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Epidemiologic Trends In Children With Toxicologic Exposures Requiring Intensive Care Before and During the COVID-19
Kaitlin Hughes1, Adam Overberg2, Kennedi Satterfield3
1Department of Pharmacy (KH), Riley Hospital for Children, Indianapolis, IN.
Insights
Pediatric poison exposures leading to pediatric intensive care unit (PICU) admissions more than doubled during the COVID-19 pandemic. This highlights the pandemic's impact on children's access to and exposure to poisons.
Area of Science:
- Toxicology
- Pediatric Critical Care
- Epidemiology
Background:
- Pediatric poison exposures frequently necessitate admission to the pediatric intensive care unit (PICU).
- Understanding trends in pediatric poison exposures and outcomes is crucial for public health initiatives.
Purpose of the Study:
- To compare pediatric poison exposure trends and patient outcomes between the pre-COVID-19 period (2018-2019) and the COVID-19 pandemic period (2020-2021).
Main Methods:
- Retrospective cohort study of patients aged 18 years or younger with suspected toxicologic exposure from January 2018 to March 2021.
- Primary endpoint: rate of PICU admissions.
- Secondary endpoints: medical outcome severity, PICU length of stay, and mechanical ventilation requirements.
Main Results:
- A total of 340 patients were included; no significant differences in age, sex, or race between cohorts.
- PICU admissions for poison exposures were significantly higher during the COVID-19 cohort (8.4%) compared to the pre-COVID-19 cohort (3.7%).
- The COVID-19 cohort experienced more extreme medical outcomes, including no effect or death.
Conclusions:
- Poisoning-related PICU admissions more than doubled during the COVID-19 pandemic compared to pre-pandemic rates.
- The findings suggest a significant impact of the COVID-19 pandemic on pediatric poison exposure and access to care.
Objective:
Pediatric poison exposures are a common reason for pediatric intensive care unit (PICU) -admission. The purpose of this study was to examine the exposure trends and patient outcomes in 2018-2019 compared with 2020-2021 amidst the COVID-19 pandemic.
Methods:
This was a retrospective cohort study of patients 18 years of age or younger with a suspected toxicologic exposure from January 2018 to March 2021. The primary endpoint was rate of PICU admissions between the 2 cohorts. Secondary endpoints included medical outcome stratified by severity, PICU length of stay, and need for mechanical ventilation.
Results:
Our study included a total of 340 patients with median age 14.5 (IQR, 11.9-16.1) years. There was no significant difference in age, sex, or race between the 2 cohorts. The percentage of patients admitted to the PICU for poison exposures was significantly higher in the COVID-19 cohort compared with the pre-COVID-19 cohort (8.4% vs 3.7%, p < 0.01). Severity of medical outcomes differed between the groups; the COVID-19 cohort had more extreme clinical presentations of no effect or death (p < 0.01). No significant difference was found among the remaining secondary outcomes. Classes of substances ingested were comparable with baseline poison center data.
Conclusions:
Poisoning-related PICU admissions occurred at more than twice the pre-pandemic rate. This may emphasize the effect of the COVID-19 pandemic on pediatric access and exposure to poisons.
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