A comprehensive overview of paracetamol poisoning admissions and long-term outcomes in New South Wales, Australia: a retrospective linked data cohort (PAVLOVA-3)

<h2>Summary</h2><h3>Background</h3> Paracetamol poisoning is a major public health issue and a leading cause of acute liver failure. Population-level data on outcomes, repetition, and long-term survival remain limited. This study characterises hospitalised paracetamol poisonings in New South Wales, Australia (population ∼8 million) using a large linked dataset. <h3>Methods</h3> We conducted a retrospective observational study of patients hospitalised with an ICD-10 diagnosis of T39·1 (Poisoning by 4-Aminophenol derivatives), 1st January 2011 to 30th September 2020, using the Poisoning And enVenomation Linkage to evaluate Outcomes and clinical Variation in Australia (PAVLOVA) cohort. Outcomes included intent, demographics, length of stay, Intensive Care Unit admission, liver injury, death, repetition, and long-term post-discharge survival. <h3>Findings</h3> There were 24,092 paracetamol poisoning admissions involving 19,895 individuals. Most admissions were intentional (78·8%, 18,987), and occurred in women (71·0%, 17,095), and the median age was 29 years (IQR, 19–45 years). Intentional poisonings had high rates of psychiatric and substance use comorbidities. Liver injury was more common in accidental poisonings (6·1%, vs intentional poisonings, 1·5%). Intentional poisoning repetition occurred in 21·8% (3374/15,472) of individuals, with greatest risk in the first year. Long-term survival was poorer in those with multiple repetitions: 7·6% (104/1373) had died by study end, compared with 4·7% (571/12,098) of people with no repeated intentional poisoning. <h3>Interpretation</h3> While intentional paracetamol poisonings rarely result in serious liver injury, there is substantial risk of poisoning repetition and long-term mortality. These findings highlight the need for health-system responses focused on post-overdose management and continuity of mental health care. <h3>Funding</h3> NHMRC, Reckitt Benckiser.