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Presentation, Management, and Child Protective Service Reporting of Children Who Test Positive for Cannabis in an
Alexandra Dubinin1, Mario Bialostozky, Andrew Richardson2
1From the University of California, San Diego, CA.
Insights
Pediatric cannabis exposures are rising, complicating emergency care. Ingestion reports reduced unnecessary testing and Child Protective Services involvement for children.
Area of Science:
- Pediatric Emergency Medicine
- Toxicology
- Public Health
Background:
- Increasing rates of cannabis ingestion among young children necessitate understanding exposure circumstances and emergency department (ED) management.
- Limited research exists on factors influencing medical management and Child Protective Services (CPS) reporting in pediatric cannabis exposures.
Purpose of the Study:
- To analyze trends in circumstances leading to pediatric cannabis exposure over time.
- To investigate factors influencing ED management and CPS reporting in cases of pediatric cannabis exposure.
Main Methods:
- Retrospective cross-sectional study of children under 10 years with cannabis-positive urine drug screens in the ED.
- Statistical analysis included single-factor ANOVA and Fisher exact tests for trends.
- Comparison of ED management for children with 'ingestion' chief complaint versus other chief complaints using t tests and Fisher exact tests.
Main Results:
- A significant increase in cannabis-positive pediatric cases was observed over time.
- Primary residence was the most common exposure location (54%), with parents as frequent users (46%).
- Children with 'ingestion' chief complaint received less testing (fewer needle sticks, imaging, lumbar punctures) and were less likely to be reported to CPS compared to those with other chief complaints.
Conclusions:
- Pediatric cannabis exposures are increasing, presenting diverse clinical scenarios that challenge ED management.
- Parental reporting of cannabis ingestion appears to mitigate potentially unnecessary medical testing in the ED.
Objectives:
Rates of cannabis ingestion among young children are increasing. Small studies have evaluated symptomatology of these children. The literature lacks research regarding factors influencing medical management. Our goal was to 1) understand circumstances leading to exposure over time and 2) gain insight into factors that may influence emergency room management and Child Protective Services reporting over time.
Methods:
Retrospective cross-sectional study on children younger than 10 years with cannabis-positive urine drug screens in the emergency room setting. Single-factor analysis of variance and Fisher exact tests were used to assess for trends. Two-tailed t tests and Fisher exact tests were used to compare management of children presenting to the emergency room with chief complaint (CC) "ingestion" versus those without.
Results:
Of the 179 children, the mean age was 3.7 years and 48% were boys. We observed a significant increase over time in cannabis-positive children. The most common location of exposure was the primary residence (54%), with parents as the most frequent users (46%). In the emergency department, the most common CC was ingestion followed by altered mental status and fatigue. Children with an "ingestion" CC were managed with less testing than those with other CCs. They received fewer needle sticks (43% vs 91%), less imaging (5% vs 56% computed tomography heads), and fewer procedures (0% vs 8% lumbar punctures). Children with "ingestion" CC were less likely to be reported to Child Protective Services.
Conclusions:
Pediatric cannabis exposures are increasing and have a wide array of clinical presentations that complicate emergency room management. Parental report of cannabis ingestion seems to impact and reduce potentially unnecessary testing.
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