Retrospective record review of patients admitted to a High-Care Unit with an Organophosphate-like toxidrome during the COVID-19 pandemic at a regional hospital in South Africa

Abstract

Background Organophosphate, a pesticide that can be used intentionally or inadvertently to induce bodily harm, is a significant cause of morbidity and mortality globally. Beyond its devastating health consequences, the COVID-19 pandemic also put a massive strain on healthcare infrastructure globally. There is limited data available in South Africa regarding the patterns of hospital admissions and outcomes for patients presenting with organophosphate-like toxidrome during the recent COVID-19 pandemic. Objectives To describe the demographics of patients admitted with an organophosphate-like toxidrome during the COVID-19 lockdown period, their clinical presentations, length of stay, and the outcomes in both COVID-19-negative and COVID-19-positive patients, and to describe their comorbidities. Methods A retrospective descriptive data analysis was conducted on patients admitted to the High-Care Unit at Edenvale Regional Hospital and treated with atropine for organophosphate-like toxidrome from January 2020 to December 2023. Of 219 identified patients, only 128 cases were analysed. Of the 91 excluded files, 31 files could not be found, and 60 files had polypharmacy ingestion (organophosphate compound and other toxins/ drugs). Results The study population consisted entirely of Black African ethnicity (100%). The mean age was 31 ± 11 years, with a male predominance (62%). The most common clinical findings included pinpoint pupils (59%), Glasgow coma scale (GCS) ≤13 (50%), and bronchorrhea (40%). Intentional ingestion accounted for 59% of cases. The COVID-19 status was unknown for 45% of cases, 7% of cases were admitted before the COVID-19 pandemic, and only 3% of cases tested positive. The median cholinesterase level was 368 U/L (interquartile range (IQR): 200-1157). Hypertension (11%) and HIV (10%) were common comorbidities. vii Atropine infusion was administered in all cases, lasting an average of 5±4 days. Relapse occurred in 12.5% (16 out of 128) of cases. Of the relapses, 87.5% were discharged, 6.25% were transferred to another hospital, and 6.25% refused hospital treatment. Mechanical ventilation was required in 58% of cases, with a median duration of 7 days (interquartile range: 5 -15). The overall survival rate for the cohort was 85.9%. Conclusion This study aimed to evaluate the effect of the COVID-19 pandemic on organophosphate-like toxidrome, however, no definitive conclusions could be drawn due to the small number of positive cases. Nonetheless, it provides insights into the regional epidemiology of organophosphate-like toxidrome and highlights the need for further research to understand the patterns and determinants of organophosphate-like toxidrome in South Africa. In addition, further research is needed to explore the impact of COVID-19 pandemic-related factors such as isolation, financial problems, fear and anxiety, and other mental health conditions that may have contributed to suicide and self-harm.