We included 24 trials involving 7099 participants. Using the Cochrane 'Risk of bias' tool, we assessed no study as being at low risk of bias for all domains. Many studies were poorly reported, so the risk of selection and detection biases were often unclear. Most studies reported important outcomes incompletely, and we judged them to be at high risk of reporting bias.All but one study enrolled oral
poisoning patients in an emergency department; the remaining study was conducted in a pre-hospital setting. Fourteen studies included multiple toxic syndromes or did not specify, while the other studies specifically investigated
paracetamol (2 studies),
carbamazepine (2 studies),
tricyclic antidepressant (2 studies), yellow oleander (2 studies),
benzodiazepine (1 study), or toxic berry intoxication (1 study). Eighteen trials investigated the effects of
activated charcoal (AC), administered as a single dose (SDAC) or in multiple doses (MDAC), alone or in combination with other
first aid interventions (a
cathartic) and/or hospital treatments. Six studies investigated
syrup of ipecac plus other
first aid interventions (SDAC +
cathartic) versus
ipecac alone. The collected evidence was mostly of low to very low certainty, often downgraded for indirectness, risk of bias or imprecision due to low numbers of events.First aid interventions that limit or delay the absorption of the
poison in the bodyWe are uncertain about the effect of SDAC compared to no intervention on the incidence of adverse events in general (zero events in both treatment groups; 1 study, 451 participants) or
vomiting specifically (Peto odds ratio (OR) 4.17, 95% confidence interval (CI) 0.30 to 57.26, 1 study, 25 participants), ICU admission (Peto OR 7.77, 95% CI 0.15 to 391.93, 1 study, 451 participants) and
clinical deterioration (zero events in both treatment groups; 1 study, 451 participants) in participants with mixed types or
paracetamol poisoning, as all evidence for these outcomes was of very low certainty. No studies assessed SDAC for mortality, duration of symptoms,
drug absorption or hospitalization.Only one study compared SDAC to
syrup of ipecac in participants with mixed types of
poisoning, providing very low-certainty evidence. Therefore we are uncertain about the effects on Glasgow Coma Scale scores (mean difference (MD) -0.15, 95% CI -0.43 to 0.13, 1 study, 34 participants) or incidence of adverse events (risk ratio (RR) 1.24, 95% CI 0.26 to 5.83, 1 study, 34 participants). No information was available concerning mortality, duration of symptoms,
drug absorption, hospitalization or ICU admission.This review also considered the added value of SDAC or MDAC to hospital interventions, which mostly included gastric lavage. No included studies investigated the use of body positioning in oral
poisoning patients.First aid interventions that evacuate the
poison from the gastrointestinal tractWe found one study comparing
ipecac versus no intervention in toxic berry ingestion in a pre-hospital setting. Low-certainty evidence suggests there may be an increase in the incidence of adverse events, but the study did not report incidence of mortality, incidence or duration of symptoms of
poisoning,
drug absorption, hospitalization or ICU admission (103 participants).In addition, we also considered the added value of
syrup of ipecac to SDAC plus a
cathartic and the added value of a
cathartic to SDAC.No studies used
cathartics as an individual intervention.First aid interventions that neutralize or dilute the
poison No included studies investigated the neutralization or dilution of the
poison in oral
poisoning patients.The review also considered combinations of different
first aid interventions.
AUTHORS' CONCLUSIONS: