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Title: Paracetamol toxicity: what would be the implications of a change in Australian treatment guidelines?
Austin Authors: Wong, Anselm ;Graudins, Andis ;Kerr, Fergus;Greene, Shaun L 
Affiliation: Austin Toxicology Service, Austin Hospital, Melbourne, Victoria, Australia
Victorian Poisons Information Centre, Austin Hospital, Melbourne, Victoria, Australia
Issue Date: 1-Apr-2014
Publication information: Emergency Medicine Australasia : EMA; 26(2): 183-7
Abstract: The present study aims to study the implications for resource utilisation if Australia adopted recent revised UK treatment guidelines for paracetamol poisoning.Retrospective database review of paracetamol toxicity presentations and calls from the Victorian Poisons Information Centre (VPIC) and Austin Hospital, Victoria, Australia, from 1 January 2010 to 31 December 2011. There were 200 presentations at the Austin Hospital, and the VPIC received 4272 calls regarding paracetamol toxicity. An analytical model was designed to estimate the cost of this additional treatment and referral to hospital. The main outcome measures were the potential increase in number of admissions requiring treatment with N-acetylcysteine (NAC), costs involved and increased number of referrals to hospitals by the VPIC.Twenty-five (12.5%, 95% confidence interval 8.4-17.6%, P < 0.01) patients in our study who did not qualify for NAC therapy based upon the current Australasian paracetamol treatment guideline would have received it if the revised UK guideline was followed. Eighteen (72%) of these presented with acute single ingestions of paracetamol. No patients re-presented to our hospital with acute liver injury or required admission to the liver transplant unit.Alignment of current Australian paracetamol treatment guidelines with those in the UK would result in an increase in ED attendances as directed by Poisons Information Centres and hospital admissions for antidotal treatment. This would be associated with increased health expenditure and inpatient bed utilisation. The present study does not support the clinical need for adoption of UK paracetamol treatment guidelines in Australia.
Gov't Doc #: 24708009
DOI: 10.1111/1742-6723.12200
Type: Journal Article
Subjects: Australia
Acetylcysteine.economics.therapeutic use
Analgesics, Non-Narcotic.poisoning
Antidotes.economics.therapeutic use
Costs and Cost Analysis
Drug Overdose.drug therapy.economics.etiology
Emergency Service, Hospital.economics.statistics & numerical data
Free Radical Scavengers.economics.therapeutic use
Health Care Costs
Hospitalization.statistics & numerical data
Practice Guidelines as Topic
Retrospective Studies
Appears in Collections:Journal articles

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