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Predictors of severe outcome following opioid intoxication in children
Neta Cohen1,2, Mathew Mathew1,2, Adrienne Davis1,2
1Division of Paediatric Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada.
Insights
Children exposed to fentanyl or aged 10 years or older face higher risks of severe outcomes from opioid intoxication. These key risk factors, including intensive care unit admission or death, should guide prevention strategies for pediatric opioid poisonings.
Area of Science:
- Toxicology
- Pediatric Emergency Medicine
- Public Health
Background:
- The opioid crisis significantly impacts public health, with increasing pediatric opioid intoxications.
- Limited data exists on risk factors for severe outcomes in children experiencing opioid intoxication.
Purpose of the Study:
- To identify predictors of severe outcomes in pediatric patients presenting with opioid intoxication.
- To explore factors associated with intensive care unit (ICU) admission or in-hospital death.
Main Methods:
- Prospective cohort study involving 165 children (0-18 years) across multiple medical centers.
- Data collected on demographics, clinical characteristics, exposure, and outcomes.
- Multivariable logistic regression analysis to determine independent predictors of severe outcome.
Main Results:
- Over half (53.9%) of pediatric opioid intoxications resulted in severe outcomes (ICU admission or death).
- Fentanyl exposure was independently associated with a 3.6-fold increased odds of severe outcome.
- Age 10 years or older was independently associated with a 2.5-fold increased odds of severe outcome.
Conclusions:
- Fentanyl exposure and older age (≥10 years) are significant predictors of severe outcomes in pediatric opioid intoxication.
- Targeting these risk factors is crucial for developing effective prevention strategies.
- Findings highlight the need for focused interventions to reduce pediatric morbidity and mortality from opioid poisonings.
Introduction:
While the opioid crisis has claimed the lives of nearly 500,000 in the U.S. over the past two decades, and pediatric cases of opioid intoxications are increasing, only sparse data exist regarding risk factors for severe outcome in children following an opioid intoxication. We explore predictors of severe outcome (i.e., intensive care unit [ICU] admission or in-hospital death) in children who presented to the Emergency Department with an opioid intoxication.
Methods:
In this prospective cohort study we collected data on all children (0-18 years) who presented with an opioid intoxication to the 50 medical centers in the US and two international centers affiliated with the Toxicology Investigators Consortium (ToxIC) of the American College of Medical Toxicology, from August 2017 through June 2020, and who received a bedside consultation by a medical toxicologist. We collected relevant demographic, clinical, management, disposition, and outcome data, and we conducted a multivariable logistic regression analysis to explore predictors of severe outcome. The primary outcome was a composite severe outcome endpoint, defined as ICU admission or in-hospital death. Covariates included sociodemographic, exposure and clinical characteristics.
Results:
Of the 165 (87 females, 52.7%) children with an opioid intoxication, 89 (53.9%) were admitted to ICU or died during hospitalization, and 76 did not meet these criteria. Seventy-four (44.8%) children were exposed to opioids prescribed to family members. Fentanyl exposure (adjusted OR [aOR] = 3.6, 95% CI: 1.0-11.6; p = 0.03) and age ≥10 years (aOR = 2.5, 95% CI: 1.2-4.8; p = 0.01) were independent predictors of severe outcome.
Conclusions:
Children with an opioid toxicity that have been exposed to fentanyl and those aged ≥10 years had 3.6 and 2.5 higher odds of ICU admission or death, respectively, than those without these characteristics. Prevention efforts should target these risk factors to mitigate poor outcomes in children with an opioid intoxication.
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