Unintentional Pediatric Marijuana Exposures at a Tertiary Care Children's Hospital in Washington State: A Retrospective Review.

BACKGROUND: Recreational marijuana became commercially available in Washington State in 2014. Children with marijuana intoxication can have lethargy and altered mental status, often resulting in extensive workup. OBJECTIVES: The aim of this study was to quantify the incidence of pediatric marijuana exposure before and after marijuana legalization/commercial availability in Washington State at a tertiary care children's hospital. METHODS: Charts of patients 9 years or younger evaluated at a tertiary care pediatric hospital from October 8, 2007, to October 31, 2016, were retrospectively reviewed. Inclusion criteria were positive tetrahydrocannabinol urine toxicology screen and diagnosis consistent with unintentional marijuana exposure. Data included age, sex, exposure date range, symptoms, ancillary tests, consults, disposition, and marijuana source. Data were analyzed in R using descriptive statistics. RESULTS: Seventeen unintentional marijuana exposures were identified during our study period, 8 cases before and 9 cases after legalization of recreational marijuana, which is 1.19 events per year in the 6.75 years before legalization compared with 3.88 events per year in the 2.32 years after (P < 0.05). Age range was 17 months to 7 years, with a median age of 21 months. Eighty-two percent received laboratory tests, 47% underwent head computed tomography, 6% underwent lumbar puncture, and 100% underwent social work evaluation. Thirty-five percent were discharged from the emergency department, 47% were admitted to general medicine, and 18% were admitted to the critical care unit. CONCLUSIONS: Unintentional marijuana exposure incidence increased after legalization of recreational marijuana in Washington State at a tertiary care children's hospital. Providers should be aware of this increasing incidence. These data should be considered in the drafting of future marijuana legislation.

Evacuation of Vulnerable and Critical Patients: Multimodal Simulation for Nurse-Led Patient Evacuation.

INTRODUCTION: Virtual simulation (VS) is an adaptable medium for teaching critical disaster management skills such as efficient hospital evacuation. We aimed to compare VS and prerecorded narrated multimedia lecture-based training of pediatric nurses for evacuation of a sick newborn in the neonatal intensive care unit and pediatric emergency department (ED) using live evacuation simulations. METHODS: Thirty neonatal intensive care unit and 30 ED nurses enrolled with 30 randomized to multimedia lecture and 30 randomized to VS, with equal block distribution of nurses from each unit. Pretraining/posttraining surveys were administered, and live evacuation simulations were scored for time to evacuation, items collected, and communication. RESULTS: Overall, disaster preparation and communication improved within the VS group as compared with the multimedia lecture group. Virtual simulation rated more immersive (P < 0.001), better at safety threat identification (P < 0.05), and better at evacuation preparation compared with multimedia lecture (P < 0.01). Virtual simulation participants felt more prepared in disaster response (P < 0.001) and patient evacuation (P < 0.001). Both groups packed equal essential items, but VS participants packed more equipment (mean, 19 vs. 15, P < 0.01) with no significant evacuation time difference between the VS group (145 ± 58 seconds) and multimedia lecture group (152 ± 59 seconds, P = not significant). Virtual simulation participants had better communication ratings with the charge nurse (P < 0.05) and family (P < 0.001). CONCLUSIONS: Virtual simulation was well received by nurses compared with multimedia lecture and may be an effective adjunct for training nurses on infant patient evacuation during a disaster.