Adherence to international recommendations for gastric lavage in medical drug poisonings in Denmark 2007–2010

Abstract

Objective. Recent reviews strongly discourage the routine use of gastric lavage in oral poisonings, but the authors suspected that gastric lavage might still be in widespread use in Denmark. We wished to estimate the extent to which gastric lavage in cases of medical drug poisoning, reported in inquiries to the Danish Poison Information Centre (DPIC) from 2007 to 2010, was performed according to international recommendations and whether adherence to recommendations improved over the period. Methods and materials. Inquiries from hospital and emergency departments (EDs) concerning medical drug poisonings were identified in the DPIC database. Patients receiving gastric lavage prior to inquiry were identified, and demographic and poisoning characteristics were retrieved. Indication for gastric lavage was determined from a predefined set of criteria. Results. 10 740 inquiries from hospitals and EDs were identified, of which 1091 cases received gastric lavage. In logistic regression, the frequency of lavage fell significantly from 13.5% in 2007 to 7.9% in 2010 (odds ratio (OR) 0.547, confidence interval (CI) 0.455–0.659). All criteria for gastric lavage were fulfilled in 60 lavaged cases (5.5%), and the fraction did not improve significantly over the period (OR 1.717, CI 0.791–3.724). No individual criterion for lavage showed consistent improvement over the period. Conclusion. Gastric lavage is still widely used in Denmark, mostly on questionable grounds where the procedure is unlikely to be beneficial. Recommendations for gastrointestinal decontamination may need to be promoted more actively, and clinicians should be encouraged to seek toxicological advice before performing gastric lavage.

Keywords:

• Poison information centres
• Gastrointestinal decontamination
• Pharmaceuticals
• Guideline implementation