1
|
Farah R, Kerns AF, Murray AC, Holstege CP. Psilocybin Exposures Reported to U.S. Poison Centers: National Trends Over a Decade. J Adolesc Health 2024; 74:1053-1056. [PMID: 38416101 DOI: 10.1016/j.jadohealth.2024.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/01/2024] [Accepted: 01/17/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE We describe trends in psilocybin exposures among adolescents and young adults as reported to US poison centers over the past decade. METHODS We queried the National Poison Data System for cases involving psilocybin during January 1, 2013-December 31, 2022. Persons aged 13-25 years were included. We examined exposures to psilocybin by demographics, clinical effects, level of care, and medical outcome. RESULTS During the 10-year study period, 4,055 psilocybin-involved exposures were reported among adolescents and young adults, 2,667 (65.8%) being single substance exposures. Most single substance cases received medical attention (adolescents: 75.3% [n = 1,176], young adults: 72.1% [n = 797]). We did not find significant change in the number of cases during 2013-2018. Cases started increasing in 2019. In 2022, cases more than tripled among adolescents and more than doubled among young adults, compared to 2018 (p < .0001). DISCUSSION Continued national surveillance is critical to determine the impact of psilocybin exposures on youth as it becomes increasingly available.
Collapse
Affiliation(s)
- Rita Farah
- Division of Medical Toxicology, Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, Virginia.
| | - Abigail F Kerns
- Division of Medical Toxicology, Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Austin C Murray
- University of Virginia, School of Medicine, Charlottesville, Virginia
| | - Christopher P Holstege
- Division of Medical Toxicology, Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
| |
Collapse
|
2
|
Farah R, Cole RJ, Holstege CP. Increasing severity of medical outcomes and associated substances in cases reported to United States poison centers. Clin Toxicol (Phila) 2024:1-8. [PMID: 38634480 DOI: 10.1080/15563650.2024.2337897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/27/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Poison centers provide free expert recommendations on the treatment of a wide variety of toxicological emergencies. Prior studies have called attention to the increasing complexity of cases reported to poison centers. We aimed first, to evaluate the trends in medical outcome severity, over a 15-year period in both the adult and pediatric populations. Second, we described the most frequently reported substances associated with major effect or death. METHODS This is a retrospective review of exposures reported to the National Poison Data System from 1 January 2007 through 31 December 2021. All closed cases, for human exposures, reported during the study period were included. We assessed trends in frequencies and rates of medical outcomes and level of care received, among the adult (age greater than 19 years) and pediatric (age 19 years and younger) populations by reason for exposure. RESULTS During the study period, the number of adult unintentional exposures resulting in major effect (37.4 percent) and death (65.3 percent) increased. The number of adult intentional exposures resulting in death increased by 233.9 percent and those resulting in a major effect increased by 133.1 percent. The rates of exposures resulting in major effect and death increased among both intentional and unintentional adult exposures. The number of pediatric unintentional exposures resulting in a major effect increased by 76.6 percent and the number of pediatric intentional exposures resulting in death and major effect increased by 122.7 and 190.1 percent, respectively. Moderate, major effect, and death rates increased in pediatric unintentional exposures and moderate and major effect rates increased in pediatric intentional exposures. CONCLUSIONS We found a worsening severity of medical outcomes in adult and pediatric cases reported to poison centers. Poison centers are increasingly managing complex cases. Monitoring trends in which substances are associated with severe outcomes is imperative for future strategic prevention efforts.
Collapse
Affiliation(s)
- Rita Farah
- Division of Medical Toxicology, Department of Emergency Medicine, University of VA, Charlottesville, VA, USA
| | - Ryan J Cole
- Division of Medical Toxicology, Department of Emergency Medicine, University of VA, Charlottesville, VA, USA
| | - Christopher P Holstege
- Division of Medical Toxicology, Department of Emergency Medicine, University of VA, Charlottesville, VA, USA
| |
Collapse
|
3
|
Mowry JB. Forty years of National Poison Data System Annual Reports. Clin Toxicol (Phila) 2023; 61:713-716. [PMID: 38084514 DOI: 10.1080/15563650.2023.2286200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023]
Abstract
INTRODUCTION The 40th National Poison Data System Annual Report from America's Poison Centers is published in this issue of Clinical Toxicology. This Commentary will focus on changes that have occurred over the years and emerging trends while highlighting some of the strengths and weaknesses of the system. FORTY YEARS OF NATIONAL POISON DATA SYSTEM ANNUAL REPORTS The National Poison Data System now receives poison exposure data from all 50 states and territories of the United States, representing all levels of care and medical outcomes, and is collected in near real-time. The 2022 report is double in size from the 1983 report and shows changes in the distribution of exposure substances and at least a doubling in the percentage of calls from a health care facility, intentional exposures, and fatalities. There was also a more modest increase in cases managed in a health care facility, and a 40% drop in the percentage of cases managed in those under age 6. While total reported poison center cases have been decreasing since 2008, cases with more serious medical outcomes have steadily increased. To address the decline in the total number of less serious cases, an online tool was initiated for consumers to obtain simple individualized poisoning recommendations as an alternative to directly contacting a poison center. FENTANYL EXPOSURES AND TISSUE CONCENTRATIONS Fentanyl exposures reported to the National Poison Data System have increased rapidly since 2019, driven by non-prescription fentanyl. Reporting of this was facilitated by the granularity of the generic coding schema and the ability to develop new generic codes rapidly, unlike some other national data sets. Total fentanyl exposures and those with more serious outcomes show a good correlation with national data on fentanyl deaths, demonstrating the ability of the National Poison Data System to function as a surveillance tool. Fentanyl concentrations reported to the National Poison Data System Fatality module showed antemortem concentrations to be slightly lower than postmortem concentrations, little difference between postmortem peripheral and central concentrations, and single substance concentrations slightly higher than cases with multiple substances. STRENGTHS AND WEAKNESSES Strengths include the breadth of the database, granularity, contemporaneous data collection, near-real-time data submission allowing for automated toxicosurveillance activities, ability to rapidly activate emergency product codes for emerging situations, a robust web-based query tool, mapping of generic codes and clinical effects to other data dictionaries, and review by toxicologists of fatalities to assign a relative contribution. Weaknesses include voluntarily reported, non-verified exposures, interpreting reported medical outcomes (non-toxic and fatalities), lag-time in collecting data on new therapeutic modalities, and mortality data varying from that reported by other sources. CONCLUSION Poison center data gives a robust, reproducible image of the populations that utilize poison center resources and seems to mirror trends noted from other data sources. This supports the continued need for poison centers in the information age to support the management of patients potentially exposed to poisons and those who are more severely poisoned.
Collapse
Affiliation(s)
- James B Mowry
- Indiana University Health - Indiana Poison Center, Indianapolis, IN, USA
| |
Collapse
|
4
|
Mehrpour O, Hoyte C, Nakhaee S, Megarbane B, Goss F. Using a decision tree algorithm to distinguish between repeated supra-therapeutic and acute acetaminophen exposures. BMC Med Inform Decis Mak 2023; 23:102. [PMID: 37264381 DOI: 10.1186/s12911-023-02188-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/04/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND This study aimed to compare clinical and laboratory characteristics of supra-therapeutic (RSTI) and acute acetaminophen exposures using a predictive decision tree (DT) algorithm. METHODS We conducted a retrospective cohort study using the National Poison Data System (NPDS). All patients with RSTI acetaminophen exposure (n = 4,522) between January 2012 and December 2017 were included. Additionally, 4,522 randomly selected acute acetaminophen ingestion cases were included. After that, the DT machine learning algorithm was applied to differentiate acute acetaminophen exposure from supratherapeutic exposures. RESULTS The DT model had accuracy, precision, recall, and F1-scores of 0.75, respectively. Age was the most relevant variable in predicting the type of acetaminophen exposure, whether RSTI or acute. Serum aminotransferase concentrations, abdominal pain, drowsiness/lethargy, and nausea/vomiting were the other most important factors distinguishing between RST and acute acetaminophen exposure. CONCLUSION DT models can potentially aid in distinguishing between acute and RSTI of acetaminophen. Further validation is needed to assess the clinical utility of this model.
Collapse
Affiliation(s)
- Omid Mehrpour
- Michigan Poison & Drug Information Center, Wayne State University School of Medicine, Detroit, MI, USA.
| | | | - Samaneh Nakhaee
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences (BUMS), Birjand, Iran
| | - Bruno Megarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS, University of Paris, Paris, 1144, France
| | - Foster Goss
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| |
Collapse
|
5
|
Mehrpour O, Saeedi F, Nakhaee S, Tavakkoli Khomeini F, Hadianfar A, Amirabadizadeh A, Hoyte C. Comparison of decision tree with common machine learning models for prediction of biguanide and sulfonylurea poisoning in the United States: an analysis of the National Poison Data System. BMC Med Inform Decis Mak 2023; 23:60. [PMID: 37024869 PMCID: PMC10080923 DOI: 10.1186/s12911-022-02095-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 12/26/2022] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Biguanides and sulfonylurea are two classes of anti-diabetic medications that have commonly been prescribed all around the world. Diagnosis of biguanide and sulfonylurea exposures is based on history taking and physical examination; thus, physicians might misdiagnose these two different clinical settings. We aimed to conduct a study to develop a model based on decision tree analysis to help physicians better diagnose these poisoning cases. METHODS The National Poison Data System was used for this six-year retrospective cohort study.The decision tree model, common machine learning models multi layers perceptron, stochastic gradient descent (SGD), Adaboosting classiefier, linear support vector machine and ensembling methods including bagging, voting and stacking methods were used. The confusion matrix, precision, recall, specificity, f1-score, and accuracy were reported to evaluate the model's performance. RESULTS Of 6183 participants, 3336 patients (54.0%) were identified as biguanides exposures, and the remaining were those with sulfonylureas exposures. The decision tree model showed that the most important clinical findings defining biguanide and sulfonylurea exposures were hypoglycemia, abdominal pain, acidosis, diaphoresis, tremor, vomiting, diarrhea, age, and reasons for exposure. The specificity, precision, recall, f1-score, and accuracy of all models were greater than 86%, 89%, 88%, and 88%, respectively. The lowest values belong to SGD model. The decision tree model has a sensitivity (recall) of 93.3%, specificity of 92.8%, precision of 93.4%, f1_score of 93.3%, and accuracy of 93.3%. CONCLUSION Our results indicated that machine learning methods including decision tree and ensembling methods provide a precise prediction model to diagnose biguanides and sulfonylureas exposure.
Collapse
Affiliation(s)
- Omid Mehrpour
- Data Science Institute, Southern Methodist University, Dallas, TX, USA.
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran.
| | - Farhad Saeedi
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | - Samaneh Nakhaee
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
| | | | - Ali Hadianfar
- Department of Epidemiology and Biostatistics, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Amirabadizadeh
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | |
Collapse
|
6
|
Mehrpour O, Hoyte C, Delva-Clark H, Al Masud A, Biswas A, Schimmel J, Nakhaee S, Goss F. Classification of acute poisoning exposures with machine learning models derived from the National Poison Data System ( NPDS). Basic Clin Pharmacol Toxicol 2022; 131:566-574. [PMID: 36181236 DOI: 10.1111/bcpt.13800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 09/10/2022] [Accepted: 09/22/2022] [Indexed: 11/29/2022]
Abstract
The primary aim of this pilot study was to develop a machine learning algorithm to predict and distinguish eight poisoning agents based on clinical symptoms. Data were used from the National Poison Data System from 2014 to 2018, for patients 0-89 years old with single-agent exposure to 8 drugs or drug classes (acetaminophen, aspirin, benzodiazepines, bupropion, calcium channel blockers, diphenhydramine, lithium, and sulfonylureas). Four classifier prediction models were applied to the data: Logistic regression, LightGBM, XGBoost, and CatBoost. There were 201031 cases used to develop and test the algorithms. Among the four models, accuracy ranged 77-80%, with precision and F1 scores of 76-80%, and recall of 77-78%. Overall specificity was 92% for all models. Accuracy was highest for identifying sulfonylureas, acetaminophen, benzodiazepines, and diphenhydramine poisoning. F1 scores were highest for correctly classifying sulfonylureas, acetaminophen, and benzodiazepine poisonings. Recall was highest for sulfonylureas, acetaminophen, and benzodiazepines, and lowest for bupropion. Specificity was >99% for models of sulfonylureas, calcium channel blockers, lithium, and aspirin. For single-agent poisoning cases among the eight possible exposures, machine learning models based on clinical signs and symptoms moderately predicted the causal agent. CatBoost and LightGBM classifier models had the highest performance of those tested.
Collapse
Affiliation(s)
- Omid Mehrpour
- Data Science Institute, Southern Methodist University, Dallas, TX, USA
| | - Christopher Hoyte
- Data Science Institute, Southern Methodist University, Dallas, TX, USA.,Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | | | | | - Ashis Biswas
- Department of Computer Science and Engineering, University of Colorado Denver, CO, USA
| | - Jonathan Schimmel
- Department of Emergency Medicine, Division of Medical Toxicology, Mount Sinai Hospital Icahn School of Medicine, New York, NY, USA
| | - Samaneh Nakhaee
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences (BUMS), Birjand, Iran
| | - Foster Goss
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| |
Collapse
|
7
|
Laudone TW, Leonard JB, Hines EQ, Seung H, Klein-Schwartz W. Changes in unintentional cannabis exposures in children 6 months to 5 years reported to United States poison centers during the first nine months of the coronavirus-19 pandemic. Clin Toxicol (Phila) 2022; 60:1029-1031. [PMID: 35471155 DOI: 10.1080/15563650.2022.2064867] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Almost half of exposures reported to United States (US) poison centers are exploratory ingestions in children under the age of 5 years. Pediatric cannabis exposures reported to US poison centers have risen over the last twenty years, with greater increases in the last 5 years. In 2020, the Coronavirus disease 2019 (COVID-19) pandemic resulted in widespread stay-at-home orders and subsequent changes in work, education, and daycare. This study describes the changes in pediatric cannabis exposures during the first nine months of the COVID-19 pandemic relative to the three years before the pandemic. METHODS Cases were identified from the National Poison Data System. Inclusion criteria was unintentional cannabis exposure in children aged 6 months to 5 years between January 1, 2017 and December 31, 2020. Analysis was performed with segmented regression of interrupted time series analysis comparing January 2017-March 2020 (pre-COVID-19) to April 2020-December 2020 (COVID-19 period). Autocorrelation was assessed using Dubin-Watson test. RESULTS There were 7,679 unintentional pediatric exposures from January 1, 2017 through December 31, 2020. There was a significant increase of 3.1% per month during the pre-COVID-19 period (p < .0001). A statistically significant immediate increase in number of exposures per month occurred in April 2020 (58.4%; p < .0001). The slope in the COVID-19 period was -0.01% (p = .99). No autocorrelation was detected. DISCUSSION AND CONCLUSIONS Unintentional cannabis exposures in children aged 6 months to 5 years reported to United States poison centers increased significantly after the initial COVID-19 stay-at-home orders. This trend may be associated with COVID-19 quarantines, increased time children are spending at home, increased availability of cannabis products in homes, or other reasons. Future efforts should evaluate specific factors that resulted in the observed increases in pediatric exposures.
Collapse
Affiliation(s)
- Thomas W Laudone
- Deparment of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA.,Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD, USA
| | - James B Leonard
- Maryland Poison Center, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Elizabeth Quaal Hines
- Maryland Poison Center, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA.,Department of Pediatric Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Hyunuk Seung
- Deparment of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Wendy Klein-Schwartz
- Maryland Poison Center, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA
| |
Collapse
|
8
|
Leonard JB, Laudone T, Hines EQ, Klein-Schwartz W. Critical care interventions in children aged 6 months to 12 years admitted to the pediatric intensive care unit after unintentional cannabis exposures. Clin Toxicol (Phila) 2022; 60:960-965. [PMID: 35384771 DOI: 10.1080/15563650.2022.2059497] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Cannabis exposures in children have risen sharply in recent years, resulting in increased hospital visits and admission to pediatric intensive care units (PICUs). The intent of this study was to describe the proportion of pediatric patients admitted to the PICU after unintentional cannabis ingestion that received critical care interventions (CCIs) along with describing trends over time in hospitalization, admission to the PICU, and clinical effects and treatments outside of the PICU. METHODS This was a retrospective database study utilizing the National Poison Data System (NPDS) from 1/1/2000 to 12/31/2020. Children 6 months to 12 years of age with single substance cannabis exposures were included. RESULTS A total of 12,882 cases were included. There was an increase in the proportion of cases seen in a hospital over time from 43.8% in 2000 to 54.6% in 2020 (range 29.1-62.6%). In patients seen in a HCF, the proportion admitted to the PICU was 9.5% in 2000 and 14% in 2020 (range: 5.6-29.0%). The 875 (6.8%) children admitted to the PICU were analyzed for the primary outcome. CCIs were performed in 69/875 (7.9%) cases that were admitted to the PICU. The most common CCIs in the PICU were intubation and sedation, 4.9 and 3.7%, respectively. CONCLUSIONS Unintentional pediatric cannabis exposures are associated with clinically significant effects, including respiratory depression, hypotension, and bradycardia, but fewer than 5% of exposures were treated with CCIs, like intubation or vasopressors, in patients admitted to the PICU. Further work should assess specific reasons for admission to the PICU.
Collapse
Affiliation(s)
- James B Leonard
- Department of Pharmacy Practice and Science, Maryland Poison Center, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Thomas Laudone
- Deparment of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA.,Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD, USA
| | - Elizabeth Quaal Hines
- Department of Pharmacy Practice and Science, Maryland Poison Center, University of Maryland School of Pharmacy, Baltimore, MD, USA.,Department of Pediatric Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Wendy Klein-Schwartz
- Department of Pharmacy Practice and Science, Maryland Poison Center, University of Maryland School of Pharmacy, Baltimore, MD, USA
| |
Collapse
|
9
|
Toce MS, Hudgins JD, Yuskaitis CJ, Monuteaux MC, Bourgeois FT. National assessment of anti-epileptic drug exposures among pre-teens and adolescents, 2000-2020. Clin Toxicol (Phila) 2022; 60:681-687. [PMID: 35025708 DOI: 10.1080/15563650.2021.2023747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND OBJECTIVES Anti-epileptic drugs (AEDs) are increasingly used to treat psychiatric conditions, exposing many children to potentially harmful medications. This includes adolescents, who are at higher risk for self-harm. The purpose of this study was to describe the epidemiology of pediatric AED poisonings and assess which AEDs are associated with more severe clinical outcomes. METHODS This retrospective cross-sectional analysis examined single-substance AED exposure cases in pre-teens (10-14 years) and adolescents (15-19 years) reported to the National Poison Database System (NPDS) between 2000 and 2020 (cases through 2019 were included for trend analysis due to incomplete population data). We described characteristics of ingestions by age group, including AEDs implicated. RESULTS There were 74,818 AED exposure cases reported to the NPDS, including 25,928 (34.7%) in pre-teens and 48,890 (65.3%) in adolescents. Among adolescents, 35,570 (72.8%) exposure cases were intentional, with 27,655 (56.6%) specifically related to a suspected suicide attempt. The most common AEDs implicated in poisonings were clonazepam (19.8%), valproic acid (15.3%), and lamotrigine (13.8%). The odds of hospitalization (adjusted odds ratio [aOR] 2.0 [95% confidence interval [CI], 2.0-2.1]), intubation (aOR 2.1 [95% CI, 1.8-2.4]), seizure (aOR 1.6 [95% CI, 1.4-1.9]), and serious outcome (aOR 1.8 [95% CI, 1.7-1.9]) were higher in the adolescent group compared to the pre-teen group. Intentional ingestions increased by a yearly rate of 2.8% (95% CI, 2.3-3.2). Intentional tiagabine exposure was associated with the greatest increased odds of serious outcome (aOR 4.7 [95% CI, 3.6-6.3]). DISCUSSION In this cross-sectional analysis of pediatric AED exposure cases reported to the NPDS, AED poisonings among pre-teens and adolescents increased significantly between 2000 and 2019. Of particular concern is the large increase in intentional exposure cases related to AEDs. With the population-adjusted rate of epilepsy diagnoses remaining relatively unchanged, these results may indicate that the rise in AED exposure cases may be related to increased prescribing of AEDs for psychiatric indications as opposed to epilepsy. CONCLUSIONS Pediatric AED poisonings reported to the NPDS are increasing, especially among adolescents engaging in intentional ingestions. These findings provide additional information for consideration in risk-benefit assessments when selecting medications for the treatment of psychiatric conditions in children.
Collapse
Affiliation(s)
- Michael S Toce
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA.,Harvard Medical Toxicology Program, Boston Children's Hospital, Boston, MA, USA
| | - Joel D Hudgins
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Christopher J Yuskaitis
- Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Boston, MA, USA.,Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Michael C Monuteaux
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Florence T Bourgeois
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA.,Pediatric Therapeutics and Regulatory Science Initiative, Computational Health Informatics Program (CHIP), Boston Children's Hospital, Boston, MA, USA
| |
Collapse
|
10
|
Spyker DA, Bronstein AC, Weber JA. Making US poison centers a part of the solution to the COVID-19 pandemic. Clin Toxicol (Phila) 2021; 60:102-114. [PMID: 34448649 DOI: 10.1080/15563650.2021.1933510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Our six goals are: 1) describe the relationship between the National Strategy for the COVID-19 Response and Pandemic Preparedness and the 55 US poison centers (PCs); 2) detail FDA emergency Use Authorization (EUA) COVID-19 vaccine-related regulatory procedures and associated acronyms; 3) list availability of specific vaccine clinical information to support PC staff COVID-19 vaccination and adverse event (AE) data collection; 4) describe required health care practitioner COVID-19 vaccine AE reporting to the Vaccine AE Reporting System (VAERS) and PC reporting options; 5) document public and health care professionals' use of PCs for COVID-19 vaccine information; and 6) propose strategy to maximize PCs contribution to the pandemic solution. METHODS We reviewed 13-Feb-2020 through 15-Apr-2021 National Poison Data System (NPDS) COVID-19 records for changes over time. We examined NPDS cases and VAERS COVID-19 vaccine reports 1-Nov-2020 through 2-Apr-2021 for vaccine manufacturer, patient characteristics, state, and clinical effects. RESULTS PCs reported 1,052,174 COVID-19 contacts; maximum (peak) contacts/day (12,163) on 16-Mar-2020. As of 5-Apr-2021 the US reported >167 million administrations of COVID-19 vaccines (Pfizer-BioNTech, Moderna or Janssen). US PCs reported 162,052 COVID-19 vaccine contacts. Most (61.1%) were medical information calls, 34.9% were drug information, and 2.58% were exposures. Over the same period VAERS reported 49,078 COVID-19 vaccine cases reporting 226,205 symptoms - headache most frequent, ranging from 20% to 40% across the 3 vaccines. CONCLUSIONS AND RECOMMENDATIONS Although differences exist between the intent and content of the 2 data sets, NPDS volume is compelling. The PC nationwide 800 number facilitates data collection and suggests comingling the 2 data streams has merit. PC professionals received tens of thousands of calls and can: 1) support fact-based vaccine information; 2) contribute vaccine AE follow-up information: 3) advocate for best-case coding and reporting, especially for vaccine adverse experiences.
Collapse
Affiliation(s)
- Daniel A Spyker
- Adjunct Assistant Professor of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Alvin C Bronstein
- Emergency Medical Services, Injury Prevention System Branch, Hawaii Department of Health, Honolulu, HI, USA
| | - Julie A Weber
- Missouri Poison Center, SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| |
Collapse
|
11
|
Abstract
OBJECTIVE Opioid-related deaths are a leading cause of accidental deaths in the United States (U.S.). This study aims to examine the national trends in opioid exposures reported to U.S. poison centers (PCs). METHODS The National Poison Data System (NPDS) was queried for opioid exposures between 2011 and 2018. We descriptively assessed the demographic and clinical characteristics. Trends in opioid frequencies and rates were analyzed using Poisson regression. Independent predictors of serious adverse events in opioid exposures were studied. RESULTS There were a total of 604,183 opioid exposure calls made to the PCs during the study period. The frequency of opioid exposures decreased by 28.9% (95% CI: -29.6%, -28.1%; p < 0.001), and the rate of opioid exposures decreased by 21.2% (95% CI: -24.7%, -16.9%; p < 0.001). Multiple substance exposures accounted for 48.9% cases. The most frequent age group was 20-29 years (19.3%). Suspected suicides accounted for 34.9% cases. There were 7,246 deaths in our study sample, with 6.8% of cases demonstrating major effects. Hydrocodone was the most frequently observed opioid causing a toxic exposure and naloxone was used in 20.6% cases. Important predictors of a serious adverse event were age, gender, multi-substance exposures, and reasons for exposure. CONCLUSIONS Analysis of calls to PCs indicated a decreasing trend of opioid exposures. However, the proportion of SAEs due to such exposures increased. There was a high proportion of intentional exposures and occurred in older age groups. PCs are a vital component of real-time public health surveillance of overdoses in the current opioid crisis.
Collapse
Affiliation(s)
- Saumitra V Rege
- Division of Medical Toxicology, Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Moira Smith
- Division of Medical Toxicology, Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Heather A Borek
- Division of Medical Toxicology, Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Christopher P Holstege
- Division of Medical Toxicology, Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| |
Collapse
|
12
|
Rege SV, Ngo DA, Ait-Daoud N, Rizer J, Sharma S, Holstege CP. Epidemiology of pediatric buprenorphine and methadone exposures reported to the poison centers. Ann Epidemiol 2020; 42:50-57.e2. [PMID: 31992493 DOI: 10.1016/j.annepidem.2019.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 10/24/2019] [Accepted: 12/30/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Buprenorphine prescriptions have increased dramatically within the United States, whereas methadone continues to be used widely. We investigated the trends and characteristics of buprenorphine and methadone exposures in the pediatric population. METHODS We identified pediatric exposures to buprenorphine and methadone using the National Poison Data System from 2013 to 2016. We descriptively assessed characteristics of the exposures. Trends in exposures were evaluated using generalized linear mixed models. RESULTS Pediatric buprenorphine exposures increased from 2013 (1097) to 2016 (1226) while methadone calls decreased (486 to 396). After adjusting for the random effects of the geographical region, the mean number of pediatric buprenorphine exposures (per 100,000 pediatric population) increased from 1.3 to 1.5 (P = .05). Conversely, the mean number of methadone exposures decreased from 0.6 to 0.4 (P = .03). Children aged ≤3 years constituted the highest percentage of both exposures. Unintentional exposures accounted for most of the buprenorphine (86.9%) and methadone (62.4%) exposures. Major clinical effects were demonstrated in 2.3% of buprenorphine exposures and were more frequent with methadone (13%). West Virginia and Maryland demonstrated the highest incidence of buprenorphine and methadone exposures, respectively. CONCLUSIONS Pediatric buprenorphine exposures increased but demonstrated less severe effects compared to methadone exposures, which decreased during the study period.
Collapse
|
13
|
Rege SV, Ngo DA, Ait-Daoud N, Sharma S, Verplancken E, Holstege CP. Trends and characteristics of naloxone therapy reported to US poison centers. Addiction 2018; 113:2309-2315. [PMID: 29989286 DOI: 10.1111/add.14378] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/24/2018] [Accepted: 07/04/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS In the United States, access to naloxone has been expanded as a measure to address growing opioid overdose mortality. The study aimed to describe the national trends in naloxone use as reported to the US poison centers (PCs). METHODS The National Poison Data System (NPDS) was queried for cases reporting naloxone therapy from 1 January 2001 to 31 December 2016. Demographic and clinical characteristics were assessed descriptively. Trends in naloxone reports were evaluated by using generalized linear mixed models that were adjusted for age, gender and random effects of the geographical census region. Cumulative incidence rates (CIR) of naloxone reports at the state- and national-level were calculated. RESULTS There were 304 249 cases reporting naloxone therapy during the study period. The frequency of naloxone reports increased from 9498 in 2000 to 26 826 in 2016. The proportion of cases where naloxone was used prior to PC recommendation increased from 59.8% in 2000 to 81.5% in 2016. The mean number of NPDS naloxone reports per 100 000 human exposures increased from 9.6 [95% confidence interval (CI) = 6.4-14.2] to 31.7 (95% CI = 21.4-46.9, P < 0.001). Among the cases, 52.4% were female and the most frequent age group was 20-39 years (39.1%). The principal reason for a toxic exposure resulting in a naloxone report was suspected suicide (55.0%). Life-threatening symptoms were seen in one-fifth of the cases, with 53.9% cases being admitted to critical care units. Opioids (59.7% cases), were the most commonly reported exposure agents, with hydrocodone being most frequently reported. The national CIR of naloxone reports to the US PCs was 6.3 cases per 100 000 population, with West Virginia demonstrating the highest incidence. CONCLUSIONS Analysis of calls to the United States poison centers indicates an increasing trend of naloxone use from 2000 to 2016.
Collapse
Affiliation(s)
- Saumitra V Rege
- Department of Emergency Medicine, Division of Medical Toxicology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Duc Anh Ngo
- Department of Emergency Medicine, Division of Medical Toxicology, University of Virginia School of Medicine, Charlottesville, VA, USA.,Department of Student Health, Division of Student Affairs, University of Virginia, Charlottesville, VA, USA
| | - Nassima Ait-Daoud
- Department of Student Health, Division of Student Affairs, University of Virginia, Charlottesville, VA, USA.,Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Sana Sharma
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Evan Verplancken
- Department of Emergency Medicine, Division of Medical Toxicology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Christopher P Holstege
- Department of Emergency Medicine, Division of Medical Toxicology, University of Virginia School of Medicine, Charlottesville, VA, USA.,Department of Student Health, Division of Student Affairs, University of Virginia, Charlottesville, VA, USA
| |
Collapse
|
14
|
Rakowsky S, Spiller HA, Casavant MJ, Chounthirath T, Hodges NL, Kim EH, Smith GA. Antipyretic Medication Exposures Among Young Children Reported to US Poison Centers, 2000-2015. Clin Pediatr (Phila) 2018; 57:266-276. [PMID: 28952373 DOI: 10.1177/0009922817698124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study used the National Poison Data System database to retrospectively analyze the characteristics and medical outcomes of exposures to antipyretic medications involving children younger than 6 years in the United States. From 2000 through 2015, United States Poison Control Centers recorded an average of 74 387 antipyretic exposures annually among children younger than 6 years. Most exposures involved ibuprofen (55.1%) or acetaminophen (40.1%). From 2000 to 2009, the number of exposures increased by 73.0%, followed by a 25.2% decrease from 2009 to 2015. Children exposed to acetaminophen had 1.98 times higher odds of a serious medical outcome compared with those exposed to ibuprofen. Although generally safe at the correct dosage, antipyretic exposures continue to cause pediatric morbidity and, in rare cases, death. Prevention efforts should focus on reducing child access; educating caregivers about the potential dangers of antipyretics; and discouraging their use, except when needed to improve a child's comfort.
Collapse
Affiliation(s)
- Sofia Rakowsky
- 1 Center for Injury Research and Policy at Nationwide Children's Hospital, Columbus, OH, USA.,2 University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Henry A Spiller
- 3 Central Ohio Poison Center, Nationwide Children's Hospital, Columbus, OH, USA.,4 The Ohio State University College of Medicine, Columbus, OH, USA
| | - Marcel J Casavant
- 1 Center for Injury Research and Policy at Nationwide Children's Hospital, Columbus, OH, USA.,3 Central Ohio Poison Center, Nationwide Children's Hospital, Columbus, OH, USA.,4 The Ohio State University College of Medicine, Columbus, OH, USA
| | - Thiphalak Chounthirath
- 1 Center for Injury Research and Policy at Nationwide Children's Hospital, Columbus, OH, USA
| | - Nichole L Hodges
- 1 Center for Injury Research and Policy at Nationwide Children's Hospital, Columbus, OH, USA
| | - Eun Hye Kim
- 1 Center for Injury Research and Policy at Nationwide Children's Hospital, Columbus, OH, USA.,4 The Ohio State University College of Medicine, Columbus, OH, USA
| | - Gary A Smith
- 1 Center for Injury Research and Policy at Nationwide Children's Hospital, Columbus, OH, USA.,4 The Ohio State University College of Medicine, Columbus, OH, USA.,5 Child Injury Prevention Alliance, Columbus, OH, USA
| |
Collapse
|
15
|
Hodges NL, Spiller HA, Casavant MJ, Chounthirath T, Smith GA. Non-health care facility medication errors resulting in serious medical outcomes. Clin Toxicol (Phila) 2017; 56:43-50. [PMID: 28691871 DOI: 10.1080/15563650.2017.1337908] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The objective of this study is to provide an epidemiologic analysis of medication errors occurring outside of health care facilities that result in serious medical outcomes (defined by the National Poison Database System as "moderate effect," "major effect," "death," or "death, indirect report"). METHODS National Poison Database System data from 2000 through 2012 were used for this retrospective analysis of non-health care facility medication errors. RESULTS From 2000 through 2012, Poison Control Centers in the United States received data on 67,603 exposures related to unintentional therapeutic pharmaceutical errors that occurred outside of health care facilities that resulted in serious medical outcomes. The overall average rate of these medication errors was 1.73 per 100,000 population, and there was a 100.0% rate increase during the 13-year study period. Medication error frequency and rates increased for all age groups except children younger than 6 years of age. Medical outcome was most commonly reported as moderate effect (93.5%), followed by major effect (5.8%) and death (0.6%). Common types of medication errors included incorrect dose, taking or administering the wrong medication, and inadvertently taking the medication twice. The medication categories most frequently associated with serious outcomes were cardiovascular drugs (20.6%) (primarily beta blockers, calcium antagonists, and clonidine), analgesics (12.0%) (most often opioids and acetaminophen, alone and combination products), and hormones/hormone antagonists (11.0%) (in particular, insulin, and sulfonylurea). CONCLUSIONS This study analyzed non-health care facility medication errors resulting in serious medical outcomes. The rate of non-health care facility medication errors resulting in serious medical outcomes is increasing, and additional efforts are needed to prevent these errors.
Collapse
Affiliation(s)
- Nichole L Hodges
- a Center for Injury Research and Policy at The Research Institute of Nationwide Children's Hospital , Columbus , OH , USA
| | - Henry A Spiller
- b Central Ohio Poison Center , Columbus , OH , USA.,c The Ohio State University College of Medicine , Columbus , OH , USA
| | - Marcel J Casavant
- a Center for Injury Research and Policy at The Research Institute of Nationwide Children's Hospital , Columbus , OH , USA.,b Central Ohio Poison Center , Columbus , OH , USA.,c The Ohio State University College of Medicine , Columbus , OH , USA
| | - Thiphalak Chounthirath
- a Center for Injury Research and Policy at The Research Institute of Nationwide Children's Hospital , Columbus , OH , USA
| | - Gary A Smith
- a Center for Injury Research and Policy at The Research Institute of Nationwide Children's Hospital , Columbus , OH , USA.,c The Ohio State University College of Medicine , Columbus , OH , USA.,d Child Injury Prevention Alliance , Columbus , OH , USA
| |
Collapse
|
16
|
Abstract
OBJECTIVE Laundry detergent pods are a new product in the US marketplace. This study investigates the epidemiologic characteristics and outcomes of laundry detergent pod exposures among young children in the United States. METHODS Using data from the National Poison Data System, exposures to laundry detergent pods among children younger than 6 years of age during 2012-2013 were investigated. RESULTS There were 17 230 children younger than 6 years exposed to laundry detergent pods in 2012-2013. From March 2012 to April 2013, the monthly number of exposures increased by 645.3%, followed by a 25.1% decrease from April to December 2013. Children younger than 3 years accounted for 73.5% of cases. The major route of exposure was ingestion, accounting for 79.7% of cases. Among exposed children, 4.4% were hospitalized and 7.5% experienced a moderate or major medical outcome. A spectrum of clinical effects from minor to serious was seen with ingestion and ocular exposures. There were 102 patients (0.6%) exposed to a detergent pod via ingestion, aspiration, or a combination of routes, including ingestion, who required tracheal intubation. There was 1 confirmed death. CONCLUSIONS Laundry detergent pods pose a serious poisoning risk to young children. This nationwide study underscores the need for increased efforts to prevent exposure of young children to these products, which may include improvements in product packaging and labeling, development of a voluntary product safety standard, and public education. Product constituent reformulation is another potential strategy to mitigate the severity of clinical effects of laundry detergent pod exposure.
Collapse
Affiliation(s)
- Amanda L Valdez
- Center for Injury Research and Policy at Nationwide Children's Hospital, Columbus, Ohio; University of Washington School of Medicine, Seattle, Washington
| | - Marcel J Casavant
- Central Ohio Poison Center, Columbus, Ohio; The Ohio State University College of Medicine, Columbus, Ohio; and
| | - Henry A Spiller
- Central Ohio Poison Center, Columbus, Ohio; The Ohio State University College of Medicine, Columbus, Ohio; and
| | | | - Huiyun Xiang
- Center for Injury Research and Policy at Nationwide Children's Hospital, Columbus, Ohio; The Ohio State University College of Medicine, Columbus, Ohio; and
| | - Gary A Smith
- Center for Injury Research and Policy at Nationwide Children's Hospital, Columbus, Ohio; The Ohio State University College of Medicine, Columbus, Ohio; and Child Injury Prevention Alliance, Columbus, Ohio
| |
Collapse
|
17
|
Smith MD, Spiller HA, Casavant MJ, Chounthirath T, Brophy TJ, Xiang H. Out-of-hospital medication errors among young children in the United States, 2002-2012. Pediatrics 2014; 134:867-76. [PMID: 25332497 DOI: 10.1542/peds.2014-0309] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To investigate out-of-hospital medication errors among young children in the United States. METHODS Using data from the National Poison Database System, a retrospective analysis of out-of-hospital medication errors among children <6 years old from 2002 through 2012 was conducted. RESULTS During 2002-2012, 696,937 children <6 years experienced out-of-hospital medication errors, averaging 63,358 episodes per year, or 1 child every 8 minutes. The average annual rate of medication errors was 26.42 per 10,000 population. Cough and cold medication errors decreased significantly, whereas the number (42.9% increase) and rate (37.2% increase) of all other medication errors rose significantly during the 11-year study period. The number and rate of medication error events decreased with increasing child age, with children <1 year accounting for 25.2% of episodes. Analgesics (25.2%) were most commonly involved in medication errors, followed by cough and cold preparations (24.6%). Ingestion accounted for 96.2% of events, and 27.0% of medication errors were attributed to inadvertently taking or being given medication twice. Most (93.5%) cases were managed outside of a health care facility; 4.4% were treated and released from a health care facility; 0.4% were admitted to a non-critical care unit; 0.3% were admitted to a critical care unit; and 25 children died. CONCLUSIONS This is the first comprehensive study to evaluate the epidemiologic characteristics of out-of-hospital medication errors among children <6 years of age on a national level. Increased efforts are needed to prevent medication errors, especially those involving non-cough and cold preparations, among young children.
Collapse
Affiliation(s)
- Maxwell D Smith
- Center for Injury Research and Policy at Nationwide Children's Hospital, Columbus, Ohio
| | - Henry A Spiller
- Central Ohio Poison Center, Columbus, Ohio; and The Ohio State University College of Medicine, Columbus, Ohio
| | - Marcel J Casavant
- Central Ohio Poison Center, Columbus, Ohio; and The Ohio State University College of Medicine, Columbus, Ohio
| | | | - Todd J Brophy
- Center for Injury Research and Policy at Nationwide Children's Hospital, Columbus, Ohio; The Ohio State University College of Medicine, Columbus, Ohio
| | - Huiyun Xiang
- Center for Injury Research and Policy at Nationwide Children's Hospital, Columbus, Ohio; The Ohio State University College of Medicine, Columbus, Ohio
| |
Collapse
|
18
|
Wang GS, Le Lait MC, Heard K. Unintentional pediatric exposures to central alpha-2 agonists reported to the National Poison Data System. J Pediatr 2014; 164:149-52. [PMID: 24094880 DOI: 10.1016/j.jpeds.2013.08.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 06/18/2013] [Accepted: 08/20/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate national trends in unintentional pediatric exposures to 3 common alpha-2 agonists: clonidine, guanfacine, and tizanidine. Secondary objectives were to describe outcomes, symptoms, treatments, and death. STUDY DESIGN Retrospective chart review from the American Association of Poison Control Centers National Poison Data System from January 2000 to December 2011 for unintentional exposure to clonidine, guanfacine, and tizanidine in children ≤ 12 years of age. RESULTS From 2000-2011, there was a significant increase (5.9% per year, CI 3.6, 8.2) in unintentional pediatric exposures to National Poison Data System for central alpha-2 agonists. There were 27,825 clonidine exposures (67.3% male, median age: 4 years), 6143 guanfacine exposures (69.8% male, median age: 6 years), and 856 tizanidine exposures (51.9% male, median age: 2 years). Guanfacine had the greatest proportional increase among the medications. Clonidine was associated with the most respiratory (799, 2.9%) and central nervous system symptoms (12,612, 45.3%), as well as the most episodes of bradycardia (2847, 10.2%) and hypotension (2365, 8.5%). Seven-hundred twenty-eight (2.0%) patients were intubated, and 141 patients (0.5%) were administered vasopressors. There were 7 cardiac arrests and 3 deaths from clonidine. CONCLUSIONS The number of unintentional pediatric exposures to alpha-2 agonists increased from 2000-2011. Clonidine exposures were the most commonly reported, more symptomatic, and associated with 3 deaths. Despite central nervous system depression, bradycardia, and hypotension being common, the need for intubation and vasopressors was rare.
Collapse
Affiliation(s)
- George Sam Wang
- Rocky Mountain Poison and Drug Center, Denver Health, Denver, CO.
| | | | - Kennon Heard
- Rocky Mountain Poison and Drug Center, Denver Health, Denver, CO
| |
Collapse
|
19
|
Mazer-Amirshahi M, Reid N, van den Anker J, Litovitz T. Effect of cough and cold medication restriction and label changes on pediatric ingestions reported to United States poison centers. J Pediatr 2013; 163:1372-6. [PMID: 23769500 DOI: 10.1016/j.jpeds.2013.04.054] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 04/05/2013] [Accepted: 04/25/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine the impact of industry and Food and Drug Administration initiatives implemented to limit the use of over-the-counter (OTC) cough and cold medications in children younger than 6 years of age. STUDY DESIGN This is a retrospective database study of OTC cough and cold medication ingestions reported to US poison centers between 2000 and 2010. Data analyzed from the National Poison Data System included the month and year of ingestion, reason for ingestion, health care utilization, and medical outcome. Ingestion frequencies were stratified by age and reason. Data were divided into pre- and postintervention periods for comparative analysis. RESULTS Unintentional ingestions of OTC cough and cold medications decreased 33.4% and therapeutic errors by 46.0%. Health care facility referral declined for unintentional ingestions (28.9% <2 years of age, 19.9% 2-5 years of age, P < .0001) and therapeutic errors in children younger than 2 years of age (59.2%, P < .0001). Moderate and severe adverse outcomes decreased for unintentional ingestions in children younger than 2 years of age by 32.4% and by 21.3% in 2- to 5-year olds, P < .0001. CONCLUSIONS The restriction of OTC cough and cold medications has led to a decline in unintentional ingestions, therapeutic errors, health care facility referral, and serious medical outcomes in children younger than 2 years of age. There has also been a decline in ingestions in 2- to 5-year-old children.
Collapse
Affiliation(s)
- Maryann Mazer-Amirshahi
- Department of Emergency Medicine, The George Washington University, Washington, DC; Department of Clinical Pharmacology, Children's National Medical Center, Washington, DC; National Capital Poison Center, Washington, DC.
| | | | | | | |
Collapse
|
20
|
Abstract
OBJECTIVE To generate national estimates of hydrocarbon-related exposures occurring in children ≤5 years of age who were treated in US emergency departments or called a regional poison control center. METHODS This retrospective review compared hydrocarbon-related injuries that occurred from January 1, 2000, through December 31, 2009, that were reported to the National Poison Data System and the National Electronic Injury Surveillance System for children ≤5 years of age. RESULTS From 2000 through 2009, the National Poison Data System reported 65 756 actual calls to regional poison centers, and the National Electronic Injury Surveillance System reported an estimated 40 158 emergency department visits for hydrocarbon-related injuries. Individuals involved were predominantly male and 1 to 2 years of age. Ingestion was the most common mechanism of injury, and most injuries did not result in hospitalization. The rate of emergency department visits and calls to poison centers decreased significantly (P < .0001) over the 10-year study period. Exposures to hydrocarbons demonstrated seasonal variation, with more occurrences in the summer months. CONCLUSIONS The comparison of the two data sets illustrates a similar trend in hydrocarbon-related injuries in children. Although cases have declined, most likely due to existing prevention efforts, hydrocarbons are still a large source of preventable exposure and injury in children.
Collapse
Affiliation(s)
- Heath A Jolliff
- Central Ohio Poison Center, Nationwide Children’s Hospital,Columbus, OH, USA.
| | | | | | | | | |
Collapse
|