TIME FROM INGESTION TO FIRST MEDICAL CONTACT AND EMERGENCY DEPARTMENT SEVERITY AMONG WHEAT PILL (ALUMINIUM PHOSPHIDE) POISONING CASES: A PROSPECTIVE OBSERVATIONAL STUDY

Abstract

Objective: To determine the association between time from wheat pill (aluminium phosphide) ingestion to first medical contact and severe clinical presentation at emergency department (ED) arrival, and to describe the distribution of care-seeking intervals and the proportion presenting with severe poisoning.

Study Design: Prospective observational analytical study.

Settings: Accident & Emergency Department, Jinnah Postgraduate Medical Centre (JPMC), Karachi.

Period: Four months from February 2025 to May 2025.

Material & Methods: 191 adults with suspected acute oral aluminium phosphide ingestion presenting within 24 hours were enrolled by non-probability purposive sampling. Time from ingestion to first qualifying medical contact and to JPMC arrival were recorded from records or attendant/patient report. Arrival Poisoning Severity Score (PSS) was assigned within 30 minutes of arrival using published organ-system criteria; PSS grade 3 was classified as severe. Data were analysed with medians (IQR) or means (SD), chi-square/Fisher exact and Mann-Whitney U tests, and crude and adjusted binary logistic regression (adjusting for age, quantity ingested and referral status). Two-sided p<0.05 was significant.

Results: Median time to first medical contact was 1.42 hours (IQR 0.89–2.00) and to JPMC arrival 2.43 hours (IQR 1.63–3.28). Ninety-one of 191 patients (47.6%, 95% CI 40.7–54.7%) had severe arrival PSS. Time to first contact was not associated with severe presentation, unadjusted (OR 1.12 per hour, 95% CI 0.85–1.48, p=0.409) or adjusted for age, quantity ingested and referral status (adjusted OR 1.15, 95% CI 0.86–1.54, p=0.356). Referral status and quantity ingested were also not significantly associated with severity (p=0.937 and p=0.076, respectively).

Conclusion: Nearly half of wheat pill poisoning presentations at this centre were severe at arrival, but time from ingestion to first medical contact was not independently associated with severity. Delay reduction strategies should not be assumed to alter arrival severity without further, adequately powered study.