Evidence map›Paper›PMID 24666324›Full record

ArticleBritish journal of clinical pharmacology2014

Effect of the UK's revised paracetamol poisoning management guidelines on admissions, adverse reactions and costs of treatment.

D Nicholas Bateman, Robert Carroll, Janice Pettie, Takahiro Yamamoto, Muhammad E M O Elamin, Lucy Peart, Margaret Dow, Judy Coyle, Kristina R Cranfield, Christopher Hook and 9 more

Open access · bronzeAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in British journal of clinical pharmacology, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 40 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
40citing papers in PubMed, 5 pooled it
24.1field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

40 citing papers in PubMed, 5 syntheses or guidelines pooled it, 130 citations in OpenAlex.

  1. Pooled it
  2. Oral paracetamol (acetaminophen) for cancer pain.The Cochrane database of systematic reviews · 2017
    Pooled it
  3. Pooled it
  4. Pooled it
  5. Paracetamol (acetaminophen) poisoning.BMJ clinical evidence · 2015
    Pooled it
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors at 5 institutions in 1 country.

D Nicholas BatemanNPIS Edinburgh & Royal Infirmary of Edinburgh, Edinburgh, UK.
Robert Carroll
Janice Pettie
Takahiro Yamamoto
Muhammad E M O Elamin
Lucy Peart
Margaret Dow
Judy Coyle
Kristina R Cranfield
Christopher Hook
Euan A Sandilands
Aravindan Veiraiah
David Webb
Alasdair Gray
Paul I Dargan
David M Wood
Simon H L Thomas
James W Dear
Michael Eddleston
Edinburgh Royal Infirmary · GBNewcastle upon Tyne Hospitals NHS Foundation Trust · GBKing's College London · GBGuy's and St Thomas' NHS Foundation Trust · GBUniversity of Bristol · GB

Funding

Department of Health DRF-2012-05-189
6 · The paper itself

Abstract

aimsIn September 2012 the UK's Commission on Human Medicines (CHM) recommended changes in the management of paracetamol poisoning: use of a single '100 mg l(-1) ' nomogram treatment line, ceasing risk assessment, treating all staggered/uncertain ingestions and increasing the duration of the initial acetylcysteine (NAC) infusion from 15 to 60 min. We evaluated the effect of this on presentation, admission, treatment, adverse reactions and costs of paracetamol poisoning.

methodsData were prospectively collected from adult patients presenting to three large UK hospitals from 3 September 2011 to 3 September 2013 (year before and after change). Infusion duration effect on vomiting and anaphylactoid reactions was examined in one centre. A cost analysis from an NHS perspective was performed for 90 000 patients/annum with paracetamol overdose.

resultsThere were increases in the numbers presenting to hospital (before 1703, after 1854; increase 8.9% [95% CI 1.9, 16.2], P = 0.011); admitted (1060/1703 [62.2%] vs. 1285/1854 [69.3%]; increase 7.1% [4.0, 10.2], P < 0.001) and proportion treated (626/1703 [36.8%] vs. 926/1854 [50.0%]; increase: 13.2% [95% CI 10.0, 16.4], P < 0.001). Increasing initial NAC infusion did not change the proportion of treated patients developing adverse reactions (15 min 87/323 [26.9%], 60 min 145/514 [28.2%]; increase: 1.3% [95% CI -4.9, 7.5], P = 0.682). Across the UK the estimated cost impact is £8.3 million (6.4 million-10.2 million) annually, with a cost-per-life saved of £17.4 million (13.4 million-21.5 million).

conclusionsThe changes introduced by the CHM in September 2012 have increased the numbers of patients admitted to hospital and treated with acetylcysteine without reducing adverse reactions. A safety and cost-benefit review of the CHM guidance is warranted, including novel treatment protocols and biomarkers in the assessment of poisoning.

Indexed as

Practice Guidelines as TopicAcetaminophenAcetylcysteineAdolescentAdultAgedAged, 80 and overAntidotesChildChild, PreschoolFemaleHealth Care CostsHospitalizationHumansInfantMaleAcetaminophenAcetylcysteineAntidotesacetylcysteineadverse effectsparacetamolpoisoningregulation

Identifiers

PMID24666324
PMCPMC4243911
OpenAlexW2119604663

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.