Epidemiology and mortality predictors of acute poisoning in a Tunisian Emergency Department: a two-year retrospective study

Introduction Acute poisoning is a major public health challenge and a frequent cause of emergency department (ED) admission in Tunisia and North Africa. This study aimed to describe the epidemiological, clinical, and therapeutic characteristics of acute poisoning cases and to identify factors associated with mortality. Methods A retrospective, single-center study was conducted at the ED of Taher Sfar University Hospital, Mahdia, from January 2022 to January 2024. All patients aged ≥12 years admitted for acute poisoning were included. Variables reflecting in-hospital interventions were excluded from the multivariate model to avoid reverse causality; only variables available at ED presentation were considered as candidate predictors. Multivariate logistic regression identified factors associated with in-hospital mortality. Results Among 7645 ED admissions, 234 cases (3.06%) were for acute poisoning. The mean age was 30 years, with a female predominance (67.5%). Intentional poisoning accounted for 86.3% of cases. Pharmaceuticals (51.7%) and pesticides (30.3%) were the most common agents. The overall mortality rate was 12.8%, highest with aluminium phosphide (68.4%). Multivariate analysis identified three independent predictors of mortality, all available at ED presentation: altered mental status (GCS ≤ 8) (aOR=8.9, 95% CI 3.2–24.7), tachypnea (aOR=9.4, 95% CI 3.2–27.6), and poisoning by aluminium phosphide (aOR=10.2, 95% CI 3.5–29.7). Conclusion Acute poisoning in this cohort predominantly involves intentional self-harm by young women, with high mortality linked to specific toxic agents and early clinical severity markers. These findings highlight the need for enhanced mental health services, stricter regulation of highly toxic pesticides, and optimized emergency care protocols in similar settings.