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Boyraz M, Botan E, Yuce S, Erdem Torun Ş. Retrospective Evaluation of Poisoning Cases Followed Up in a Pediatric Intensive Care Unit-A 12-Year Experience in a Single Center. Pediatr Emerg Care 2023; 39:766-772. [PMID: 37665962 DOI: 10.1097/pec.0000000000003041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
OBJECTIVES Poisonings constitute an important part of preventable morbidity and mortality in pediatric intensive care units (PICUs) and hospitalizations. However, information on poisoning requiring intensive care is limited. This study aimed epidemiological evaluation of poisoning cases treated in the PICU in a single center. METHODS The records of 504 patients admitted to the PICU due to acute poisoning between 2010 and 2022 were retrospectively reviewed. Data were evaluated using descriptive methods and the χ 2 test, and statistical differences with P value <0.05 were considered significant. RESULTS The age range of the patients ranged from 1 month to 216 months (18 years), and the rate of girls was 53.2% (n = 268), whereas the rate of boys was 46.8% (n = 236). The mean age was 4.4 ± 4.3 years for boys, 6.7 ± 5.8 years for girls, and 5.6 ± 5.3 years for all patients. It was determined that 79.6% of the cases were poisoned by accident and 20.4% by suicide. A total of 76.7% of the patients who were poisoned for suicide were girls and 23.3% were boys. The mean age of these patients was 14.3 ± 3.0 years. On the other hand, 47.1% of the children who were accidentally poisoned were girls and 52.9% were boys, and the mean age of these children was 3.4 ± 2.9 years. Although 79.9% of poisonings occurred at home, the causative agent was oral poisoning in 97.4% of the cases. Approximately two thirds (69.2%) of the cases were drug-related, whereas 30.8% were related to nondrug substances. In drug-related poisonings, central nervous system drugs (35.8%) were the most common agent, followed by analgesic/antipyretic (20.9%) agents, whereas among the nonpharmaceutical factors, insecticides (agricultural pesticides, rat poison, pesticides, etc) were the most common, followed by poisonous herbs (beetleweed, widow's weed, cannabis, etc). The mean admission time of the patients to the hospital was 6.3 ± 8.4 hours, and the mean length of stay in the intensive care unit was 1.6 ± 1.3 days. In the 12 years of our study, only 3 patients died due to poisoning, and our mortality rate was 0.5%. Four patients (0.7%) were referred to the Alcohol and Drug Addicts Treatment and Research Center. CONCLUSIONS In this study, in which we retrospectively analyzed the profiles of poisoning cases hospitalized in the PICU for 12 years, we determined that poisonous weeds were the major factor in accidental poisonings, and suicidal poisonings were above the expected rates even at the young age group such as 8-12 years old. These results show the importance of determining the poisoning profile of the health care service area.
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Affiliation(s)
| | - Edin Botan
- Pediatric Intensive Care Division, Department of Pediatrics, Health Sciences University, Van Research and Training Hospital, Van
| | - Servet Yuce
- Department of Public Health, Istanbul Faculty of Medicine, Istanbul University, İstanbul, Turkiye
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Roversi M, Martini M, Musolino A, Pisani M, Zampini G, Genuini L, Bottari G, Di Nardo M, Stoppa F, Marano M. Drug self-poisoning in adolescents: A report of 267 cases. Toxicol Rep 2023; 10:680-685. [PMID: 37304378 PMCID: PMC10247951 DOI: 10.1016/j.toxrep.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/17/2023] [Accepted: 05/28/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction The current study aims at describing a sample of adolescents admitted to a tertiary referral pediatric hospital for drug self-poisoning and to identify variables that could explain and predict a higher severity of intoxication. Methods We retrospectively reviewed the cases of drug self-poisoning in adolescents admitted to the Bambino Gesù Children's Hospital between January 2014 and June 2022 requiring consultation by the local Pediatric Poison Control Center (PPCC). We reported the type and class of drug ingested and correlated the clinical characteristics of the patients with their Poison Severity Score. Results The data of 267 patients were reported. Most patients were female (85.8 %), with a median age of 15.8 years at presentation. Half of the patients were symptomatic at admission (44.2 %), and most had at least one psychiatric comorbidity (71.1 %). Most patients were hospitalized (79.6 %), 16.6 % of cases required antidote administration and a minority required intensive care. Most patients received a PSS score of 0 (59.6 %). The most frequently ingested drug was acetaminophen (28.1 %) followed by ibuprofen (10.1 %) and aripiprazole (10.1 %). Antipsychotics as a class were the most abused drugs (33.1 %). The correlation of clinical variables with the PSS showed that older and male patients were more prone to be severely intoxicated. Conclusions This single-center study identifies the most commonly ingested drugs in a large sample of adolescents with voluntary drug self-poisoning, also showing that older and male patients are more susceptible to severe intoxication.
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Affiliation(s)
- Marco Roversi
- Clinical Trial Area, Development and Implementation of Drugs, Vaccines, and Medical Devices for pediatric use, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | - Matteo Martini
- Pediatric Poison Control Centre, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Antonio Musolino
- Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | - Mara Pisani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giorgio Zampini
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Leonardo Genuini
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Gabriella Bottari
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Francesca Stoppa
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Marco Marano
- Pediatric Poison Control Centre, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Arbaeen A, Noghrehchi F, Wheate NJ, Cairns R. Hospitalised poisonings in Australian children: a 10-year retrospective study. Clin Toxicol (Phila) 2023; 61:153-161. [PMID: 36892513 DOI: 10.1080/15563650.2022.2147538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
INTRODUCTION Paediatric poisoning is a major cause of childhood injury, and most poisonings are preventable. We aimed to describe hospitalisations resulting from poisoning and envenomation in Australian children, including demographics, cause of the exposure, hospital length of stay, rates of intensive care unit admission and in-hospital deaths. We also aimed to describe risk factors for increased length of stay and intensive care unit admission. METHODS A retrospective analysis was performed of hospitalised poisoning and envenomation cases of children (<15 years) in Australia from 1 July 2009 to 30 June 2019. A nationwide hospital admissions database was used for this study. RESULTS During the 10-year study period 33,438 children were admitted to hospital due to a pharmaceutical or non-pharmaceutical poisoning/envenomation; an average of 74.8 cases per 100,000 population per year. Approximately 10 children were admitted to hospital each day for poisoning. Over 70% of these cases were due to pharmaceuticals (n = 23,628), most frequently non-opioid analgesics, anti-pyretics and anti-rheumatics (n = 8759, 37.1% of pharmaceutical exposures). The most common non-pharmaceutical exposure was contact with venomous animals and toxic plants (n = 4578, 46.7% of non-pharmaceuticals). Intentional self-harm occurred in 7833 (23.4%) of cases. Intensive care unit admission was required in 519 cases (2.5% of the 20,739 cases where this information was available), while 200 (0.96% of 20,739) needed ventilator support. Ten children (0.03%) died. Older age, female sex, poisoning with pharmaceuticals and metropolitan hospital location were associated with increased length of stay. Older age and poisoning with pharmaceuticals were also associated with intensive care unit admission. CONCLUSION Approximately 10 children were admitted to hospital with poisoning every day in Australia. Most poisonings were due to pharmaceuticals, particularly simple analgesics that are found in most Australian homes. Severe outcomes (intensive care unit admissions and deaths) were rare.
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Affiliation(s)
- Abrar Arbaeen
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Firouzeh Noghrehchi
- Discipline of Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Nial J Wheate
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Rose Cairns
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.,The Children's Hospital at Westmead, New South Wales Poisons Information Centre, NSW, Australia
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Smola C, Wu CL, Narayanan S, Nichols MH, Pruitt C. Utilization of Monitored Beds for Children Admitted With Unintentional Poisonings. Pediatr Emerg Care 2022; 38:121-125. [PMID: 35226620 DOI: 10.1097/pec.0000000000002542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Children with unintentional poisonings (UPs) are frequently admitted to monitored beds (MBs), though most require minimal interventions. We aimed to (1) describe clinical factors and outcomes for children admitted for UPs and (2) identify clinical factors associated with MB placement. METHODS In this single-center retrospective cohort study, we studied patients younger than 6 years admitted from the emergency department (ED) for UPs over a 5-year period to a quaternary-care children's hospital. Primary outcome was disposition (MB vs non-MB). Secondary outcomes included length of stay, escalation of inpatient care, 7-day readmission, and death. Covariates included age, certainty of ingestion, altered mental status, and ED provider training level. Subanalysis of drug class effect on disposition was also studied. Associations of clinical factors with MB placement were tested with multivariable logistic regression. RESULTS Of 401 patients screened, 345 subjects met inclusion criteria. Most subjects (308 of 345 [89%]) were admitted to MBs. Children with high certainty of ingestion (adjusted odds ratio [aOR], 4.2; 95% confidence interval [CI], 1.52-11.58), altered mental status (aOR, 5.82; 95% CI, 2.45-13.79), and a fellow (vs faculty) ED provider (aOR, 2.34; 95% CI, 1.04-5.24) were more likely to be admitted to MBs. No escalations of care, readmissions, or deaths occurred. Exposures to cardiac drugs had increased MB placement (aOR, 6.74; 95% CI, 1.93-23.59). CONCLUSIONS The majority of children admitted for UPs were placed in MBs. Regardless of inpatient placement, no adverse events were observed, suggesting opportunities for optimized resource utilization. Future research may focus on direct costs, inpatient interventions, or prospective outcomes to validate these findings.
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Affiliation(s)
- Cassi Smola
- From the Division of Pediatric Hospital Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Chang L Wu
- From the Division of Pediatric Hospital Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Sridaran Narayanan
- Division of Pediatric Hospital Medicine, Children's National, Washington, DC
| | - Michele H Nichols
- Division of Pediatric Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Chris Pruitt
- Division of Pediatric Emergency Medicine, Medical University of Sou\th Carolina, Charleston, SC
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Investigation of pediatric poisoning in Aksaray. JOURNAL OF CONTEMPORARY MEDICINE 2021. [DOI: 10.16899/jcm.904622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Vu M, Erdelyi S, Mangat B, Chan H, Brubacher JR, Staples JA. Emergency department visits on Lunar New Year's Eve in Vancouver, Canada. Am J Emerg Med 2021; 55:196-198. [PMID: 34175194 DOI: 10.1016/j.ajem.2021.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/06/2021] [Accepted: 06/12/2021] [Indexed: 10/21/2022] Open
Affiliation(s)
- Mitchell Vu
- Department of Medicine, University of British Columbia, Vancouver, Canada.
| | - Shannon Erdelyi
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada.
| | - Birinder Mangat
- Department of Medicine, University of British Columbia, Vancouver, Canada.
| | - Herbert Chan
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada.
| | - Jeffrey R Brubacher
- Centre for Clinical Epidemiology & Evaluation (C2E2), Vancouver, Canada; Department of Emergency Medicine, University of British Columbia, Vancouver, Canada.
| | - John A Staples
- Department of Medicine, University of British Columbia, Vancouver, Canada; Centre for Clinical Epidemiology & Evaluation (C2E2), Vancouver, Canada.
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ÖZKALE M, ÖZKALE Y. Çocuk yoğun bakım ünitesinde takip edilen zehirlenme olgularının demografik, epidemiyolojik ve klinik özellikleri. CUKUROVA MEDICAL JOURNAL 2020. [DOI: 10.17826/cumj.732815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Lee J, Fan NC, Yao TC, Hsia SH, Lee EP, Huang JL, Wu HP. Clinical spectrum of acute poisoning in children admitted to the pediatric emergency department. Pediatr Neonatol 2019; 60:59-67. [PMID: 29748113 DOI: 10.1016/j.pedneo.2018.04.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 10/20/2017] [Accepted: 04/09/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pediatric poisoning is a common emergency worldwide. Routine surveillance is required for public health authorities and physicians to update strategies for prevention and management of pediatric poisoning. This study investigated the epidemiology of poisoning among children admitted to an emergency department (ED). METHODS This was a retrospective descriptive study. Data were collected from patients under 18 years old (y/o) presenting with poisoning at the largest ED in North Taiwan from 2011 to 2015. RESULTS Five-year records of 590 patients-309 (52.3%) boys and 281 (47.7%) girls-were analyzed. The mean age was 5.07 y/o (Standard Deviation [SD] = 5.02 years), and 94.7% of events occurred at home. Incidence was highest from 6 p.m. to 12 a.m. (42.2%, n = 249). Most patients younger than 11 y/o were male, but this gender distribution was reversed in adolescents (11-17 y/o). Pharmaceutical ingestion (41.4%, n = 244) was the leading cause of poisoning; pesticide was the most common non-pharmaceutical poison ingested (9.5%, n = 55). Carbon monoxide (CO) intoxication (87.6%, n = 99) and snakebite (75%, n = 9) were the common causes of inhalation (n = 113) and venom (n = 12) poisoning, respectively. The mean duration of the ED stay was 5.45 h (SD = 7.39 h), and 101 cases (17.2%), including 21 cases (3.6%) requiring intensive care, were admitted to the hospital. All patients survived. CONCLUSION Most poisonings occurred in young children, at home, by unintentional ingestion of a single substance, from 6 p.m. to 12 a.m. Female adolescents were the common intentional poisoning patients and pharmaceutical ingestion was the leading cause of poisoning. This kind of information enables ED physicians to improve preparations for pediatric poisoning cases and allows public health authorities to sharpen the focus of poisoning prevention efforts.
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Affiliation(s)
- Jung Lee
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Nai-Chia Fan
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tsung-Chieh Yao
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Pediatric Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan
| | - Shao-Hsuan Hsia
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan
| | - En-Pei Lee
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan
| | - Jing-Long Huang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Pediatric Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan.
| | - Han-Ping Wu
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Yimaer A, Chen G, Zhang M, Zhou L, Fang X, Jiang W. Childhood pesticide poisoning in Zhejiang, China: a retrospective analysis from 2006 to 2015. BMC Public Health 2017; 17:602. [PMID: 28659131 PMCID: PMC5490151 DOI: 10.1186/s12889-017-4505-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 06/14/2017] [Indexed: 02/08/2023] Open
Abstract
Background Pesticide poisoning in children has been a serious public health issue around the world, especially in the developing countries where agriculture is still one of the largest economic sectors. The purpose of this study was to analyze epidemiological characteristics of acute pesticide poisoning in children from Zhejiang province, China. Methods The pesticide poisoning cases for children were retrieved from Occupational Disease Surveillance and Reporting System, Zhejiang Provincial Center for Disease Control and Prevention, China. The incident cases, deaths, and fatality rate of child pesticide poisoning from 2006 through 2015 were calculated. Results During the study period, totally 2952 children were poisoned by pesticides, with 66 deaths, resulting in a fatality rate of 2.24%. Among them, there were 1607 male cases with 28 deaths, and 1345 female cases with 38 deaths. Most of the cases occurred in preschool children (1349) and adolescent age group (1269). Organophosphate and carbamate insecticides were the cause of most poisonings (1130), leading to 34 deaths. The highest fatality rate (3.13%) was due to poisoning by herbicides and fungicides, causing 14 deaths out of 448 cases. Poisoning occurred mostly in rural areas (78%). And most pesticide poisoning occurred in the summer (896) and fall (811), while fewest poisoning cases in the winter (483) but with the highest fatality rate (3.52%). Conclusions This study shows that pesticide poisoning of children is a major health problem in Zhejiang, suggesting preventive strategies should be conducted to control childhood pesticide poisoning.
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Affiliation(s)
- Aziguli Yimaer
- Department of Public Health, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Guangdi Chen
- Department of Public Health, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Meibian Zhang
- Department of Environmental and Occupational Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, 310051, China
| | - Lifang Zhou
- Department of Environmental and Occupational Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, 310051, China
| | - Xinglin Fang
- Department of Environmental and Occupational Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, 310051, China.
| | - Wei Jiang
- Department of Public Health, Zhejiang University School of Medicine, Hangzhou, 310058, China.
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Azab SMS, Hirshon JM, Hirshon JM, Hayes BD, El-Setouhy M, Smith GS, Sakr ML, Tawfik H, Klein-Schwartz W. Epidemiology of acute poisoning in children presenting to the poisoning treatment center at Ain Shams University in Cairo, Egypt, 2009-2013. Clin Toxicol (Phila) 2016; 54:20-6. [PMID: 26653953 PMCID: PMC4933840 DOI: 10.3109/15563650.2015.1112014] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Pediatric poisonings represent a major and preventable cause of morbidity and mortality throughout the world. Epidemiologic information about poisoning among children in many lower- and middle-income countries is scarce. This study describes the epidemiology of acute poisonings in children presenting to Ain Shams University's Poisoning Treatment Center (ASU-PTC) in Cairo and determines the causative agents and characteristics of acute poisoning in several pediatric age groups. METHODS This retrospective study involved acutely poisoned patients, 0-18 years of age, who presented to the ASU-PTC between 1 January 2009 and 31 December 2013. Data were extracted from electronic records maintained by the ASU-PTC. Collected data included demographics, substance of exposure, circumstances of the poisoning, patient disposition, and outcome. RESULTS During the 5-year study period, 38 470 patients meeting our criteria were treated by the ASU-PTC; 19 987 (52%) were younger than 6 years of age; 4196 (11%) were 6-12 years; and 14 287 (37%) were >12 years. Unintentional poisoning accounted for 68.5% of the ingestions, though among adolescents 84.1% of ingestions were with self-harm intent. In all age groups, the most frequent causative drugs were non-opioid analgesics, antipyretics, and antirheumatics. The most common nonpharmaceutical agents were corrosives in preschool children and pesticides in adolescents. Most patients had no/minor effects (29 174 [75.8%]); hospitalization rates were highest among adolescents. There were 119 deaths (case fatality rate of 0.3), primarily from pesticide ingestion. CONCLUSION Poisoning in preschool children is mainly unintentional and commonly due to nonpharmaceutical agents whereas poisoning in adolescents is mainly intentional (self-harm). Pesticides, mainly organophosphorous compounds and carbamates, were the most frequent agents leading to morbidity and mortality.
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Affiliation(s)
- Sonya M S Azab
- a Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine , Ain Shams University , Cairo , Egypt
| | | | - John Mark Hirshon
- b Department of Emergency Medicine , University of Maryland School of Medicine , Baltimore , MD , USA
- c Charles McC. Mathias. Jr. National Study Center for Trauma and EMS , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Bryan D Hayes
- d Department of Pharmacy Services , University of Maryland Medical Center , Baltimore , MD , USA
| | - Maged El-Setouhy
- e Department of Community , Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University , Cairo , Egypt
- f Substance Abuse Research Center, Jazan University , Jazan , Saudi Arabia
| | - Gordon S Smith
- g Department of Pharmacy Practice and Science , Maryland Poison Center, University of Maryland School of Pharmacy , Baltimore , MD , USA
| | - Mahmoud Lotfy Sakr
- a Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine , Ain Shams University , Cairo , Egypt
- h Poisoning Treatment Center, Ain Shams University Hospitals , Cairo , Egypt
| | - Hany Tawfik
- h Poisoning Treatment Center, Ain Shams University Hospitals , Cairo , Egypt
| | - Wendy Klein-Schwartz
- i Maryland Poison Center, University of Maryland School of Pharmacy , Baltimore , MD , USA
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The Comparison of Accidental Poisonings Between Pharmaceuticals and Nonpharmaceuticals in Children Younger than 3 Years. Pediatr Emerg Care 2015; 31:825-9. [PMID: 26359824 DOI: 10.1097/pec.0000000000000506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The management of pediatric poisoning is dependent on the type of toxicant ingested; however, little information has been published regarding the difference in poisoning by pharmaceuticals and nonpharmaceuticals in children. We compared the accidental poisoning of children younger than 3 years who had ingested pharmaceuticals or nonpharmaceuticals using emergency medical information center data. METHODS We retrospectively reviewed the records of the poisonings of children younger than 3 years who were evaluated by the Seoul Emergency Medical Information Center in 2011. The demographic data and detailed information regarding the poisonings were investigated. The substances that caused the poisonings were divided into the following 2 groups: pharmaceuticals and nonpharmaceuticals, and their characteristics and the differences between the 2 types of poisonings were investigated. RESULTS A total of 1279 cases were collected, most of which involved children who were 13 to 24 months old. Boys (51.3%) were involved more than girls. Exposure to nonpharmaceuticals (60.7%) was more common than exposure to pharmaceuticals. Personal care products and respiratory agents were the most commonly implicated substances. There were several significant differences between the pharmaceutical and nonpharmaceutical groups. Poisoning by pharmaceuticals occurred more frequently in older children and more frequently at night. Although the exact exposure of the children in the pharmaceutical group was known and they required more treatment in the emergency department, they were not given extra immediate first aid than the children in the nonpharmaceutical group. CONCLUSIONS Because there were several significant differences in the characteristics of accidental pediatric poisonings between the pharmaceutical and nonpharmaceutical groups, preventive strategies and educational programs should be implemented on the basis of the causative agent.
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Role of a poison center in reducing unintentional childhood ingestion by targeting pre-event risk factors. Pediatr Emerg Care 2013; 29:296-300. [PMID: 23426244 DOI: 10.1097/pec.0b013e3182850a17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Unintentional poisoning is a frequent presentation in the pediatric emergency care settings. We sought to determine the current incidence of unintentional poison ingestions in children who present to the emergency care in the city of Al Ain in United Arab Emirates, to create a profile of the products ingested, and to compare our data with a previous study conducted before the inception of a poison and drug information center. METHODS We reviewed all cases of unintentional poisoning in children 10 years or younger, who presented at 2 tertiary level emergency care centers during January-December 2010. Two hundred cases met our inclusion criteria. Data on demographics, type and amount of noxious substance ingested, time of presentation, and outcomes were collected. Annual incidence was estimated, and data were compared with the previous study. RESULTS The annual incidence of unintentional poisoning in the UAE is 2.35 per 1000 children 10 years or younger. The incidence is decreasing, especially for household chemical ingestions. The incidence is twice as high among native Emirati children compared with expatriate children. There was an increase in cosmetics- and synthetic hormone-related poisonings, as well as in the involvement of younger infants. CONCLUSIONS The incidence of unintentional pediatric poisoning in the UAE is decreasing particularly in household chemical ingestions. Targeted health promotion campaigns by the poison center may have led to this drop. The sociological, environmental, and cultural factors that might be contributing to the greater use of emergency care in native children should be investigated.
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Callahan ST, Fuchs DC, Shelton RC, Balmer LS, Dudley JA, Gideon PS, Deranieri MM, Stratton SM, Williams CL, Ray WA, Cooper WO. Identifying suicidal behavior among adolescents using administrative claims data. Pharmacoepidemiol Drug Saf 2013; 22:769-75. [PMID: 23412882 DOI: 10.1002/pds.3421] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 01/22/2013] [Accepted: 01/24/2013] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess the safety of psychotropic medication use in children and adolescents, it is critical to be able to identify suicidal behaviors from medical claims data and distinguish them from other injuries. The purpose of this study was to develop an algorithm using administrative claims data to identify medically treated suicidal behavior in a cohort of children and adolescents. METHODS The cohort included 80,183 youth (6-18 years) enrolled in Tennessee's Medicaid program from 1995-2006 who were prescribed antidepressants. Potential episodes of suicidal behavior were identified using external cause-of-injury codes (E-codes) and ICD-9-CM codes corresponding to the potential mechanisms of or injuries resulting from suicidal behavior. For each identified episode, medical records were reviewed to determine if the injury was self-inflicted and if intent to die was explicitly stated or could be inferred. RESULTS Medical records were reviewed for 2676 episodes of potential self-harm identified through claims data. Among 1162 episodes that were classified as suicidal behavior, 1117 (96%) had a claim for suicide and self-inflicted injury, poisoning by drugs, or both. The positive predictive value of code groups to predict suicidal behavior ranged from 0-88% and improved when there was a concomitant hospitalization but with the limitation of excluding some episodes of confirmed suicidal behavior. CONCLUSIONS Nearly all episodes of confirmed suicidal behavior in this cohort of youth included an ICD-9-CM code for suicide or poisoning by drugs. An algorithm combining these ICD-9-CM codes and hospital stay greatly improved the positive predictive value for identifying medically treated suicidal behavior.
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Affiliation(s)
- S Todd Callahan
- Division of Adolescent and Young Adult Health, Department of Pediatrics, Vanderbilt School of Medicine, Nashville, Tennessee, USA.
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