Patterns of emergency department visits for suicidal attempts associated with toxic ingestion: A retrospective cross-sectional study.

BACKGROUND

Intentional self-poisoning is a growing cause of emergency department (ED) presentations worldwide. In Israel, where medication overdoses predominate, understanding the substances involved and their outcomes is crucial for prevention and management. This study aimed to characterize substance patterns, evaluate clinical outcomes, and highlight the contribution of medical toxicology in the care of these patients.

METHODS

A retrospective cross-sectional study was conducted using data from the Tel Aviv Sourasky Medical Center Toxicology Registry between 2017 and 2024. Patients presenting to the ED following intentional ingestion of pharmacological agents were included. Demographic, clinical, and laboratory variables were reviewed and compared between single-substance and polypharmacy ingestions. Clinical outcomes were categorized according to the American Association of Poison Control Centers (AAPCC) definitions.

RESULTS

Of 322 patients, 179 (55.6%) involved single-substance and 143 (44.4%) multiple-substance ingestions. The mean age was 38 ± 21 years, and 68.9% were female. Polypharmacy was associated with higher involvement of CNS-acting agents-particularly benzodiazepines (42.0%), antidepressants (31.5%), and opioids (14.7%)-and a trend toward more biochemical abnormalities and intensive interventions. Most cases resulted in mild or moderate effects, while 21.1% experienced major toxicity and 2.5% died. All patients were reviewed by the toxicology service, with bedside consultations in 55% of cases, guiding antidote use and management decisions.

CONCLUSIONS

Intentional self-poisoning in Israel is predominantly medication-related and frequently involves polypharmacy with CNS depressants. Early toxicology consultation is essential to guide treatment, prevent complications, and optimize outcomes. Beyond clinical management, medical toxicologists play a vital role in surveillance, prevention, and the humanistic duty of restoring both physical stability and psychological balance in patients at risk of self-harm.