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Peer-reviewedCC BYHealth science reports

Baseline Clinical Predictors and Toxicological Drivers of In-Hospital Poisoning Mortality in Resource-Constrained Emergency Care: A Firth Penalized Regression Analysis.

  • Zewdu Hurisa1
  • Ayalneh Demissie2
  • Nebyu Mekonnen1
  • Birhanu Asefa1
  • Abera Girma1
  • Helen Bekele3
  • Tesfa Gebremeskel4
4 affiliations
  1. 1Department of Internal Medicine, College of Health Sciences Arsi University Asella Ethiopia.
  2. 2Department of Public Health, College of Health Sciences Arsi University Asella Ethiopia.
  3. 3ASTU Student Health Center Adama Science and Technology University Adama Ethiopia.
  4. 4Department of Pediatrics and Child Health, College of Health Sciences Arsi University Asella Ethiopia.
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Abstract

Background

Evidence regarding clinical characteristics and determinants of mortality among patients with acute poisoning in agricultural regions of Ethiopia remains limited. This study aimed to evaluate baseline clinical predictors associated with in-hospital mortality among acutely poisoned patients in a low-resource tertiary emergency department.Methods

A retrospective observational study was conducted among consecutive acute poisoning cases presenting to Asella Referral and Teaching Hospital (October 2022-September 2024). Of 372 screened cases, 7 patients who left against medical advice were excluded, yielding a final analytical cohort of 365 patients. Sociodemographic, toxicological, and clinical data were extracted from medical records. The primary outcome was in-hospital mortality. Multivariable Firth penalized logistic regression was performed to minimize small-sample bias given sparse outcome events (15 deaths). A sensitivity model additionally adjusted for sex and rural residence.Results

The median age of patients was 22.0 years (IQR: 19.0-27.0); 230 (61.8%) were aged 15-24 years, 199 (53.5%) were female, and 245 (65.9%) were rural residents. Insecticides were the predominant poisoning category (157; 42.2%). Aluminum Phosphide (AlP) exposure occurred in 43 (11.6%) patients, resulting in 12 deaths (case-fatality rate: 27.9%; 95% CI 15.3%-43.7%). Overall in-hospital mortality was 4.1% (15/365; 95% CI 2.3%-6.6%), with AlP accounting for 80.0% of all cohort deaths. In the primary multivariable Firth model, AlP exposure (aOR 30.48, 95% CI 7.88-117.95) and admission Glasgow Coma Scale < 15 (aOR 19.90, 95% CI 5.09-77.88) were strongly and independently associated with in-hospital mortality. These associations remained robust in sensitivity analyses.Conclusions

Impaired consciousness at admission (GCS < 15) and Aluminum Phosphide exposure serve as critical baseline indicators for rapid, low-cost risk stratification. While these exploratory parameters highlight high-risk groups, prospective multi-center validation across diverse hospital tiers is required before formal integration into clinical triage algorithms.

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Cite

BibTeXRIS
BibTeX
@article{hurisa2026baseline,
  title = {{Baseline Clinical Predictors and Toxicological Drivers of In-Hospital Poisoning Mortality in Resource-Constrained Emergency Care: A Firth Penalized Regression Analysis.}},
  author = {Zewdu Hurisa and Ayalneh Demissie and Nebyu Mekonnen and Birhanu Asefa and Abera Girma and Helen Bekele and Tesfa Gebremeskel},
  journal = {Health science reports},
  year = {2026},
  month = oct,
  doi = {10.1002/hsr2.73455},
  url = {https://europepmc.org/article/MED/42948168},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Baseline Clinical Predictors and Toxicological Drivers of In-Hospital Poisoning Mortality in Resource-Constrained Emergency Care: A Firth Penalized Regression Analysis.
AU  - Zewdu Hurisa
AU  - Ayalneh Demissie
AU  - Nebyu Mekonnen
AU  - Birhanu Asefa
AU  - Abera Girma
AU  - Helen Bekele
AU  - Tesfa Gebremeskel
PY  - 2026
DA  - 2026/10/27
JO  - Health science reports
DO  - 10.1002/hsr2.73455
UR  - https://europepmc.org/article/MED/42948168
AB  - Background  Evidence regarding clinical characteristics and determinants of mortality among patients with acute poisoning in agricultural regions of Ethiopia remains limited. This study aimed to evaluate baseline clinical predictors associated with in-hospital mortality among acutely poisoned patients in a low-resource tertiary emergency department.Methods  A retrospective observational study was conducted among consecutive acute poisoning cases presenting to Asella Referral and Teaching Hospital (October 2022-September 2024). Of 372 screened cases, 7 patients who left against medical advice were excluded, yielding a final analytical cohort of 365 patients. Sociodemographic, toxicological, and clinical data were extracted from medical records. The primary outcome was in-hospital mortality. Multivariable Firth penalized logistic regression was performed to minimize small-sample bias given sparse outcome events (15 deaths). A sensitivity model additionally adjusted for sex and rural residence.Results  The median age of patients was 22.0 years (IQR: 19.0-27.0); 230 (61.8%) were aged 15-24 years, 199 (53.5%) were female, and 245 (65.9%) were rural residents. Insecticides were the predominant poisoning category (157; 42.2%). Aluminum Phosphide (AlP) exposure occurred in 43 (11.6%) patients, resulting in 12 deaths (case-fatality rate: 27.9%; 95% CI 15.3%-43.7%). Overall in-hospital mortality was 4.1% (15/365; 95% CI 2.3%-6.6%), with AlP accounting for 80.0% of all cohort deaths. In the primary multivariable Firth model, AlP exposure (aOR 30.48, 95% CI 7.88-117.95) and admission Glasgow Coma Scale < 15 (aOR 19.90, 95% CI 5.09-77.88) were strongly and independently associated with in-hospital mortality. These associations remained robust in sensitivity analyses.Conclusions  Impaired consciousness at admission (GCS < 15) and Aluminum Phosphide exposure serve as critical baseline indicators for rapid, low-cost risk stratification. While these exploratory parameters highlight high-risk groups, prospective multi-center validation across diverse hospital tiers is required before formal integration into clinical triage algorithms.
SN  - 2398-8835
ER  -