Drug poisoning in the community among children: a nine years' experience from a tertiary care center in south India

Eight-year epidemiological study for drug poisoning in Qassim, Saudi Arabia, 2008-2015

Literature reported drug poisoning as a major cause for visiting emergency departments, with various rates of occurrences across countries, regions, socioeconomic status, and cultures. Therefore, this study was conducted in Qassim to describe the sociodemographic patterns of acute drug poisoning as well as the most common drugs involved. A retrospective method of data collection was used employing medical record review for drug poisoning cases that occurred in the Qassim region during the 8 years from January 2008 to December 2015. Data was collected using a standardized, validated data collection sheet. The study failed to reveal any pattern (either decreasing or increasing) in the number of poisoning cases over time. Most cases (56.2%) of drug poisoning were accidental, caused by analgesics (35%), affected children younger than 5 years of age (41.4%), and occurred via ingestion (99.2%). It can be concluded that as most poisoning cases affected children, this highlights the importance of increasing awareness and educating families about the safe handling and storage of drugs out of reach of children.

Epidemiology, risk factors, and strategies to prevent and manage poisonings due to pharmaceuticals in children in low income and low-middle income countries: A systematic review

Background

There are significant disparities in the burden of disease due to poisoning between children in low- and high-income countries (HICs). However, there is limited data on the impact of increasing pharmaceutical access in low income countries (LICs) and low-middle income countries (LMICs) on the epidemiology of and risk factors associated with poisoning in children in these settings. Furthermore, while strategies in HICs have effectively reduced the burden of disease due to poisonings in children, there is limited information regarding the efficacy of these interventions in LICs/LMICs.

Methods

We conducted a systematic review in eight databases for literature published between January 2000 to April 2022 to evaluate the epidemiology and risk factors associated with poisonings due to pharmaceuticals and effective strategies to prevent and manage them in children in LICs/LMICs. From 16 061 retrieved articles, 41 were included in the final analysis.

Results

Pharmaceuticals were a common cause of poisoning in children in LICs/LMICs, occurring in between 12.4% and 72.36% of cases. Major risk factors were unsafe medication storage and inadequate caregiver knowledge. Delayed access to care and younger age were associated with increased mortality. Prevention strategies that included education demonstrated improvements in knowledge; however, their impact on incidence and mortality was unclear. Management strategies detailed individual patient care interventions, most commonly gastric lavage and activated charcoal. Meanwhile, delayed presentation, limited provider knowledge, and inadequate laboratory resources to support therapeutic monitoring hindered optimal management.

Conclusions

The combination of educational interventions for prevention, along with regulatory processes to maximise medication storage and formulation safety, could be effective in reducing the burden of poisoning in LICs/LMICs. The development of national or regional protocols for the management of common medication poisonings, augmented by the development of poison control centers and expansion of laboratory access in facilities may help reduce the morbidity and mortality associated with pharmaceutical poisonings in children in LICs/LMICs. Further evidence regarding contextual factors, risk and benefit profiles, the pattern of poisoning, and the impact of preventive and treatment interventions specific to LICs/LMICs is needed to better refine recommendations in these settings.

Registration

PROSPERO: CRD42022315686.

Characteristics of Emergency Department Presentations of Pediatric Poisoning Between 2011 and 2016: A Retrospective Observational Study in South Korea

OBJECTIVES

Pediatric poisoning represents a major preventable cause of morbidity. The epidemiology of pediatric poisoning differs by country and region. This study aimed to characterize pediatric poisoning in South Korea over the last 6 years and to discuss current regulations related to the causative agents involved in pediatric poisoning.

METHODS

Data were obtained for injury presentation in emergency departments (EDs) using the in-depth surveillance system of the Korea Centers for Disease Control and Prevention.

RESULTS

Pediatric poisoning accounted for 1.2% of injury-related ED presentations among children and 2.0% of deaths related to child injury. The annual number of pediatric poisoning-related ED presentations and the number of accidental poisonings have significantly increased over the last 6 years. There was no significant change in the type of causative agent involved in pediatric poisoning, and a therapeutic agent was the most common agent, regardless of the intentionality of pediatric poisoning (39.4% in accidental poisoning; 86.4% in intentional poisoning). Cold medications and cardiovascular drugs were the two most common drug types involved in accidental poisoning, whereas acetaminophen and psychotropics were most commonly involved in intentional poisoning. The case fatality rate of pediatric poisoning was 0.2% over 6 years.

CONCLUSIONS

Over 6 years, the annual number of total poisoning cases and of accidental poisoning cases in particular increased despite a lack of change in the types of causative agents related to pediatric poisoning. This phenomenon may reflect failed preventative measures. Thus, the implementation of tailored preventative measures based on epidemiological data should be accelerated.

Accidental and Deliberate Self-Poisoning with Medications and Medication Errors among Children in Rural Sri Lanka

Context. Pharmaceutical products are the leading cause accidental poisoning in middle- and high-income countries. Patterns of poisoning with medicinal drugs change across different geographic regions and over decades owing to variability in prescription practice, sociocultural factors, safe storage of medicines, and free availability of over the counter medications. Methods. This multicentre descriptive study was conducted over a seven-year period (February 2007 to January 2014) to assess patterns and trends of medicinal drug-related poisoning among children less than 12 years of age in thirty-six hospitals across rural Sri Lanka. Children with both accidental and deliberate medication poisonings and medication errors were recruited to the study. Data on poisoning events and medication errors were gathered via patient/parent interviews using multistructured questionnaires that assessed demographic factors, first aid measures, location and circumstances of poisoning, clinical management, and complications. In addition, focus group discussions were performed on all children and their families who had deliberate poisoning events and medication errors. Results and Conclusions. Among 1621 children presented with acute poisoning over seven years of age, 410 children had acute poisoning with medications. Male children (225, 54.9%) outnumbered female children. Paracetomol (137, 35.6%), salbutamol (55, 14.3%), and chlorpheniramine (35, 9.1%) were the most commonly poisoned medications. Prospective data at Anuradhapura teaching hospital (n = 112) revealed that unsafe first aid measures were practiced on 22 (19.6%) children. Although the majority of children remained asymptomatic (61, 54.5%), neurological symptoms (34, 67%) were predominantly seen in symptomatic children. The majority of poisonings took place within home premises (76, 67.9%). There were 16 reports of medication errors (14.2% of acute poisoning events) either due to erroneous administration by caregivers or erroneous issue of medicines by health workers. The current study did not observe mortality following medication poisonings. This study brings to light the burden of medicinal drug-related poisoning morbidity among children in rural Sri Lanka. Potentially, interventions such as community educational initiatives, written safety warnings, increased use of child resistant containers, and enforcement of laws to bring down accidental medication poisonings need to be implemented, and their effectiveness should be evaluated.