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Pediatric Exposures Reported to the Toxicology Investigators Consortium, 2010-2015
Neil M Desai1, Rakesh D Mistry, Lina Brou2
1From the Section of Pediatric Emergency Medicine, British Columbia Children's Hospital, Vancouver, BC, Canada.
Insights
Pediatric toxicology consultations increased significantly from 2010 to 2015, with analgesics being the most common exposure. Understanding these trends is crucial for effective hospital preparedness and treatment strategies.
Area of Science:
- Medical Toxicology
- Pediatric Emergency Medicine
- Public Health Surveillance
Background:
- Poisoning is a leading cause of fatal injuries in children.
- Effective hospital and provider readiness relies on accurate data of pediatric poisoning patterns and treatments.
- Surveillance data is essential for age-specific clinical exposure and therapeutic modality understanding.
Purpose of the Study:
- To characterize trends in clinically significant pediatric toxic exposures.
- To analyze the management and therapeutic modalities employed for these exposures.
- To inform hospital-level planning and provider education.
Main Methods:
- Retrospective review of the Toxicology Investigators Consortium (ToxIC) Registry.
- Analysis of pediatric cases (18 years or younger) from January 1, 2010, to December 31, 2015.
- Inclusion of data on demographics, exposure details, survival, and treatments like antidotes and decontamination.
Main Results:
- A notable increase in pediatric toxicology consultations from 2010 to 2015 (23.7% to 29.9%).
- Adolescents and females comprised the majority of exposures, with intentional ingestions being most common.
- Analgesics were the most frequent exposure agent; N-acetylcysteine was the most used antidote. Geographic variations in exposures and treatments were observed.
Conclusions:
- Toxicology consultations for pediatric exposures have risen substantially.
- Identifying key pediatric exposures, common therapies, and geographic patterns is vital.
- This understanding supports facility planning, pharmacy stocking, and enhanced provider education.
Background And Objective:
Poisoning is the leading cause of injury death in pediatric patients. Hospital and provider readiness, including pharmacy stocking, depends on reliable surveillance data describing local patterns of age-specific clinically significant exposures and the therapeutic modalities employed in their treatment. We aimed to characterize trends in clinically significant toxic exposures and their management.
Methods:
We performed a retrospective review of patients 18 years or younger in the American College of Medical Toxicology's Toxicology Investigators Consortium (ToxIC) Registry, a self-reporting database completed by bedside consulting medical toxicologists. We reviewed cases from January 1, 2010, through December 31, 2015. In 2015, ToxIC included 101 health care facilities. Data collected included demographics, geographic region, encounter and exposure details, survival, and therapeutic modalities employed, including antidotes, antivenoms, gastric decontamination, enhanced elimination, hyperbaric oxygen therapy, and extracorporeal membrane oxygenation.
Results:
From 2010 to 2015, 11,616 consults were recorded in ToxIC. Pediatric consultations increased from 934 (23.7%) in 2010 to 2425 (29.9%) in 2015 (P < 0.001). Exposures were most commonly reported in females (57.8%) and adolescents (59.4%). Intentional ingestions (55.5%) comprised the majority of cases. The most frequent agents of exposure were analgesics (21.0%). There were 38 deaths reported (0.9%). The antidote used most commonly was N-acetylcysteine (11.0%). Geographic variation was demonstrated in prevalence of envenomations and heavy metal exposures, their respective treatments, and overall use of decontamination.
Conclusions:
Toxicology consultations for pediatric exposures increased from 2010 to 2015. Understanding which pediatric exposures require toxicologist management, the therapies most frequently employed, and geographical patterns is paramount to facility-level planning, pharmacy stocking, and provider education.
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