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Medical Toxicology Consultations and Mortality Among Patients With Poisonings in the PICU

Paul M Wax1,2, Rachel E Culbreth1, Jeffrey Brent3,4

  • 1American College of Medical Toxicology, Phoenix, Arizona.

JAMA Network Open
|February 28, 2025
PubMed

Insights

Medical toxicology consultations significantly reduce mortality and length of stay in pediatric intensive care units (PICUs) for poisoned children. These consultations offer life-saving interventions, especially in severe poisoning cases.

Area of Science:

  • Pediatric critical care medicine
  • Medical toxicology
  • Public health

Background:

  • Poisonings are a major cause of preventable child mortality and morbidity.
  • Pediatric intensive care units (PICUs) manage complex pediatric poisoning cases.
  • Medical toxicologists are specialized physicians for poisoning treatment, but not universally available.

Purpose of the Study:

  • To evaluate the impact of medical toxicology consultations on mortality and length of stay for pediatric patients with toxicological exposures.

Main Methods:

  • Secondary analysis of a cross-sectional registry (Virtual Pediatric System) of PICU admissions from 135 US sites (January 2019 - June 2023).
  • Included patients with toxicological exposures admitted to participating PICUs.
  • Used multilevel models to assess associations between medical toxicology consultations and outcomes, adjusting for covariates.

Main Results:

  • Medical toxicology consultations were associated with a 64% lower odds of death in the PICU and a 61% lower odds of overall hospitalization mortality.
  • Consultations were linked to a 15% reduction in PICU length of stay and a 10% reduction in overall hospital length of stay.
  • Patients receiving consultations had similar baseline mortality risk compared to those without.

Conclusions:

  • Medical toxicology consultations are associated with significantly lower mortality and shorter lengths of stay for pediatric patients with toxicological exposures.
  • These findings suggest that medical toxicology consultations can provide life-saving treatment and improve outcomes in severe pediatric poisoning cases.
  • Increased availability of medical toxicology expertise in PICUs may enhance patient care and reduce preventable deaths.
Abstract

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