A sudden admission to the emergency room can reveal the hidden public health trends lurking within a community.
Walking through the doors of an emergency ward often means confronting the unexpected. For the medical teams at Sina Hospital in Tabriz, a major poisoning referral center in Northwestern Iran, these crises provide critical insights into a significant public health challenge. Poisoning accounts for 15% to 20% of all emergency department visits in Iran, standing as the second most common cause of mortality in the country 1 6 . Understanding its patterns—the "what," "who," and "why"—is the first step toward saving lives and building effective prevention strategies. This article delves into the findings of a 2012-13 study at Sina Hospital, exploring the toxic agents that most frequently bring patients through its doors and the human stories behind the statistics.
Of all emergency department visits in Iran are due to poisoning
Of poisoning cases involved pharmaceutical drugs
Of patients were female, showing higher incidence in this region
To understand the data from Tabriz, one must first grasp the national landscape. Poisoning is a major health problem in Iran, but its pattern is not uniform; it changes from city to city, shaped by local agriculture, industry, and even culture 1 .
Pharmaceutical drugs, particularly those acting on the central nervous system, are the most common cause of poisoning in most major Iranian cities, including Tehran, Shiraz, and Isfahan 1 6 . These are often ingested with suicidal intent 6 .
While pharmaceuticals are the most frequent cause, poisoning by opioids, tramadol, and pesticides (like organophosphates and aluminum phosphide) remains a common and often fatal hazard 1 .
Agricultural areas with high pesticide exposure
Venomous animal bites and stings
Carbon monoxide poisoning
Majoon Birjandi (cannabis mixture)
Pharmaceutical drug overdoses
Sina Hospital, as a tertiary referral center, handles some of the most severe poisoning cases in Northwestern Iran. The 2012-13 investigation into its admissions provides a detailed snapshot of this critical health issue.
In medical terms, "poisoning" denotes injury or impairment caused by the chemical action of a substance 4 . It can be intentional, as in a suicide attempt, or unintentional, such as an accidental ingestion 9 .
Securing the airway, breathing, and circulation is always the first priority 9 .
Identifying the toxin through patient history, physical examination for "toxidromes" (characteristic sets of symptoms), and laboratory tests 4 .
Preventing further absorption of the poison, for instance, using activated charcoal for gastrointestinal toxins 4 .
Giving a specific antidote when available, such as N-acetylcysteine for acetaminophen overdose 9 .
Using techniques like hemodialysis to remove the toxin from the body more quickly 4 .
The Tabriz study was a systematic review of patient records. Researchers collected data on:
Age, gender, occupation, and location of patients.
Toxic agent, intent, time between exposure and hospital arrival.
This methodology allowed epidemiologists to paint a comprehensive picture of the poisoning burden on the emergency healthcare system.
The findings from Tabriz revealed clear and concerning trends. The data tells a stark story. Young adults, particularly married women, were the most likely to be admitted for intentional drug poisoning. This points to significant underlying social and mental health pressures. The high mortality associated with certain pesticides, despite their lower frequency, highlights their extreme toxicity and the critical need for rapid, specialized care 1 .
~75% of cases involved drugs, with benzodiazepines and antidepressants most common
65.1% of patients were female, showing higher incidence in this region
90.2% of cases were intentional, primarily suicide attempts
55.36% of patients were married
Conducting a clinical epidemiological study like the one at Sina Hospital requires a suite of "tools" to collect, process, and analyze data. The following details key components of the research toolkit.
| Item | Function in Research |
|---|---|
| Electronic Medical Record (EMR) System | The digital backbone of the study, used to track patient demographics, admission details, treatments, and outcomes over the study period 2 . |
| Diagnostic Code Manual (ICD-10) | Provides standardized codes for different types of poisonings, ensuring consistent classification and accurate data retrieval 2 . |
| Toxicology Laboratory Tests | Blood and urine tests (e.g., for acetaminophen, ethanol, methanol) used to confirm the presence and concentration of a suspected poison 4 . |
| Data Validation Protocols | Procedures to check the accuracy and completeness of the collected data, often by comparing coded information with manually abstracted records 2 . |
| Statistical Analysis Software (e.g., SPSS) | Used to perform descriptive and inferential statistics, identifying significant trends, correlations, and risk factors within the patient population 8 . |
The 2012-13 investigation into Sina Hospital's emergency ward revealed a clear and urgent narrative: the primary poisoning threat in Tabriz came from intentional ingestion of pharmaceutical drugs, disproportionately affecting young adults. While these findings are over a decade old, they established a critical baseline. Subsequent studies, including one on methanol poisoning during the COVID-19 pandemic, have shown that the same hospital continues to be a frontline defense against toxicological crises 8 . Research like this does more than just document statistics; it informs public health policy, guides the stocking of emergency antidotes, and shapes community education programs. Ultimately, by understanding the specific poisoning patterns of a region, healthcare systems can move from merely treating crises to actively preventing them.