Fatal poisoning in childhood, England & Wales 1968–2000

Patterns and trends of medicinal poisoning substances: a population-based cohort study of injuries in 0-11 year old children from 1998-2018

BACKGROUND

There have been sharp increases in antidepressant and opioid prescriptions over the last 10 years, as well as increased over-the-counter medicine availability. However, the impact on childhood medicinal poisonings rates, particularly by socioeconomic deprivation is unclear. This study reports population level medicinal poisoning substance patterns in England among children aged 0-11 years, helping inform safety advice and poisoning prevention interventions.

METHODS

An open cohort study of 1,489,620 0-11 year olds was conducted from 1998 to 2018, using the Clinical Practice Research Datalink, to examine inpatient hospital admissions for poisoning. Incidence rates and adjusted incidence rate ratios (aIRR) were calculated for poisoning substance groups by age, sex, socio-economic deprivation and year.

RESULTS

3,685 medicinal poisoning hospital admissions were identified. The most common substances were paracetamol (33.2%), dependence/withdrawal risk drugs (DWRD - antidepressants, opioids, gabapentinoids, benzodiazepines) (13.5%) and other over-the-counter (OTC) analgesics/anti-common cold drugs (13.0%). Over the study period DWRD poisonings decreased 33% (aIRR 0.67, 95%CI 0.50-0.90 comparing 2013/14-2017/18 to 1998/99-2002/03), while paracetamol poisonings increased 43% (aIRR 1.43, 95%CI 1.20-1.70 for the same periods), with no change in incidence rates for other OTC drugs (aIRR 0.82, 95% CI 0.60-1.12) or all medications combined (aIRR 0.97, 95%CI 0.88-1.07). A gradient in poisonings by area-level socioeconomic deprivation was shown for all medications (aIRR 1.32, 95%CI 1.18-1.47 for most deprived compared to least deprived quintile), and DWRDs (aIRR 2.03, 95%CI 1.42-2.88 for 4th most deprived quintile and aIRR 1.88, 95%CI 1.32-2.66 for 5th most deprived quintile, compared to least deprived quintile), but not for paracetamol or other OTC drug poisonings.

CONCLUSIONS

Poisonings from DWRDs decreased by 33%, while paracetamol poisonings increased by 43% during the study period. There was a gradient by area-level socioeconomic deprivation in prescribed medication poisonings, including drugs with withdrawal/dependence risk, but not OTC medication poisonings. Households in more socioeconomically deprived areas have the potential to benefit most from measures to improve safe storage of medicines and are likely to require targeted interventions providing education and safety equipment. In addition, universal promotion of the safe storage of OTC and prescribed medicines must be provided by prescribers, community pharmacies and other outlets of such medication.

Parental knowledge attitude and practices about chemical and medicinal poisons: A hospital based study from Karachi, Pakistan

BACKGROUND

Unintentional poisoning is among the leading cause of death in children less than 20 years age. The incidence of unintentional poisoning in Low-income countries LMICs is four times higher compared to high-income countries (HICs). In Pakistan a 10% (25/211) incidence of unintentional poisonings among 0-15-year-old children has been reported. Most of the poisoning occur because of household chemical and medicines. This study aimed to assess the knowledge, attitude, and practices (KAP) of parents in Karachi regarding poisonous household chemicals and medicines.

METHODS

This KAP study was conducted at Aga Khan University Hospital, Karachi from May to August 2019. A maximum sample of 384 was calculated using a 50% knowledge about household chemicals. Data were collected about parental knowledge, attitude and practices about poisons and chemicals at home and presented as frequency and percentages. Chi-square test of independence (or Fisher's exact test) was used. Data were analyzed using SPSS version 20.

RESULTS

A total of 364 parents of 0-16-year-old children completed the survey out of which 229 were mothers and 127 were fathers (eight had missing data). We had 70% of parents that kept chemicals and medicines locked in cabinets and 80% chose to never leave medicines unattended, there are still 20-30% parents that need improvement in the parental knowledge and practices for storing chemicals and medicines. A general lack of knowledge regarding poisoning first aid and emergency response centers was noted.

CONCLUSIONS

Two-pronged approach for future interventions could be useful; (1) Improving the knowledge and practice among the remaining 20-30% through repeated awareness' sessions for the community. (2) Information regarding PCCS needs to be made readily available to the parents which is a measure useful in cases a child poisoning occurs.

Clinical and Laboratory Characteristics Predicting the Severity of Carbon Monoxide Poisoning in Children: A Single-Center Retrospective Study

OBJECTIVES

Carbon monoxide poisoning (COP) is extremely common throughout the world. The purpose of this study was to assess the demographic, clinical, and laboratory characteristics predicting the severity COP in children.

METHODS

The study included 380 children diagnosed with COP between January 2017 and January 2021 and 380 healthy controls. Carbon monoxide poisoning was diagnosed based on the medical history and a carboxyhemoglobin (COHb) level of more than 5%. The patients were classified as mild (COHb 10%), moderate (COHb 10%-25%), or severely (COHb > 25%) poisoned.

RESULTS

The mean age of the severe group was 8.60 ± 6.30, for the moderate group was 9.50 ± 5.81, for the mild group was 8.79 ± 5.94, and for the control group was 8.95 ± 5.98. The most common place of exposure was at home and all cases were affected accidentally. The coal stove was the most common source of exposure, followed by natural gas. The most common symptoms were nausea/vomiting, vertigo, and headache. Neurologic symptoms such as syncope, confusion, dyspnea, and seizures were more common in the severe group. A total of 91.3% of the children had hyperbaric oxygen therapy, 3.8% were intubated, and 3.8% were transferred to intensive care in the severe group, whereas no death or sequela was observed. Mean platelet volume and red cell distribution width had the highest area under the curve in the receiver operating characteristic analysis (0.659; 0.379). A positive and low statistically significant relationship was found between COHb levels and troponin and lactate levels in the severe group ( P < 0.05).

CONCLUSIONS

Carbon monoxide poisoning progressed more severely in children presented with neurological symptoms and have elevated red cell distribution width and mean platelet volume. Even in severe COP cases, satisfactory results have been obtained with early and appropriate treatment.

Hospitalizations and deaths related to adverse drug events worldwide: Systematic review of studies with national coverage

PURPOSE

Adverse drug events are related to negative outcomes in healthcare, including hospitalization, increased duration of hospital stay and death. The aim of this study was to conduct a systematic review to evaluate hospitalizations and deaths related to adverse drug events worldwide, reported in studies with national coverage.

METHODS

The protocol was registered in PROSPERO (CRD42020157008). We performed a systematic search on Medline, Embase, CINAHL, LILACS, and the Cochrane Library (until March 2020) using pre-specified terms. We included published studies that reported data on hospitalizations and/or deaths related to adverse drug events from a national perspective and the use of secondary data as a source of information. Two reviewers independently extracted and synthesized data. The quality of the studies was assessed using an adapted version of the Joanna Briggs Institute critical appraisal checklist for prevalence studies. Narrative summaries of findings were undertaken.

RESULTS

Among 59,336 citations, 62 studies were included for data extraction and synthesis. Among these studies, 41 studies included the outcome of hospitalization, 16 included the death outcome, and five included both outcomes. Administrative databases regarding discharges and registries of vital statistics were the most common sources of information. The relative frequency of hospitalizations ranged from 0.03% to 7.3%, and from 9.7 to 383.0/100,000 population, whereas mortality rate ranged from 0.1 to 7.88/100,000 population.

CONCLUSION

Our study highlights information about adverse drug events using large administrative databases in a national scenario and provides an overview of databases and methods implemented to detect adverse drug events.

Prevention of unintentional injuries in children under five years

We looked at existing recommendations for preventing unintentional injuries in children under five years of age, and we attempted to identify the main sources used as evidence for formulating these recommendations.

We conducted a literature search up to the 18th October 2019 by using key terms and manual search in selected sources. We summarized the recommendations and source of the evidence in tables for each of five areas of unintentional injuries: road traffic injuries, drowning, poisoning, thermal injuries, falls.

In 2008, the World Health Organization (WHO) published a comprehensive report with strategies for child injury prevention for the European region. More recently, the WHO published several guidance documents focused on one area such as drowning, usually with a global focus. The PrevInfad workgroup (Spanish Association of Primary Care Pediatrics) updated their document on road safety in April 2019, providing recommendations and a summary of the existing evidence. Preventive strategies for injuries in childhood are mainly based on surveillance data and the identification of risk factors. The key strategies for preventing unintentional injuries are a combination of environmental and behaviour modification, that can be achieved through engineering, enforcement and education. Consequently, for this kind of strategies, it is important to evaluate the effectiveness of both the intervention itself, and the way the intervention is advised to parents and caretakers so that there is good compliance of the recommendation.

Predictors of Severe Clinical Course in Children With Carbon Monoxide Poisoning

OBJECTIVE

Carbon monoxide (CO) is a gas, which is produced by incomplete combustion of hydrocarbon-containing substances, and causes significant tissue and organ damage in the common event of CO poisoning. This study aims to evaluate the demographic, clinical, and laboratory characteristics of patients diagnosed with CO poisoning in the emergency department and to determine the factors associated with severe course in the acute phase of poisoning.

METHODS

A total of 331 patients diagnosed with CO poisoning in Hacettepe University Children's Hospital, Pediatric Emergency Unit, between January 2004 and March 2014 were included in the study. Their demographic characteristics, presenting complaints, physical examination findings, Glasgow Coma Scale scores, carboxyhemoglobin, leukocyte, hemoglobin, troponin T, pH and lactate levels, type of treatment (normobaric or hyperbaric oxygen), intensive care unit admissions, and outcome of poisoning were investigated.

RESULTS

Ninety-three patients were given hyperbaric oxygen. Fifty-one patients were admitted to the pediatric intensive care unit, 18 patients have had a severe clinical course, and 6 patients have died. The risk factors associated with severe disease course were determined to be low Glasgow Coma Scale score, high leukocyte count, and high troponin T levels at presentation.

CONCLUSIONS

Glasgow Coma Scale score, leukocyte count, and troponin T level may be beneficial in predicting clinical outcomes and tailoring therapy in children with CO poisoning.

Risk Factors and Outcome Analysis in Children with Carbon Monoxide Poisoning

BACKGROUND

Carbon monoxide (CO) poisoning is one of the common causes of poisoning in patients and can result in significant morbidity and mortality. However, few studies have focused on the pediatric group.

METHODS

We retrospectively reviewed children (age < 18 years) with CO poisoning from nonfire accidents at a tertiary medical center in Taiwan from 2002 to 2010. We analyzed the patients' characteristics, management, and outcome; compared the data of patients who received hyperbaric oxygen (HBO) to those who received normobaric oxygen (NBO) therapy; and identified the ri0sk factors for patients who developed delayed neurological sequelae (DNS) or permanent neurological sequelae (PNS).

RESULTS

A total of 81 children were enrolled. The annual case number increased from five cases in 2002 to 20 in 2010, particularly during the cold months (December to February). The most common source of exposure was an indoor heating system (54.3%). The most common presenting symptoms were vomiting (32.1%) and consciousness changes (30.9%). HBO treatment tended to be administered to patients with a higher initial COHb (%) (p < 0.001), an initial Glasgow coma scale change (p < 0.001), and admission to the hospital (p = 0.002). After multivariate analysis, treatment in the intensive care unit because of prolonged loss of consciousness (p = 0.002) was the only independent risk factor for patients with DNS; only rescue by a ventilator (p < 0.001) was an independent risk factor for patients with PNS. In comparison to the NBO therapy, HBO treatment did not show benefit or harm to patients according to the incidence of inducing DNS or PNS after multivariate analysis.

CONCLUSION

For those with treatment in the intensive care unit because of prolonged loss of consciousness and rescue by a ventilator, special attention should be given and follow-up should be performed to determine whether DNS or PNS occurs, particularly epilepsy and cognitive deficits.

Regional variations in pediatric medication exposure: Spatial analysis of poison center utilization in western Pennsylvania

CONTEXT

Medication drug exposures among young children continue to rise despite current poison prevention efforts. These exposures result in increased healthcare utilization and medical costs. New tactics are needed to reduce injuries related to pediatric drug exposures.

OBJECTIVE

We aimed to identify cluster patterns in: (1) calls for pediatric medication drug exposures and (2) a subset of calls that resulted in medical evaluation referrals. We identified and evaluated population characteristics associated with cluster patterns.

METHODS

We analyzed 26,685 pharmaceutical drug exposures involving children <5 years of age based on calls reported to the Pittsburgh Poison Center from 1 January 2006 to 31 December 2010. We performed spatial statistics to assess for clustering. We used logistic regression to estimate population characteristics associated with clustering.

RESULTS

Spatial analysis identified 22 exposure clusters and five referral clusters. Sixty-five percent of 89 ZIP codes in the clusters of drug exposure with healthcare facility (HCF) referral were not identified in the exposure clusters. ZIP codes in the HCF referral clusters were characterized as rural, impoverished, and with high rates of unemployment and school dropouts.

DISCUSSION

Our principal findings demonstrate pediatric drug exposures do exist in discrete geographic clusters and with distinct socioeconomic characteristics.

CONCLUSION

This study offers a starting point for subsequent investigations into the geographic and social context of pediatric medication drug exposures. This is an important step in revising pediatric poison prevention strategies.

Fatal poisoning of chilhood in the Eastern Black Sea region of Turkey (2009-2013)

Poisoning is a major problem worldwide among children. Nonetheless, the offending agent, the associated morbidity and mortality vary from place to place and show changes over a period of time. The aim of this study was to investigate the medico-legal paediatric autopsies of childhood poisonings in the Eastern Black Sea Region of Turkey. Reports of autopsies performed between 2009 and 2013 in the Morgue Department of the Council of Forensic Medicine. All medico-legal paediatric autopsies in Trabzon (n:1049) were retrospectively examined. The study comprised an investigation into 62 deaths from poisoning in children aged 0-18 years. The parameters of age, sex, toxic substance category and origin were evaluated. Poisoning accounted for 5.9% of the deaths of children aged 0-18 years. Of the 62 cases, 32 (51.6%) were male and 30 (48.4%) were female, giving a female to male ratio of 1/1.1. The primary causes of fatal poisoning in children were carbon monoxide (64.5%, n = 40), followed by drugs (16.1%, n = 10), insecticides (9.7%, n = 6), mushrooms (6.5%, n = 4), and snake venom (3.2%, n = 2). The results of this study implicated carbon monoxide poisoning as a serious risk factor for mortality in our region. Childhood poisoning may be prevented by public education and simple precautions in general.

Use of hair testing to determine methadone exposure in pediatric deaths

A case of death attributed to methadone acute poisoning in an infant aged 11 months is reported. A sudden infant death syndrome (SIDS) was suspected, whereas a traumatic cause of death was excluded regarding autopsy findings. Specimens were submitted to a large toxicological analysis, which included ethanol measurement by HS-GC-FID, a targeted screening for drugs of abuse and various prescription drug classes followed by quantification using UPLC-MS/MS methods. Methadone and its metabolite (EDDP) were detected in all the tested fluids, as well as in hair, with a blood concentration of methadone considered as lethal for children (73 ng/mL). The cause of death was determined to be acute "methadone poisoning", and the manner of death was "accidental". A discussion of the case circumstances, the difficulties with the interpretation of toxicological findings in children (blood concentration and hair testing), and the origin of exposure are discussed.

Carbon monoxide-related deaths in Ankara between 2001 and 2011

OBJECTIVE

The aim of the present study was to describe the epidemiology of unintentional carbon monoxide (CO) poisonings (between 2001 and 2011) in Ankara, Turkey.

METHODS

Data were collected from the records of Ankara Branch of Council of Forensic Medicine and the licensed official institutes and hospitals for medico-legal autopsies. A total of 10,720 medico-legal autopsy reports were obtained and reviewed by the authors.

RESULTS

Among 622 fatal poisoning cases during the period, 380 deaths were due to unintentional CO poisoning. The mean CO saturation of the groups was 55.4 ± 13.4 (% saturation). The minimum and maximum levels of CO in blood was 3.6 and 86.5 (% saturation), respectively. Of all the fatal poisonings determined by Ankara Branch of Council of Forensic Medicine, CO poisoning was the most common mortality cause (61.1%). Among the cases, 301 (79.2%) were found to be death in their houses, 43 (11.3%) in hospitals, 15 (3.9%) in their workplaces and 11 (2.9%) in some public places such as park and garden. Most of the cases were from the capital city of Turkey, Ankara (n = 203, 53.4%). When we compared the cities according to their population, it was realized that the highest death rate due to CO poisoning was in Kirikkale (12.3/100,000), followed by Karabuk (8.3/100,000), Cankiri (7.8/100,000) and Kirsehir (5.0/100,000).

DISCUSSION AND CONCLUSION

These findings add new data to the pool of knowledge in terms of the need of safety, proper heating system instructions and more education on CO poisoning in Turkey.

Opioid Related Deaths of Infants and Young Children

The prevalence of the opioid drugs is increasing worldwide. Greater access in turn increases the risk of infants and young children being exposed to potentially fatal concentrations of these drugs, either by accident or through the negligent or deliberate actions of a caregiver. This report reviews opioid-related fatalities in this population and discusses homicidal and accidental poisonings and the possible routes of exposure, including through breastfeeding. As with adults, autopsy findings in fatal pediatric opioid toxicity are nonspecific and such cases may mimic death from natural diseases such as metabolic disorders or channelopathies. A detailed review of the case history together with a complete autopsy and toxicology testing are essential for the correct certification of these deaths. Further challenges arise from the fact that toxic ranges for opioids are not well-defined in the pediatric population, and the forensic pathologist must rely on case reports and small case series’ to assist in the determination of “how much is too much”. Resources such as the National Association of Medical Examiners Pediatric Toxicology Registry (NAME PedTox) continue to be of great value, but depend on the voluntary submission of case data from members. Emerging phar-macogenetic data are revealing genetic variations associated with altered metabolism and tissue distribution of opioids; therefore, molecular autopsy techniques should be considered in these challenging cases, especially where the manner of death is unclear.

Poisoning mortality in Danish children and adolescents, 1970-2006 - a registry-based study

AIM

To study poisoning mortality from birth to the end of teenage.

METHODS

Registry study within the Danish population including all deaths from poisoning in the 0-19-year age groups for the years 1970-2006.

RESULTS

Poisoning mortality was age dependent with a modest peak in preschool children because of accidents and a very steep increase from 0.1/10(5) person years (p.y.) at 12 years to 6.1/10(5) p.y. at 19 years. Accidents, suicide and undetermined manner of death all contributed to the increase. A significant proportion of accidental and undetermined manner of death was caused by opioides and probably abuse related. During the study period, mortality decreased by more than 50% with all manners of death contributing significantly to the decline. Carbon monoxide poisoning was the overall dominating cause of death and contributed most to reduction in mortality. Poisoning death caused by opioides and unspecified drugs was unchanged over time.

CONCLUSION

Poisoning mortality among the youngest Danish children was dominated by accidental poisonings. During teenage, the level and pattern of adults was approached with respect to suicidal and abuse related deaths. A fall in mortality since mid-eighties was explained by fewer deaths from carbon monoxide poisoning.

Acute poisoning among children admitted to a regional university hospital in Northern Greece

OBJECTIVES

The aim of our study was to elucidate the current pattern of acute poisoning among children admitted to a regional University Hospital in the prefecture of Evros in Northern Greece. We also compared the obtained findings with those of two previous studies performed in the same region.

METHODS

Demographic and clinical data, management, and outcome of children with acute poisoning were recorded in our region, during the past 5-years (2005-2009, period C) and compared to similar studies carried out in the periods 1985-1989 (period A) and 1995-1999 (period B).

RESULTS

Comparison between the three periods showed that in period Athe lower incidence of children's acute poisoning (CAP) was observed. Also this revealed a 20%-reduction in the frequency of poisoning over the past 5-years (period C) compared to period B (p = 0.219), a significant increase in tobacco intoxication over the years (in the order A-C; p < 0.001 for comparisons of periods A and B, and periods B and C), while poisoning from insecticides-pesticides decreased (p < 0.001). The incidence of poisoning via salicylates significantly reduced from 9.7% in period A to 6.2% in period B, and further to 4.7% in period C (p = 0.016), whereas during the same periods poisoning via paracetamol increased from 2.3% to 5.1% and then to 10.4%, respectively (p < 0.001). Atrend toward a higher incidence of suicide attempt via poisoning was found during the three periods (from 3.0% in period A to 4.7% and 6.6%, in periods B and C, respectively; p = 0.049).

CONCLUSIONS

The frequency of acute poisoning among children has decreased over the past 5 years. The incidences of poisoning via paracetamol and tobacco, and attempted suicide have increased in recent years. Targeted and continuous educational preventive programs are mandatory.

Methadone toxicity in infants: a report of two fatalities

Fatalities in infants resulting from methadone toxicity are rare within the United Kingdom. We report two cases of fatality attributed to methadone toxicity in infants aged 3(1/2) and 15 months of age, respectively. One of the two cases was also associated with diazepam ingestion. We discuss the difficulties with the interpretation of paediatric forensic toxicology and review the current literature related to methadone and diazepam toxicity in infants and older children.

Poisoning deaths among Finnish children from 1969 to 2003

AIM

Trends in paediatric deaths due to poisoning are little studied. The aim of this study was to investigate the cause and secular trend of poisoning deaths among Finnish children.

METHODS

Death certificates of all Finnish children aged 0-15 who died due to poisoning between 1969 and 2003 were obtained from the Statistics of Finland and analysed.

RESULTS

During the study period, altogether 121 children aged 0-15 years died from poisoning in Finland. Among 0- to 4-year olds, the incidence of poisoning deaths declined to practically zero by the beginning of 1980s. Most of these deaths were unintentional poisonings. Among 5- to 15-year olds, the incidence of poisoning deaths varied during the study period. In this age group, up to 53% of the deaths were suicides among girls compared with 20% among boys (p = 0.017). The corresponding figures for substance abuse were 54% among boys and 9% among girls (p < 0.001).

CONCLUSION

Despite the declining secular trend seen in paediatric poisoning deaths in Finland from 1969 to 2003, the risk of death from both intentional and unintentional poisoning persists in children. Health programmes should be continued especially to promote well-being in families and to prevent teenage suicides and substance abuse.

Opium as a fatal substance

OBJECTIVE

Poisoning does the most serious damages in pediatrics. In the northeast of Iran (Golestan province), opium is used widely for symptomatic therapy of routine illnesses in young children by parents. In the present study, opium toxicity was assessed in young children referred to pediatric centers in our area.

METHODS

This survey was done as a prospective cross-sectional study. At first, a pilot study was undertaken to estimate the condition of opium intoxicated children and evaluate the validity of questionnaire. We collected data in collaboration with committee of Adverse Drug Reactions (ADR) in Golestan Province. All members of ADR committee in pediatric centers were trained to complete questionnaires in referred or admitted children under-5-year. Data was entered into computer and analyzed by Chi-square and Fisher exact test.

RESULTS

In this survey, 67 opium-intoxicated children were recruited. Minimum age of the cases was 6 days and maximum 5-year. Uneducated mothers, in most cases, gave opium to the child. Most of them were from the low socio-economic level. Ethnic was disparity was observed. Four deaths occurred.

CONCLUSION

As the results showed, opioids are dangerous in pediatric population, especially under 5-year. Respiratory depression, bradypnea, coma and death are the serious outcomes of opium toxicity in pediatrics. Such a practice of unrestricted use of opium contributes to children mortality and so it is essential to launch educational programs.

Mortalities among children and adolescents in manipal, southern India

OBJECTIVE

To describe the epidemiology and trends of traumatic deaths among children and adolescents in Manipal, Southern India.

METHODS

Analysis of all trauma deaths in children and adolescents aged between 1 and 19 years, autopsied between January 1994 and December 2005. The study is based on autopsy records, information furnished by the police, and chemical analysis report.

RESULTS

There has been a substantial decline in the incidence of traumatic deaths among children and adolescents during 1994 to 2005. Road traffic injuries were responsible for maximum mortalities (38.4%), followed by those because of burns (24.9%) and poisoning (15.9%). Males comprised 59.6% of cases. Male-to-female ratio was 1.5:1. Males predominantly died of traffic injuries (45.2%), whereas females as a result of burns (37.4%). There was more than two-fold increase in injury-related mortalities from childhood to adolescence (1:2.3).

CONCLUSION

Among children and adolescents, traffic injuries and burns are responsible for maximum injury-related mortalities in males and females, respectively. More injury reducing measures are required for effective reduction in traumatic deaths.

Incidence of poisoning deaths in Finland in 1971–2005

Poisonings cause considerable morbidity and mortality worldwide. However, only few countries have published nationwide statistics on poisoning deaths. Based on the Official Cause-of-Death Statistics of Finland, we investigated the incidence and secular trend of poisoning deaths in Finland in 1971–2005. Alcohol poisoning deaths and other poisoning deaths were analyzed separately. During the 35-year study period, other poisoning deaths (non-alcohol) increased from 2.6/100,000 in men and 1.4/100,000 in women in 1971 to 6.8/100,000 and 3.2/100,000 in 2005, respectively. Alcohol poisoning death rates also increased from 9.6/100,000 in men and 0.7/100,000 in women in 1971 to 16.8/100,000 and 4.2/100,000 in 2005, respectively. In the early 1970s, the incidence rates of alcohol deaths were about 10 times higher in men compared with women, whereas in the last few years of observation, men's incidence rate was only about four times higher. Our study showed that alcohol and other poisoning deaths increased in Finland between 1971 and 2005. Men’s risk was markedly higher than women’s risk, but in the later years, women’s risk was increasing. Poisoning death rates among children and adolescents were low throughout the period.

Acute child poisonings in Oslo: a 2-year prospective study

AIM

To study the current epidemiology, clinical course and outcome of poisonings among children in Oslo and compare findings to a similar study from 1980.

METHODS

Observational study with prospective inclusion of all children (<15 years of age) with a main diagnosis of acute poisoning treated in hospital or outpatient clinic in Oslo for 2 years.

RESULTS

One hundred seventy-five episodes of acute poisoning were included at the outpatient clinic only (n = 65), the paediatric department only (n = 82) or both (n = 28 referrals). Annual incidence was 97 per 100 000, significantly lower than in 1980 (230 per 100 000). Highest incidence was in 1-year-old males (576 per 100 000). In children <8 years of age, the most common toxic agents were pharmaceuticals (39%) and household products (32%); children > or = 8 years ingested mainly ethanol (46%) or pharmaceuticals (36%). Five percent of all children were comatose, and complications were seen in 13%. All children survived without sequelae. Half of the admissions needed treatment; most commonly used treatments were activated charcoal (33%), gastric lavage (9%) and emetics (9%).

CONCLUSION

The incidence of child poisonings in Oslo has significantly reduced since 1980. Only half of the poisonings needed treatment, most of the poisonings were mild and the clinical outcome was good.