This retrospective single-center study at a Tunisian ED (Mahdia, Jan 2022–Jan 2024) described the epidemiology of acute poisoning in 234 patients aged ≥12 years and used multivariate logistic regression to identify clinical predictors of in-hospital mortality available at the time of ED presentation.
Overall mortality was 12.8% (30/234); three independent predictors of death were GCS ≤8 (aOR 8.9, 95% CI 3.2–24.7), tachypnea >20/min (aOR 9.4, 95% CI 3.2–27.6), and aluminium phosphide poisoning (aOR 10.2, 95% CI 3.5–29.7), which alone carried a 68.4% case fatality rate. The model showed excellent discrimination (AUC 0.89).
Single-center retrospective design limits generalizability; confirmatory toxicology was obtained in only 15.8% of cases, risking misclassification; with only 30 deaths the multivariate model was capped at three predictors, leaving potential confounders unaddressed.
In resource-limited EDs, two bedside findings at triage — GCS ≤8 and respiratory rate >20/min — combined with exposure to aluminium phosphide should trigger immediate ICU-level care. Stricter regulation of aluminium phosphide and integration of psychiatric liaison services into the ED could substantially reduce both mortality and repeat self-harm.
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