Toxicological Emergencies in a Tertiary Emergency Department: A Retrospective Single-Centre Study in Singapore

Chong, Bryon Frankie Hon Khi; Kolhe, Lokesh Krishnaji; Lin, Annette Yingcui; Vaikunthan, Rajaratnam; Ngo, Adeline Su-Yin

doi:10.22038/apjmt.2026.94370.1557

Toxicological Emergencies in a Tertiary Emergency Department: A Retrospective Single-Centre Study in Singapore

Document Type : Original Article

Authors

Bryon Frankie Hon Khi Chong ¹

Lokesh Krishnaji Kolhe ¹

Annette Yingcui Lin ¹

Rajaratnam Vaikunthan ²

Adeline Su-Yin Ngo ¹

¹ Department of Emergency Medicine, Woodlands Hospital, National Healthcare Group (NHG) Health, Singapore

² Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, National Healthcare Group (NHG) Health, Singapore

10.22038/apjmt.2026.94370.1557

Abstract

Background: Toxicological emergencies, including pharmaceutical poisonings and envenomation, remain a significant clinical and operational burden in emergency departments. This study described the presentation patterns, clinical severity, management, healthcare utilisation, outcomes, and toxicology consultation patterns at a newly established tertiary hospital in Singapore.
Methods: A retrospective observational study was conducted of all toxicological cases presenting to the emergency department from 1 May 2024 to 30 April 2025. Data on demographics, exposure types, Poisoning Severity Score (PSS), interventions, and clinical outcomes were summarised descriptively. The association between PSS and hospital length of stay was explored using Spearman correlation.
Results: Among 121 presentations, 98 (81.0%) involved poisoning and 23 (19.0%) envenomation. Of the poisoning cases, 83 (84.7%) were intentional, and 89 (90.8%) had PSS 0-1. Toxicology consultation was obtained in 8 cases (6.6%). Six poisoning cases (6.1%) required intensive care, and no in-hospital mortality was recorded. An exploratory analysis among poisoning cases showed a positive correlation between PSS and hospital length of stay (Spearman = 0.527, p < 0.001).
Conclusion: Most presentations were low-severity poisonings, and intentional exposure predominated. In this modest, predominantly low-severity cohort, intensive care admission and toxicology consultation were infrequent, and no in-hospital deaths were recorded. PSS showed an exploratory positive correlation with hospital length of stay; this finding is hypothesis-generating and does not validate PSS as a triage or management tool. These descriptive findings provide contemporary baseline data for toxicology service planning. Prospective multicentre comparative studies are warranted.

Keywords

Poisoning

Bites and Stings

Emergency Medicine

Referral and Consultation

Singapore

Subjects

Toxicology

1. Gedik MS, Hakkoymaz H, Kilci Aİ, Küçük ÖF. General approach to cases of drug intoxication. Eurasian J Crit Care. 2023; 5:17-21.

2. Ponampalam R, Tan HH, Ng KC, Lee WY, Tan SC. Demographics of toxic exposures presenting to three public hospital emergency departments in Singapore 2001-2003. Int J Emerg Med. 2009; 2:25-31.

3. Arciaga GJ, Tan HH, Kuan KK, Mong R, Kant A. A 24/7 hospital toxicology service: experience of a new start-up. Proc Singapore Healthc. 2018; 27:223-8.

4. Ponampalam R, Loh CS. Cost benefits of the Drug and Poison Information Centre in preventing unnecessary hospitalisation: the Singapore experience. Hong Kong J Emerg Med. 2010; 17:45-53.

5. Kuan KK, Ponampalam R, Arciaga GJ, Kant A, Mong R, Ng M, et al. Insights into poisoning in Singapore and its impact on healthcare resource: through the lens of a cluster toxicology consultation service. Proc Singapore Healthc. 2026; 35:1-8.

6. Wang X, Xie Y, Cai J, Zhang X, Zhou W, Zhang J, et al. Epidemiological and clinical characteristics of acute poisoning with the impact of the COVID-19 pandemic: a multicenter retrospective study in Jiangsu province, China from 2017 to 2023. BMC Public Health. 2025; 25:3136.

7. Li C, Zhang H, Yang B. Trends in emergency department visits for acute intoxication: a 3-year retrospective study in Hangzhou, East China. Front Public Health. 2025; 13:1598559.

8. Persson HE, Sjöberg GK, Haines JA, Pronczuk de Garbino J. Poisoning severity score: grading of acute poisoning. J Toxicol Clin Toxicol. 1998;36(3):205-13.

9. Curry SC, Brooks DE, Skolnik AB, Gerkin RD, Glenn S. Effect of a medical toxicology admitting service on length of stay, cost, and mortality among inpatients discharged with poisoning-related diagnoses. J Med Toxicol. 2015; 11:65-72.

10. McCabe DJ, Sun J, Vakkalanka JP, Kang T, Radke J. Association between bedside medical toxicology consultation and hospital triage and resource utilization for poisoned patients. Am J Emerg Med. 2026; 108:122-9.

11. Traub SJ, Saghafian S, Buras MR, Temkit M. Resource utilization in emergency department patients with known or suspected poisoning. J Med Toxicol. 2017; 13:238-44.

12. Hondebrink L, Rietjens SJ, Donker DW, Hunault CC, van den Hengel-Koot I, Verputten PM, et al. A quarter of admitted poisoned patients have a mild poisoning and require no treatment: an observational study. Eur J Intern Med. 2019; 66:41-7.

13. Schwarz ES, Kopec KT, Wiegand TJ, Wax PM, Brent J. Should we be using the Poisoning Severity Score? J Med Toxicol. 2017; 13:135-45.

14. Qin P, Stanley B, Melle I, Mehlum L. Association of psychiatric services referral and attendance following treatment for deliberate self-harm with prospective mortality in Norwegian patients. JAMA Psychiatry. 2022; 79:651-8.

15. Tang D, Chan WL, Phua DH. Performance of an emergency department observation unit protocol in reducing length of stay for acetaminophen overdose: a retrospective study. Int J Emerg Med. 2018; 11:48.

16. Kuan KK, Lim HC, Goh G, Arciaga GS, Goh PL, Mong R, et al. Cost savings and efficacy in management of paracetamol poisoning in a 23-hours emergency department observation unit: a comparison to inpatient care. Cureus. 2019;11(12): e6294.