Epidemiology of acute pediatric poisonings in Spain: a prospective multicenter study from the Spanish Society of Pediatric Emergency Medicine.

OBJECTIVE: To identify types of childhood poisoning exposures leading to consultation to emergency departments (ED) in Spain. METHODS: We carried out a multicenter prospective registry-based cohort study including children with acute poisonings presenting to 55 pediatric EDs of the Spanish Society of Pediatric Emergency Medicine between 2008 and 2017, during previously designated certain days. RESULTS: During the study period, we registered 749 803 pediatric ED presentations, of which 1749 were for poisonings (0.23%). Most commonly involved toxicants were therapeutic drugs (845, 48.3%), household products (387, 22.1%), ethanol (168, 9.6%), cosmetics (88, 5%) and CO (73, 4.2%). We identified five types of poisoning presentations. Two types occurring at home involving young children accounted for 1368 episodes (78.2%): non-intentional ingestions and dosage error of therapeutic drugs (791, 45.2%), and non-intentional ingestions of household products and cosmetics (577, 33%). Most commonly involved toxicants were benzodiazepines and detergents in each group. The remaining three groups required more interventions in the ED and had a lower rate of outpatient management: intentional ingestion of therapeutic drugs (105, 6%, frequently suicide attempts, mainly with benzodiazepines or combinations of therapeutic drugs), non-intentional inhalation of CO (76, 4.3%) and recreational ingestion of ethanol or use of illicit drugs (200, 11.4%). The distribution of these groups showed differences related to sex, domestic habits of storage of toxicants, symptoms, management in the ED and patient disposition. CONCLUSION: We identified five different types of childhood poisoning presentations to Spanish EDs. Best practices need to be identified for prevention of these episodes. European Journal of Emergency Medicine XXX: 000-000 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

International Epidemiological Differences in Acute Poisonings in Pediatric Emergency Departments.

BACKGROUND AND OBJECTIVE: Identifying international differences in the epidemiology of acute poisonings in children may help in improving prevention. We sought to evaluate the international epidemiological differences in acute poisonings in children presenting to emergency departments (EDs) from 8 different global regions. METHODS: This was an international multicenter cross-sectional prospective study including children younger than 18 years with acute poisonings presenting to 105 EDs in 20 countries was conducted. Data collection started at each ED between January and September 2013, and continued for 1 year. RESULTS: During the study period, we registered 363,245 pediatric ED presentations, of which 1727 were for poisoning (0.47%; 95% confidence interval, 0.45%-0.50%), with a significant variation in incidence between the regions. Full data were obtained for 1688 presentations. Most poisonings (1361 [80.6%]) occurred at home with either ingestion (1504 [89.0%]) or inhalation of the toxin (126 [7.6%]). Nonintentional exposures accounted for 1157 poisonings (68.5%; mainly in South America and Eastern Mediterranean region), with therapeutic drugs (494 [42.7%]), household products (310 [26.8%]), and pesticides (59 [5.1%]) being the most common toxins. Suicide attempts accounted for 233 exposures (13.8%; mainly in the Western Pacific region and North America), with therapeutic drugs (214 [91.8%], mainly psychotropics and acetaminophen) being the most common toxins. Significant differences between regions were found in both types of poisonings. Recreational poisonings were more common in Europe and Western Pacific region. No patient died. CONCLUSIONS: There are substantial epidemiological differences in acute poisonings among children in different countries and regions of the globe. International best practices need to be identified for prevention of acute poisonings in childhood.

International Variability in Gastrointestinal Decontamination With Acute Poisonings.

BACKGROUND AND OBJECTIVES: Identifying international differences in the management of acute pediatric poisonings may help improve the quality of care. The objective of this study was to assess the international variation and appropriateness of gastrointestinal decontamination (GID) procedures performed in children and adolescents who present with acute poisonings to emergency departments. METHODS: This was an international, multicenter, cross-sectional prospective study including children <18 years with poisoning exposures presenting to 105 emergency departments in 20 countries from 8 global regions belonging to the Pediatric Emergency Research Networks. Data collection started between January and September 2013 and continued for 1 year. The appropriateness of GID procedures performed was analyzed using the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists' recommendations. Multivariate logistic regression was performed to identify independent risk factors for performing GID procedures. RESULTS: We included 1688 patients, 338 of whom (20.0%, 95% confidence interval 18.1%-22.0%) underwent the following GID procedures: activated charcoal (166, 49.1%), activated charcoal and gastric lavage (122, 36.1%), gastric lavage (47, 13.9%), and ipecac (3, 0.9%). In 155 (45.8%, 40.5%-51.2%), the GID procedure was considered appropriate, with significant differences between regions. Independent risk factors for GID procedures included age, toxin category, mechanism of poisoning, absence of symptoms, and the region where the intoxication occurred (P < .001). CONCLUSIONS: Globally, there are substantial differences in the use and appropriateness of GID procedures in the management of pediatric poisonings. International best practices need to be better implemented.

[Prehospital management of acute childhood poisoning in Spain]. / Atención prehospitalaria en las intoxicaciones agudas pediátricas en España.

OBJECTIVES: This objective was to analyze prehospital management of acute childhood poisonings. Poisonings treated in 59 pediatric emergency departments participating in the Toxicology Observation Project of the Spanish Society of Pediatric Emergency Medicine were registered prospectively between 2008 and 2014. We analyzed consultations made and treatments received before the patient arrived in the emergency department. A total of 902 poisonings were registered; in 870 cases (96.4%) cases whether or not a prehospital consultation had been made was on record. An emergency service of come type was contacted or visited in 312 cases (35.9%). Calls were most often made to the central emergency service (122 cases [14%]), primary care centers (100 cases [11.5%]), or the National Toxicology Institute (60 cases, [6.9%]). Choice of service to call or visit varied greatly according to type of poisoning. Prehospital treatment was more often received if a service had been contacted (26.3%) than if not (6.8%) (P<.001). Treatment was also more specific to the type of poisoning (e.g., decontamination, oxygen therapy, antidotes) if a prehospital service had been contacted. About half the cases that consulted a poisoning service but did not receive treatment before coming to a hospital did receive treatment in the hospital emergency department. We conclude that a substantial percentage of patients who seek care for childhood poisoning from an emergency department have also consulted a prehospital service. Better prehospital management of such cases could facilitate earlier treatment when required and also preempt unnecessary trips to pediatric emergency departments.

OBJETIVO: El objetivo es analizar las actuaciones prehospitalarias en las intoxicaciones agudas pediátricas. Para ello, se utilizó el registro prospectivo de las intoxicaciones registradas en 59 servicios de urgencias pediátricos (SUP) incluidos en el Observatorio Toxicológico de la Sociedad Española de Urgencias de Pediatría entre 2008 y 2014. Se analizan las consultas prehospitalarias realizadas y los tratamientos recibidos. Se recogieron 902 intoxicaciones, de las que en 870 (96,4%) constaba la existencia o no de una consulta prehospitalaria. Globalmente, 312 pacientes (35,9%) contactaron con algún servicio prehospitalario, principalmente servicio de emergencias (122, 14%), centros de atención primaria (100, 11,5%) y el Instituto Nacional de Toxicología (60, 6,9%). El servicio consultado varió significativamente en relación con el mecanismo de la intoxicación. El grupo que consultó recibió tratamiento prehospitalario con más frecuencia (26,3% vs 6,8% del grupo que no contactó, p < 0,001) y más específico para una intoxicación (descontaminación, oxigenoterapia, antídotos). Alrededor de la mitad de los pacientes que consultaron con un servicio prehospitalario y no recibieron tratamiento antes de llegar al hospital, lo recibieron al llegar a urgencias. Se concluye que un porcentaje alto de pacientes que consultan en los SUP españoles por una intoxicación han consultado previamente con un servicio prehospitalario. Un mejor tratamiento prehospitalario de estas consultas podría facilitar el inicio precoz del tratamiento cuando se requiere y también evitar consultas innecesarias en los SUP.

Atención prehospitalaria en las intoxicaciones agudas pediátricas en España / Prehospital management of acute childhood poisoning in Spain

El objetivo es analizar las actuaciones prehospitalarias en las intoxicaciones agudas pediátricas. Para ello, se utilizó el registro prospectivo de las intoxicaciones registradas en 59 servicios de urgencias pediátricos (SUP) incluidos en el Observatorio Toxicológico de la Sociedad Española de Urgencias de Pediatría entre 2008 y 2014. Se analizan las consultas prehospitalarias realizadas y los tratamientos recibidos. Se recogieron 902 intoxicaciones, de las que en 870 (96,4%) constaba la existencia o no de una consulta prehospitalaria. Globalmente, 312 pacientes (35,9%) contactaron con algún servicio prehospitalario, principalmente servicio de emergencias (122, 14%), centros de atención primaria (100, 11,5%) y el Instituto Nacional de Toxicología (60, 6,9%). El servicio consultado varió significativamente en relación con el mecanismo de la intoxicación. El grupo que consultó recibió tratamiento prehospitalario con más frecuencia (26,3% vs 6,8% del grupo que no contactó, p < 0,001) y más específico para una intoxicación (descontaminación, oxigenoterapia, antídotos). Alrededor de la mitad de los pacientes que consultaron con un servicio prehospitalario y no recibieron tratamiento antes de llegar al hospital, lo recibieron al llegar a urgencias. Se concluye que un porcentaje alto de pacientes que consultan en los SUP españoles por una intoxicación han consultado previamente con un servicio prehospitalario. Un mejor tratamiento prehospitalario de estas consultas podría facilitar el inicio precoz del tratamiento cuando se requiere y también evitar consultas innecesarias en los SUP (AU)

This objective was to analyze prehospital management of acute childhood poisonings. Poisonings treated in 59 pediatric emergency departments participating in the Toxicology Observation Project of the Spanish Society of Pediatric Emergency Medicine were registered prospectively between 2008 and 2014. We analyzed consultations made and treatments received before the patient arrived in the emergency department. A total of 902 poisonings were registered; in 870 cases (96.4%) cases whether or not a prehospital consultation had been made was on record. An emergency service of come type was contacted or visited in 312 cases (35.9%). Calls were most often made to the central emergency service (122 cases [14%]), primary care centers (100 cases [11.5%]), or the National Toxicology Institute (60 cases, [6.9%]). Choice of service to call or visit varied greatly according to type of poisoning. Prehospital treatment was more often received if a service had been contacted (26.3%) than if not (6.8%) (P<.001). Treatment was also more specific to the type of poisoning (e.g., decontamination, oxygen therapy, antidotes) if a prehospital service had been contacted. About half the cases that consulted a poisoning service but did not receive treatment before coming to a hospital did receive treatment in the hospital emergency department. We conclude that a substantial percentage of patients who seek care for childhood poisoning from an emergency department have also consulted a prehospital service. Better prehospital management of such cases could facilitate earlier treatment when required and also preempt unnecessary trips to pediatric emergency departments (AU)

Intoxicaciones por droga ilegal en niños de corta edad en los servicios de urgencias pediátricos españoles / Poisoning by illegal drugs in young children in Spanish paediatric emergency departments

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Intoxicaciones agudas no intencionadas asociadas a recipientes no originales / Acute accidental poisonings related to non-original containers

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Toxicology surveillance system of the Spanish Society of Paediatric Emergencies: first-year analysis.

We aim to describe the characteristics and the management of the paediatric poisonings registered in the Toxicology Surveillance System created by the Intoxications Working Group of the Spanish Society of Paediatric Emergencies. We reviewed 130 episodes registered during 1 year. The main involved substances were drugs (73, 56.2%), household products (24,18.5%) and ethanol (16, 12.3%). Most common mechanisms were accidental poisonings at home in children of less than 5 years (91, 70%; principally, paracetamol or anticatharrals) and patients of 12-18 years (24.6%), with recreational alcohol consumption or suicide attempt. Approximately 10% received prehospital treatment and 56.9% received treatment in the paediatric emergency department (PED), which mainly activated charcoal. Approximately 50% were managed as outpatients, and all did well. Although intoxications are infrequent in PED and the short-term prognosis is good, the consumption of healthcare resources is high.