(O-I3) Gender Differences in ED Presentations and Outcomes Among Patients with Intentional Poisoning at a Tertiary Care Center in Lebanon

Objectives: Our study aims to evaluate the gender differences in toxicological exposures related to patient characteristics, history of psychiatric illness, reason/route of exposure, exposure agent, ED management, ED outcomes, and disposition.

Background: Mental health disorders and psychiatric emergencies are common in Lebanon. Based on recently published reports in 2020, the majority of patients presenting with acute toxicological exposure were related to intentional poisoning (51.6%), mostly due to suspected suicide (37.7%). Though it is known that depression and suicide attempts by poisoning are higher in women than men, there is a lack of descriptive data on the gender differences in characteristics, presentations to the Emergency Department (ED), and outcomes of intentional poisoning in Lebanon.

Methods: This is a retrospective chart review of an existing toxicological database at a tertiary care center during the period between 1st, March 2015 and 1st, March 2023. Patients presenting with acute overdose and those above 6 years of age were included. Extracted variables included patient demographics, exposure agent, reason and route of exposure, ED management, ED medical outcome, and disposition. The past psychiatric illness variable was classified into 8 categories according to the ICD10. Frequencies and percentages were conducted for categorical variables. Means, standard deviations, ranges, and percentiles were used for continuous variables. Bivariate analysis was performed using Chi-square or Fisher’s Exact Test where appropriate. P-value < 0.05 will be considered to indicate statistical significance.

Results: A total of 444 intentional poisoning cases were analyzed, out of which 142 (31%) were men, and 302 (68%) were women. The most common age group was 20-59 years old, with an average of 30 years. The most common past psychiatric illness was mood disorder. Men were more likely to have mental and behavioral disorders due to psychoactive substance abuse and behavioral/emotional disorders with childhood/adolescent onset. On the other hand, females were more likely to have mood disorders. Suspected suicide was the most common reason for intentional poisoning among both genders (78.8%), significantly more common in women. Ingestion was the most common route of exposure, with a higher prevalence in women. Men (6.3%) were more likely to use a nasal exposure route than females (0.3%). Sedatives/hypnotics/antipsychotics, antihistamines, and Melitracen/Flupentixol were significantly more common in women compared to men. Ethanol, stimulant, and street drugs were significantly more common in men (18.3%) versus women (2.6%), where cocaine followed by cannabinoids topped the list. Opioids were also significantly more prevalent in men (11.3%) versus women (3%), where codeine was the most common opioid substance. In terms of the ED outcome and disposition, no significant difference was found between genders.

Conclusions: Our study highlights significant gender differences in toxicological exposures among patients with intentional poisoning in Lebanon. Women were more likely to present with sedative/hypnotic/antipsychotic, antihistamine, and melitracen/flupentixol than men. Men were more likely to present with intoxication related to stimulant drugs, ethanol, and opioids.

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Funding (Optional): none