Accidental pharmacological poisonings in young children: population-based study in three settings

Insights into hospitalization pattern for drug, medicament, and biological substance poisoning, adverse effect, and underdosing in Australia: An ecological study between 1998 and 2019

BACKGROUND

Drug, medicament, and biological substance poisoning, adverse effects, and underdosing are significant public health concerns. Gaining insight into the patterns and trends in hospitalizations caused by these occurrences is essential for the development of preventative initiatives, optimization of treatment regimens, and improvement of patient safety. The aim of this study is to examine the trend of hospitalisation related to poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances in Australia between 1998 and 2019.

METHODS

This is an ecological descriptive study that examined hospitalisation related to poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances in Australia between 1998 and 2019. A nationwide hospital admissions database was used for this study.

RESULTS

Between 1998 and 2019, a total of 683,869 hospital admission episodes were recorded in Australia. The overall annual number of hospital admissions for various reasons increased by 20.5% from 29,854 in 1998 to 35,960 in 2019, representing a decrease in hospital admission rate of 10.6% [from 158.69 (95% CI 156.90-160.49) in 1998 to 141.91 (95% CI 140.44-143.37) in 2019 per 100,000 persons, trend test, p<0.05]. Overnight-stay admissions accounted for 69.2% of the total number of hospital admissions, and 30.8% were same-day admissions. Rates of same-day hospital admission decreased by 13.3% [from 50.55 (95%CI 49.54-51.57) in 1998 to 43.81 (95%CI 43.00-44.63) in 2019 per 100,000 persons]. Rates of overnight-stay hospital admission decreased by 11.1% [from 108.14 (95%CI 106.66-109.63) in 1998 to 96.17 (95%CI 94.96-97.38) in 2019 per 100,000 persons]. Admissions related to antiepileptic, sedative-hypnotic and antiparkinsonism drugs was the most prevalent hospital admissions type accounting for 26.8%. Females were responsible for 418,751 hospital admission episodes, representing 61.5% of the total number of hospital admission.

CONCLUSION

This study found that while the overall annual number of admissions increased, the rate of admission decreased over the same period. The most common reasons for admissions were antiepileptic, sedative-hypnotic, and anti-parkinsonism drugs. The study also noted increases in admissions related to anaesthetics, therapeutic gases, hormones, and their synthetic substitutes. These findings suggest a concerning rise in the suboptimal use of these medications. In order to combat the increasing incidence of this type of admissions, it is imperative to strengthen public awareness initiatives on medicine safety and abuse.

A retrospective analysis of therapeutic drug exposures in New Zealand National Poisons Centre data 2018-2020

OBJECTIVE

The New Zealand National Poisons Centre advises the general public and health professionals on management of exposures to various substances. The epidemiology of medicine exposures was used to characterise inappropriate use of medicines across age groups.

METHODS

Data from contacts in 2018-2020 were analysed: patient demographics (age, gender), number of therapeutic substances, and advice given. The most frequent individual therapeutic substance exposures across age groups and the reasons for these occurring were determined.

RESULTS

A total of 76% of children's (aged 0-12 or unknown child) exposures were exploratory in nature, involving a variety of medicines. Youth (aged 13-19) had frequently engaged in intentional self-poisoning (61% of their exposures), and most commonly by exposure to paracetamol, antidepressants, and quetiapine. Adults (aged 20-64) and older adults (aged 65 and over) were frequently affected by therapeutic errors (50% and 86% of their exposures, respectively). Adults were most frequently exposed to paracetamol, codeine, tramadol, antidepressants, and hypnotics, while older adults were exposed to paracetamol and various cardiac medications.

CONCLUSIONS

Types of inappropriate medicine exposures vary in different age groups.

IMPLICATIONS FOR PUBLIC HEALTH

Poisons centre data add to pharmacovigilance monitoring of potential harm from medicines and inform medication safety policies and interventions.

Hospitalised poisonings in Australian children: a 10-year retrospective study

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.

Affecting children’s knowledge about rational use of medicines using read-along videos of pictorial storybooks

Although efforts have been taken to educate the public about medication from a very young age, there are very limited availability and accessibility of education material for children. The aim of this study is to assess the impact of read-along videos of pictorial storybooks on children’s knowledge about rational use of medicines. This study compared pre and post knowledge scores in a nonrandomized, one-group pre-test-post-test experimental design. Pre-recorded read-along storytelling videos were used as intervention covering two topics on rational use of medicine -medicine storage and antibiotic resistance. The questionnaire and intervention videos were distributed using Google Forms to children aged six and seven in Malaysia via online social media platforms. 521 children completed the study. The mean baseline knowledge score for medication storage was 4.89 (SD = 1.12) pre-test and 5.44 (SD = 0.78) post-test while for antibiotic resistance the mean was 3.616 (SD = 1.340) pre-test and 4.820 (SD = 1.134) post-test. A Wilcoxon signed-rank test showed statistically significant changes on medication storage (Z = −10.21, p < 0.001) and antibiotic resistance (Z = −14.869, p < 0.001) related knowledge among children. Pictorial storybook read-along video interventions were shown to be effective in improving children’s knowledge on rational use of medicine. Education and awareness on the use of antibiotics should be prioritized.

Clinical and Epidemiological Characteristics of Acute Poisoning in Children in Southwestern China: A Review of 1755 Cases from 2014 to 2020

Purpose

Acute poisoning is a major cause of disability and death in children, but there is a lack of large-scale and multicenter epidemiological data on acute poisoning in children.

Patients and Methods

The current study was a retrospective analysis of clinical data from 1755 children aged 0 to 14 years who were hospitalized between 01 January 2014 and 31 December 2020 in southwestern China.

Results

Acute poisoning was common in childhood, particularly in early childhood (607; 34.6%) and preschool (655; 37.3%), and most cases occurred in rural areas (1191; 67.9%). It was more common in boys (934; 53.2%) than in girls (821; 46.8%). In urban areas, poisoning was mainly caused by drugs (266; 47.2%), chemical agents (59; 10.5%), and alcohol (54; 9.6%). In rural areas, it was mainly caused by pesticides (620; 52.1%) and medications (213; 17.9%), the route of poisoning was usually the digestive tract (1671; 95.2%), in most cases the poisoning was accidental (1618; 92.3%), and pesticides (659; 37.5%) and medications (479; 27.3%) predominated. After timely treatment, the majority of patients had no substantial organ damage, sequelae, or disabilities, and mortality was low (17; 1.0%).

Conclusion

Acute poisoning is a frequent accident in childhood, mainly in infants and preschool children, mostly in rural areas, and poisoning mostly occurs via the digestive tract. Family and community education should be conducted to prevent poisoning.

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Paediatric poisoning presentations reported to a regional toxicology service in Australia

AIM

The aim of this study is to describe the epidemiology and health-care utilisation of paediatric emergency department (ED) presentations due to poisoning.

METHODS

A retrospective review of all ED presentations of paediatric poisoning cases (<18 years) reported to a tertiary toxicology service from 2015 to 2016 was conducted. Cases were classified into three age groups: pre-school (0-6 years), primary school (7-11 years) and adolescent (12-17 years). Outcomes included patient transfer, length of ED stay (LOS) and proportion admitted to a medical ward, mental health unit or intensive care unit (ICU).

RESULTS

From 764 consultations over a 2-year period, 87 were excluded as non-ED presentations. From these, there were 194 (29%; 47% female) pre-school aged, 34 (5%; 41% female) primary school aged and 449 (66%; 77% female) adolescent presentations. Deliberate self-poisoning was most common in 394 of 449 (88%) adolescents. Accidental exposures accounted for 159 (82%) of pre-school presentations and natural toxins occurred in all three age groups. Paracetamol, selective serotonin reuptake inhibitors, antipsychotics and ibuprofen were the most common toxins. Discharge from ED occurred in 147 of 194 (76%) pre-school, 24 of 34 (71%) primary school and 223 of 449 (50%) adolescent presentations. Of the 449 adolescents, 137 (31%) were admitted medically (median LOS 19.9 h), 19 were admitted to ICU (median LOS 71 h) and 70 (16%) admitted to mental health (median LOS 122 h). Five pre-school aged children were admitted to ICU.

CONCLUSIONS

Adolescent deliberate self-poisoning has a significant impact on hospital resources, with mental health problems requiring extended length of stay. There were fewer pre-school accidental poisoning consultations, which were mainly discharged from ED.

Opioid exposures in children under 5 years of age (2004-2019): A retrospective study of calls to Australia's largest poisons information centre

AIM

To describe time trends in opioid exposures in children under 5 years, and to describe patient demographics, the medicines involved, the reasons for exposure and disposition.

METHODS

A retrospective analysis of paediatric (<5 years of age) opioid exposure calls to the New South Wales Poisons Information Centre (NSWPIC, Australia's largest poison centre), 2004-2019. Joinpoint regression analysis was used to examine temporal trends.

RESULTS

There were 4807 cases of paediatric opioid exposure during the 16 year study period, with an average of 300 exposures per year. Exposures increased, 2004-2007, with an annual percentage change (APC) of 14.6% (95% CI = 4.3 to 26.0%), then decreased, 2007-2016, APC -3.4% (95% CI = -5.3 to -1.3%). A steeper decrease was observed after 2016, APC -14.1% (95% CI = -21.8 to -5.6%). The overall APC was -2.3% (95% CI = -4.7 to 0.2%), 2004-2019. Accidental exposures accounted for 86% of calls (4137). The majority of calls were from family members regarding exposures that happened at home, highlighting the need for safety initiatives. The preparations most frequently involved were paracetamol/opioid combination products (primarily codeine), 53% (2566) and ibuprofen/opioid combinations 14% (650). Twenty-two percent of cases were referred to a hospital (1062), and a further 15% (719) of calls originated from hospital staff.

CONCLUSION

Opioid exposures in young Australian children continue to occur; however, the rate has declined since 2007. Safe storage and parent education initiatives could further reduce the burden of paediatric opioid poisoning in Australia.

Paediatric poisoning exposures in schools: reports to Australia's largest poisons centre

OBJECTIVE

To describe poisoning exposures occurring at school in a large sample of Australian children.

DESIGN

A population-based retrospective cohort study.

SETTING

Cases reported to the New South Wales Poisons Information Centre (NSWPIC), Australia's largest poisons information centre, taking 50% of the nation's poisoning calls.

PATIENTS

Poisoning exposures occurring in children and adolescents while at school were included, over a 4.5-year period (January 2014 to June 2018).

MAIN OUTCOME MEASURES

Time trends in poisonings, demographics, exposure characteristics, substances involved, disposition.

RESULTS

There were 1751 calls relating to exposures at school made to NSWPIC. Most calls concerned accidental exposures (60.8%, n=1064), followed by deliberate self-poisonings (self-harm, 12.3%, n=216). Over a quarter of cases were hospitalised (n=468), where the call originated from hospital or patients referred to hospital by NSWPIC. Disposition varied by exposure type, and hospitalisation was highest with deliberate self-poisonings (92.6%, n=200), recreational exposures (57.1%, n=12) and other intentional exposures (32.6%, n=45). The median age was 12 (IQR 8-15 years), and 54.7% were male (n=958). The most common pharmaceutical exposures were to paracetamol (n=100), methylphenidate (n=78) and ibuprofen (n=53), with the majority being deliberate self-poisonings. Copper sulfate was responsible for 55 science class cases, 45% of which were hospitalised. Cases may be increasing, with 81.3 (±8.2) calls per quarter, 2014-2016, and 129.3 (±24.3) calls per quarter, 2017-2018.

CONCLUSIONS

Poisoning exposures occurring at school are common, with disposition and substances involved varying considerably by exposure reason. The relatively high number of referrals to hospital highlights the need for investigation into preventative measures.