Factors Associated with Major PICU Interventions in Adolescents Hospitalized for Intentional Pharmaceutical Poisoning

Objective: Intentional pharmaceutical poisoning is one of the most common methods of self-harm among adolescents and frequently results in pediatric intensive care unit (PICU) admission because of the potential for severe pharmaceutical-related toxicity. Although mortality is generally low, a subset of patients may require advanced intensive care interventions. Methods: This retrospective observational cohort study was conducted in the pediatric intensive care unit of a tertiary referral hospital between January 2022 and January 2026 and included adolescents admitted to the PICU due to intentional pharmaceutical poisoning. Demographic characteristics, psychiatric history, clinical findings, laboratory parameters, administered treatments, and clinical outcomes were evaluated. The primary outcome measure was defined as the requirement for a major PICU intervention, including invasive or noninvasive mechanical ventilation, vasoactive support, continuous renal replacement therapy (CRRT), therapeutic plasma exchange, extracorporeal membrane oxygenation (ECMO), intensive care-level seizure management, or clinically significant arrhythmia requiring intensive care support. Patients with and without major PICU intervention requirements were compared. Results: A total of 125 adolescent patients were included in the study, and the majority were female. Multiple-pharmaceutical ingestion and a history of psychiatric diagnoses were common comorbidities. Although the clinical course was stable in most patients, 15 patients (12%) required major pediatric intensive care interventions. Patients requiring major interventions had lower Glasgow Coma Scale scores, higher lactate levels, more frequent symptomatic presentation, and higher rates of Poisoning Severity Score (PSS) ≥ 3. Overall mortality in the cohort was low. Conclusions: Although most adolescents admitted to the PICU due to intentional pharmaceutical poisoning experienced mild-to-moderate toxicity, a subgroup required advanced intensive care support. Neurological impairment at presentation, symptomatic clinical presentation, and markers of increased physiologic stress appeared to be associated with more severe clinical courses. In pediatric poisonings, evaluating the need for advanced intensive care support rather than focusing solely on mortality may better reflect clinical severity.