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Emergency department use after pediatric pharmaceutical ingestion: comparison of two national databases

Jennifer Setlik1, Mona Ho, G Randall Bond

  • 1Cincinnati Children's Hospital, Emergency Medicine, Cincinnati, OH, USA. jennifer.setlik@cchmc.org

Clinical Toxicology (Philadelphia, Pa.)
|January 15, 2010
PubMed

Insights

Estimates of pediatric emergency department visits for medication errors vary. The National Poison Data System (NPDS) offers a higher count than the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP), suggesting potential underestimation by both systems.

Area of Science:

  • Public Health
  • Pediatric Emergency Medicine
  • Toxicology

Background:

  • Estimating pediatric emergency department (ED) visits for medication-related injuries is challenging due to the lack of a gold standard.
  • A previous National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) estimate reported 53,517 annual ED visits for unintentional pediatric medication exposure (children ≤4 years) from 2001-2003.

Purpose of the Study:

  • To generate a comparable estimate of pediatric medication exposures resulting in ED visits using the American Association of Poison Control Centers' (AAPCC) National Poison Data System (NPDS).
  • To compare the NPDS estimates with the existing NEISS-AIP estimates for unintentional pediatric medication exposures.

Main Methods:

  • The NPDS database was queried for electronic medical records of children aged 4 years or younger.
  • Data included unintentional pharmaceutical exposures requiring presentation to a health care facility (HCF) between 2001 and 2003.
  • Criteria were aligned with those used in the NEISS-AIP study for direct comparison.

Main Results:

  • The NPDS identified 178,513 cases (57,100 in 2001, 60,098 in 2002, 61,315 in 2003) meeting the criteria.
  • Hospitalization rates were 13% for NPDS versus 10% for NEISS-AIP.
  • The most common substances involved were acetaminophen, cough/cold preparations, and cardiovascular drugs, with similar distributions between the two databases.

Conclusions:

  • The NPDS estimate is higher than the NEISS-AIP estimate but falls within the 95% confidence interval, suggesting the actual number of ED visits is likely close to both figures.
  • As NPDS represents an actual count and NEISS-AIP an extrapolation, both may underestimate the true public health burden of pediatric medication exposures.
  • The NEISS-AIP extrapolation methodology may require re-evaluation to improve accuracy.
Abstract

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