Evaluating clinical characteristics and outcomes associated with body stuffers presenting to the emergency department: a five-year retrospective analysis from a United States poison center.

INTRODUCTION: "Body stuffing" refers to the ingestion of illicit drugs, often to evade law enforcement or prosecution. Management presents a clinical challenge, often centered around determining appropriate observation duration for asymptomatic or symptomatically resolved patients. To better guide clinical decision-making, this study aims to evaluate clinical characteristics, outcomes, and the efficacy of an often-implemented monitoring duration associated with body stuffers. METHODS: We performed a five-year retrospective analysis of body stuffing cases reported to a single United States poison center from 1 January 2019 to 31 December 2023. All ages and sexes were included. Non-ingestion routes and cases where emergency department care was not pursued were excluded. Outcomes included time to new symptom onset and development of new symptoms after emergency department presentation, frequency of symptoms, specific drug(s) and drug wrapping details, and hospital length of stay. Categorical variables were summarized as frequencies and percentages and continuous variables used the median and interquartile range (IQR). RESULTS: Ninety-four cases were included for final analysis. Most cases involved males (70/94, 74.5%) and most (39/67, 58.2%) involved patient observation and monitoring in the emergency department for ≤ 6 hours. Wrappers consisted mainly of plastic or cellophane (74/114, 64.9%). Opioids were most frequently ingested (56/114, 49.1%). Patients were symptomatic in 57/94 (60.6%) of cases. New symptoms developed in 12/94 (12.8%) of patients after initial emergency department presentation, with only 2/94 (2.1%) previously asymptomatic patients developing symptoms >6 hours after emergency department presentation. DISCUSSION: This study supports the six hour observation period, with some exceptions. Case outliers underscore the limitations of a six hour observation period and the need for clinical judgement in body stuffer cases. CONCLUSION: Most body stuffers do not develop new or progressive symptoms after presentation within six hours, supporting but not definitively validating the commonly recommended six hour observation time. A modified observation period may be warranted in certain cases.