Toxic Exposures in Children: A Review of Emergency Department Transfers to a Tertiary Pediatric Hospital

Pediatric poisonings are a common emergency department (ED) presentation. In some instances, the first hospital may not have the capability to manage a pediatric patient beyond initial stabilization, requiring transfer to a tertiary children's hospital. This study aims to describe the clinical characteristics and outcomes of pediatric transfers following various xenobiotic exposures.

We performed a retrospective analysis of patients ≤18 years transferred to a tertiary children's hospital for any intentional or unintentional xenobiotic exposure between July 1, 2021 and June 30, 2023. An electronic data query was performed using specific keywords, and then, medical record reviews were conducted by a team of emergency medicine physicians and medical toxicologists. Information regarding exposure, interventions, and disposition was collected.

A total of 544 patients were identified, and 167 were included in this analysis. The median age was 15 years (IQR: 5, 17). Of the 167 patients, 134 (80.2%) were admitted to the children's hospital. Acetaminophen was the most common exposure (n = 37, 22.2%), followed by polysubstance (n = 24, 14.3%) and tetrahydrocannabinol (n = 13, 7.8%). Intravenous normal saline bolus was the most common initial intervention. Forty-eight (28.8%) patients were directly admitted from the first ED, and 119 patients were ED to ED transfers. Of those, 86 (72.3%) patients were ultimately admitted from the second ED to an inpatient unit.

Most transferred patients were admitted, making these transfers clinically indicated and an appropriate use of resources. When comparing characteristics of admitted versus discharged patients, no clear difference beyond age was noted.