Poisonings with malicious or criminal intent in the emergency department

Patients with malicious poisoning (MP) are individuals who are the victims of another person's intent to harm them through poisoning. Limited studies have investigated the clinical features and outcomes of MP. We evaluated the characteristics and outcomes of MP cases presented to emergency departments (EDs). This multicenter retrospective study enrolled MP patients who presented to three EDs in northern Taiwan. Patients with uncertain or unreasonable exposure histories and those who remained asymptomatic throughout the incident were excluded. In total, 14,329 poisoning cases were recorded between 2012 and 2019; of these, 82 (0.57%) were identified as MP cases. The incidence of MP was highest among individuals aged 13-49 years. Friends (37.8%) were the most common perpetrators, followed by family members (15.9%) and colleagues (4.9%). Sedative/hypnotics were the most frequently used substance (36.6%), followed by stimulants (26.8%) and street ketamine (6.1%). Most patients (75.6%) were discharged from the ED after a thorough assessment, while 11 (13.4%) were admitted. Of those admitted, six (7.3%) required admission to an intensive care unit. No mortalities were reported. Preschool victims (aged < 6 years) exhibited more severe poisoning, with lower Glasgow Coma Scale scores and higher rates of intubation compared to non- preschool victims. Patients with MP exhibited characteristics that differed significantly from other forms of poisoning. Healthcare providers must remain vigilant for signs of MP in ED patients, particularly preschool children.