Trends of prescription psychotropic medication exposures in pediatric patients, 2009-2018.

BACKGROUND: Mental health disorders and related suicide attempts are increasing in both the adult and pediatric patient populations. Because of the increasing prevalence of mental health disorders, there is increased use of psychotropic medications in adult and pediatric patients, which can pose a risk for potentially adverse pediatric ingestions. The objective was to determine trends and outcomes for pediatric psychotropic medication ingestions reported to the American Association of Poison Control Centers (AAPCC) National Poison Data System (NPDS). METHODS: This was a retrospective review of pediatric (≤18 years of age) exposures reported to AAPCC NPDS between January 1, 2009 and December 31, 2018. Single psychotropic medication ingestions of atypical antipsychotics, bupropion, buspirone, clonidine, lithium, methylphenidate, mirtazapine, monoamine oxidase inhibitors (MAOIs), selective norepinephrine reuptake inhibitors (SNRIs), selective serotonin reuptake inhibitors (SSRIs), trazodone, and tricyclic antidepressants (TCAs) were examined. RESULTS: Over the 10-year study period, 356,548 pediatric psychotropic medication ingestions were reported to NPDS. SSRI ingestions were the most frequently reported (34%), followed by atypical antipsychotics (17%), and methylphenidate (15%). Unintentional ingestions were most prominent in patients 0-12 years of age (79%), whereas, in patients age 13-18 years, 76% were intentional. SSRI ingestions were asymptomatic in 68% of cases. Clonidine and bupropion ingestions had the highest proportion of moderate and major clinical effects (29 and 25%, respectively). There were 29 deaths: atypical antipsychotics (n = 4), bupropion (n = 10), lithium (n = 1), SNRI (n = 1), SSRIs (n = 7), and TCAs (n = 6); 19 (65%) were in adolescent patients. CONCLUSIONS: SSRIs were the most frequently reported ingestion, while bupropion and clonidine were associated with a high percentage of moderate and major clinical effects. This study demonstrates opportunities for targeted prevention strategies to prevent potentially adverse pediatric ingestions to psychotropic medications.

Use of both Fab and F(ab')2 fragment antivenom in a pediatric patient for treatment of a North American Crotalidae envenomation.

Crotalidae envenomation has been managed successfully in emergency departments across the world with antivenom. Over the years, antivenom has evolved and newer agents have been studied with the possibility of eliminating maintenance antivenom therapy. Here we report a patient who had worsening platelet and fibrinogen concentrations, as well as complaints of swelling and pain at the site of a rattlesnake envenomation following an initial dose of F(ab')2AV (Crotalidae immune F(ab')2 (equine) [ANAVIP®]) Crotalidae antivenom. The patient was subsequently transferred to a tertiary children's hospital for a higher level of care and received FabAV (Crotalidae polyvalent immune Fab (ovine) [CroFab®]) Crotalidae antivenom. The details of this patient's treatment course highlight the possibility that patients who receive F(ab')2AV, may require additional antivenom treatment. Furthermore, it appears that based on our single patient experience, giving FabAV after F(ab')2AV is safe and effective.

Establishment of a Medication Acuity Scoring Tool at a Tertiary Pediatric Teaching Hospital: A 2-Phase Process.

BACKGROUND: Currently, there is no validated objective rating system to address the acuity of medication orders that pharmacists review. OBJECTIVE: The objective was to assess the acuity of a given medication through creating and validating an acuity scoring tool. METHODS: Phase I included the development of the medication acuity scoring tool (MAST) from national safety standards and clinical experience. A survey was administered to pharmacists nationwide to establish a consensus on the individual components of the tool and their associated weighted scores. Phase II was designed to assess MAST's predictive validity by comparing a medication acuity rating generated by MAST to a rating assigned based upon clinical experience of experts. Additionally, in phase II, interrater and intrarater reliability of MAST was evaluated. RESULTS: In phase I, most of MAST's components and their associated scores achieved >75% agreement for inclusion in the final tool. In phase II, without MAST, approximately 50% of pharmacist-assigned acuity ratings were statistically consistent with tool-generated acuity ratings, and there was fair agreement between respondents (k=0.31). With the use of MAST, agreement in acuity ratings improved to substantial (k=0.69), and intrarater reliability was almost perfect (k=0.88). CONCLUSION: MAST is a validated rating system that captures the acuity of medications.