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Adolescent Drug Ingestions Requiring ICU Stay: Single-Center Retrospective Cohort Study
Lauren Titus1, Matthew Kosasih2, Melodee Liegl3
1Section of Hospital Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
Objectives:
Ingestions are a prevalent form of self-harm in teenagers and are unfortunately an increasingly common reason for admission to both acute care and critical care services. The goal of this study was to identify characteristics associated with requiring PICU stay among adolescents hospitalized for ingestions.
Design:
Retrospective cohort study comparing patients admitted to hospital medicine service and critical care service from January 2019 to December 2019.
Setting:
Freestanding children's hospital in the midwestern United States.
Patients:
Adolescents 12-18 years old hospitalized for ingestion.
Interventions:
None.
Measurements And Main Results:
Out of 209 patients included in the study cohort, 95 required PICU admission. High-risk behaviors (having had sex or usage of alcohol, drugs, tobacco, or vaping) were endorsed by 190 of 209 patients (91%). We compared patient characteristics, ingestion history, workup, and pharmacological and PICU-specific interventions between patients hospitalized on the hospital medicine service and the PICU. We failed to identify an association between reason for ingestion, substance ingested, and previously identified suicide risk factors including previous suicide attempt, previous self-harm, and psychiatric comorbidity and admission to PICU, as opposed to non-PICU admission. PICU stay was associated with longer peak corrected QT interval value, receiving a pharmacological intervention, and longer duration of hospital stay. Fifteen of 95 patients (16% [95% CI, 9-25%]) in the PICU received a PICU-specific intervention.
Conclusions:
We failed to identify specific patient demographics or mental behavioral health characteristics associated with PICU stay after ingestion. Therefore, we believe that all adolescents hospitalized due to ingestion-irrespective of disposition-should receive standardized high-risk behavior screening due to the pervasive nature of these behaviors among this patient population. PICU-specific care, beyond observation, could be needed in as high as one-in-four PICU admissions. Further research is needed to inform optimal disposition and resource allocation for this patient population.
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