-2

    Evidence obtained from well-designed cohort or case–control analytic studies, preferably from more than one center or research group.

  4. II-3

    Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments (such as the results of the introduction of penicillin treatment in the 1940s) could also be regarded as this type of evidence.

  5. III

    Opinions of respected authorities, based on clinical experience, descriptive studies and case reports, or reports of expert committees.

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Hantson, P. (2016). Poisoning Fatalities. In: Brent, J., Burkhart, K., Dargan, P., Hatten, B., Megarbane, B., Palmer, R. (eds) Critical Care Toxicology. Springer, Cham. https://doi.org/10.1007/978-3-319-20790-2_58-1

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