A demographic comparison and characterization of pediatric poisoning before and after the emergence of COVID-19.

BACKGROUND: To compare relative rates of pediatric poisoning before and after COVID-19, including by demographic and urban-rural status, and by agent identified, using data from one university healthcare system and children's hospital. METHODS: Using retrospective, cross sectional design from deidentified healthcare claims data, we extracted all encounters with the ICD-10-CM for Poisoning by, Adverse effects of, and Underdosing of drugs, medicants and biological substances (T36-T50) and grouped the encounters as those after state mandates regulating activity came into effect (Post-COVID-19 (3/17/2020-3/18/2021)) Pre-COVID-19 (3/18/2019-3/17/2020). We then compared poisoning agent, age at the time of the encounter, recorded sex, race, ethnicity, rural/urban residence, and visit type using Mann-Whitney U test, chi-square test of association, incidence rates and incident rate ratios between the time periods. FINDINGS: The sample included 1608 unique patients 0-17 years of age and 4216 encounters. We also identified IRRs >1 in nearly every demographic subgroup with the exception of Non-Hispanic Blacks. The comparison of specific drugs or medicants identified a significant decrease in poisoning by Systemic antibiotics (T36); but an increase in Hormones and their synthetic substitutes and antagonists (T38), Non opioid analgesics antipyretic and antirheumatic (T39), Psychotropic Drugs (T39) and Systemic and hematologic agents (T45). CONCLUSION: This study identifies pediatric subgroups highly affected by pediatric poisoning during the time-period immediately after the identification of COVID-19 and characterizes the drugs commonly associated with poisonings. APPLICATION TO PRACTICE: With a further understanding nursing has the potential to impact pediatric poisoning in the inpatient, outpatient and public health setting.

Increased rates of suicide ideation and attempts in rural dwellers following the SARS-CoV-2 pandemic.

PURPOSE: Those factors identified to increase the risk of suicide in rural dwellers were exacerbated by the SARS-CoV-2 pandemic, specifically economic factors, substance use, access to health care, and access to lethal weapons. Because the effects of SARS-CoV-2 on suicide ideation and attempts in rural populations have not been fully characterized in published literature, this study compares: (1) the rates of suicide ideation and attempts between the 6 months affected by SARS-CoV-2 to same months of the preceding year (3/18/2020-9/18/20; 3/18/2019-9/18/19), (2) demographics (ie, age, sex, residence, race, and ethnicity), and (3) the locations in which the encounters were billed (inpatient, outpatient, and emergency department). METHODS: Deidentified claims data associated with patient encounters billed for Suicide Ideation and Suicide Attempt were grouped based on time period and analyzed using descriptive statistics, incidence rate ratio (IRR), 2-sample t-test, chi-square test of association, or Fisher's exact test. FINDINGS: Suicidal ideation encounters increased in the 6 months post-SARS-CoV-2 when compared to the 6 months of the prior year (IRR = 1.19; P < .001). Males (IRR = 1.27, P < .001), those residing rural areas (IRR = 1.22, P = .01), and Black, non-Hispanic (IRR = 1.24, P = .024) were found to have increased rates of suicide ideation post-SARS-Cov-2. In adults, White, non-Hispanics (IRR = 1.16; P < .001) had increased rates of post-SARS-CoV-2. In the pediatric subset, those who were aged 14-17 (IRR = 1.50; P < .001), resided in rural areas (IRR = 1.61, P = .009), and idenitifed as Hispanic (IRR = 1.89; P = .037) or Black, non-Hispanic (IRR = 1.61, P = .009) had increased rates post-SARS-CoV-2. CONCLUSIONS: Our study identified rural dwellers to be at increased risk for suicide ideation.

Color vision disturbances secondary to oral tranexamic acid.

Tranexamic acid (TXA) is an antifibrinolytic commonly used to reduce blood loss due to surgical procedures, heavy menstruation, trauma, bleeding disorders, among other uses. Possible adverse reactions associated with TXA include abdominal pain, headache, fatigue, cerebral thrombosis, dizziness, retinal artery occlusion, chromatopsia, and more. We present a case of acute color vision disturbance developed soon after initiation of oral TXA for epistaxis prophylaxis in the setting of factor VII deficiency. To our knowledge we report the only case of color vision disturbance in a pediatric patient and the only case after receiving oral TXA. Soon after discontinuing oral TXA the patient's altered perception of color vision resolved. The patient was subsequently discharged home with a prescription for an alternative antifibrinolytic (aminocaproic acid) and follow-up with neuro-ophthalmology.

A comparison of child abuse and neglect encounters before and after school closings due to SARS-Cov-2.

BACKGROUND: Risk factors for child abuse and neglect and commonly used reporting mechanisms were highly affected by SARS-Cov-2 pandemic; yet, little is known about the effects of SARS-Cov-2 on rates of child abuse and neglect. OBJECTIVE: To compare overall rates, demographics, types of abuse and acuity of child abuse and neglect encounters seen at one university health system for the 6 months before and after school closings due to the SARS-Cov-2 pandemic. PARTICIPANTS AND SETTING: Data was extracted from a database of billed ICD10 codes for child abuse and neglect including sexual abuse codes. There were 579 encounters for patients <18 years of age and 476 unique patients. METHODS: In addition to ICD10 code and pre/post school closing, each encounter was identified to be inpatient, outpatient and/or emergency department. Demographic data such as age, gender, ethnicity, and race were extracted. Incident rate ratios in addition to descriptive statistics, Mann-Whitney U test, two-sample t-test, or the chi-square test of association were used in the analysis. RESULTS: No significant differences were identified for total rates of child abuse and neglect encounters (p = .08), physical abuse (p = .91) nor child maltreatment (p = .86) codes or in the age (p = .46), gender (p = .58), and race/ethnicity (p = .15) of patient encounters pre- versus post-school closings. The sexual abuse incidence and inpatient encounters increased by 85% (IRR = 1.85, p < .0001; IRR = 1.85, p = .004, respectively). CONCLUSIONS: Our findings provide a unique contribution to the existing literature in that we identified a significant increase in the incidence of sexual abuse and higher patient acuity as evidenced by higher rates of inpatient encounters after school closing due to SARS-Cov-2.