Paracetamol toxicity: what would be the implications of a change in Australian treatment guidelines?
OBJECTIVE
The present study aims to study the implications for resource utilisation if Australia adopted recent revised UK treatment guidelines for paracetamol poisoning.


METHODS
Retrospective database review of paracetamol toxicity presentations and calls from the Victorian Poisons Information Centre (VPIC) and Austin Hospital, Victoria, Australia, from 1 January 2010 to 31 December 2011. There were 200 presentations at the Austin Hospital, and the VPIC received 4272 calls regarding paracetamol toxicity. An analytical model was designed to estimate the cost of this additional treatment and referral to hospital. The main outcome measures were the potential increase in number of admissions requiring treatment with N-acetylcysteine (NAC), costs involved and increased number of referrals to hospitals by the VPIC.


RESULTS
Twenty-five (12.5%, 95% confidence interval 8.4-17.6%, P < 0.01) patients in our study who did not qualify for NAC therapy based upon the current Australasian paracetamol treatment guideline would have received it if the revised UK guideline was followed. Eighteen (72%) of these presented with acute single ingestions of paracetamol. No patients re-presented to our hospital with acute liver injury or required admission to the liver transplant unit.


CONCLUSIONS
Alignment of current Australian paracetamol treatment guidelines with those in the UK would result in an increase in ED attendances as directed by Poisons Information Centres and hospital admissions for antidotal treatment. This would be associated with increased health expenditure and inpatient bed utilisation. The present study does not support the clinical need for adoption of UK paracetamol treatment guidelines in Australia.
Victorian Poisons Information Centre, Austin Hospital, Melbourne, Victoria, Australia; Austin Toxicology Service, Austin Hospital, Melbourne, Victoria, Australia.
Anselm
A
Wong
Andis
A
Graudins
Fergus
F
Kerr
Shaun L
SL
Greene
D000082:Acetaminophen / Q000506:poisoning*; D000111:Acetylcysteine / Q000191:economics / Q000627:therapeutic use*; D018712:Analgesics, Non-Narcotic / Q000506:poisoning*; D000931:Antidotes / Q000191:economics / Q000627:therapeutic use*; D003365:Costs and Cost Analysis; D062787:Drug Overdose / Q000188:drug therapy* / Q000191:economics / Q000209:etiology; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D016166:Free Radical Scavengers / Q000191:economics / Q000627:therapeutic use*; D017048:Health Care Costs; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D014739:Victoria
D018712:Analgesics, Non-Narcotic; D000931:Antidotes; D016166:Free Radical Scavengers; D000082:Acetaminophen; D000111:Acetylcysteine
Australia; guideline; nomogram; paracetamol; poisoning