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1.
Pediatr Res ; 2020 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-32170194

RESUMO

BACKGROUND: To test whether children awaken from slow wave sleep and perform an escape procedure better in response to a smoke alarm that uses a male voice, female voice, combination of a low-frequency tone plus a female voice (hybrid alarm), or high-frequency tone. METHODS: Using a randomized, non-blinded, repeated-measures design, 188 children aged 5-12 years were exposed during stage 4 slow wave sleep to four smoke alarms. RESULTS: Among study subjects, 84.6%, 87.2%, 88.8%, and 56.4% awakened and 84.0%, 86.7%, 88.8%, and 55.3% successfully performed the escape procedure within 5 min of alarm onset in response to the male voice, female voice, hybrid, and high-frequency tone alarms, respectively, while the median time-to-escape was 12.0, 12.0, 13.0, and 96.5 s for these four alarms, respectively. All pairwise comparisons between the high-frequency tone alarm and each of the other three alarms were statistically significant for the proportions of subjects who awakened or escaped and for time-to-awaken and time-to-escape. There were no significant differences in these outcome measures between the latter three alarms. CONCLUSIONS: Use of the male or female voice or hybrid alarms in children's sleep areas may reduce residential fire-related injuries and deaths among children old enough to perform self-rescue. IMPACT: The male voice, female voice, and hybrid alarms were each significantly more effective than a high-frequency tone alarm in awakening children aged 5-12 years from slow wave sleep and prompting their performance of an escape procedure. There were no significant differences in the effectiveness of the male voice, female voice, and hybrid alarms when compared with each other. Use of these alarms in children's sleep areas may reduce residential fire-related injuries and deaths among children old enough to perform self-rescue.

2.
Clin Pediatr (Phila) ; 59(1): 34-44, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31672059

RESUMO

This study investigated children <18 years old treated for burns in United States (US) emergency departments from 1990 to 2014 using data from the National Electronic Injury Surveillance System. There were 2 548 971 children treated for burns during the study period, averaging 101 959 annually. The number and rate of burns decreased by 30.0% and 38.9%, respectively, (both P < .001) during the study. Most patients (58.4%) were boys, 64.0% were <6 years old, and 7.4% were admitted to the hospital. Thermal burns accounted for 60.2% of injuries. The hand/fingers were most commonly injured (37.1%), followed by head/neck (19.6%). The most common specified mechanism of injury was grabbing/touching (18.4%), followed by spilling/splashing (16.4%). Although the number of children treated for burns has decreased, it remains an important source of pediatric injury, demonstrating the need to increase prevention efforts, especially among young children. This is the first study to use a nationally representative sample to investigate burn mechanisms.

3.
Eye (Lond) ; 2019 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-31813934

RESUMO

BACKGROUND/OBJECTIVES: To investigate ocular exposures associated with household cleaning products in the United States. SUBJECTS/METHODS: A retrospective analysis of ocular exposures associated with household cleaning products was conducted using data from the National Poison Data System from 2000 through 2016. RESULTS: From January 2000 through December 2016, poison control centres in the United States received 319,508 calls for household cleaning product-related ocular exposures, averaging 18,795 exposures annually. The annual frequency of exposures decreased significantly by 28.8% during the study period. The rate of exposures per 100,000 US residents was 28.4 among young children (<6 years), 4.8 among older children (6-12 years), 4.2 among teenagers (13-19 years), and 4.2 among adults (≥20 years); children 2 years old had the highest rate of exposure (62.8). Bleaches (25.9%), wall/floor/tile cleaners (13.4%), disinfectants (10.8%), laundry detergents (6.1%), and glass cleaners (5.3%) were the non-miscellaneous product subcategories most commonly associated with ocular exposures. The product subcategories associated with the greatest proportion of major medical outcomes were drain cleaners (1.4%), oven cleaners (1.1%), and automatic dishwasher detergents (0.4%). CONCLUSIONS: On average, the United States poison control centres received approximately two reports of household cleaning product-related ocular exposures every hour during the 17-year study period. Although the annual number and rate of exposures declined during this time, the number of these exposures remains high, especially among young children, underscoring the need for additional prevention efforts. Contrary to the overall trend, ocular exposures to laundry detergent packets have increased significantly and merit special preventive action.

4.
Clin Toxicol (Phila) ; : 1-8, 2019 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-31766893

RESUMO

Context/Objective: To investigate the epidemiology of exposures to psychoactive substances of natural origin in the United States.Methods: Data from the National Poison Data System were retrospectively analyzed to investigate exposures to psychoactive substances of natural origin.Results: From January 1, 2000 through December 31, 2017, there were 67,369 calls to poison control centers in the United States regarding exposures to natural psychoactive substances, equaling an average of 3,743 exposures annually. Individuals >19 years of age (41.4%) and 13-19-year-olds (34.8%) accounted for most exposures with the highest annual rate reported among 13-19-year-olds at 79.4 per million population. The substances most commonly involved were marijuana (46.9%), anticholinergic plants (21.1%), and hallucinogenic mushrooms (15.6%). Kratom, khat, anticholinergic plants, and hallucinogenic mushrooms were the substances with the highest percentages of hospital admission and serious medical outcomes. The overall rate of exposure to natural psychoactive substances per million population increased significantly by 74.1% from 17.6 in 2000 to 30.7 in 2017 (p < 0.001). This increase was driven by a significant 150.0% increase in the rate of exposure to marijuana from 9.9 in 2000 to 24.7 in 2017 (p < 0.001). Despite this overall increase, most substances showed a significant decrease in exposure rate from 2000 to 2017, except for marijuana, nutmeg, and kratom. Kratom demonstrated a significant 4,948.9% increase from 2011 to 2017 and accounted for 8 of the 42 deaths identified in this study.Conclusions: While rates of exposure to most natural psychoactive substances decreased during the 18-year study period, rates for marijuana, nutmeg, and kratom increased significantly.

5.
Am J Emerg Med ; 2019 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-31402233

RESUMO

BACKGROUND: Horse-related injuries can cause severe morbidity and mortality. The objective of this study is to investigate the epidemiological features of horse-related injuries treated in emergency departments (EDs) in the United States. METHODS: A retrospective analysis of horse-related injuries from 1990 through 2017 was conducted utilizing the National Electronic Injury Surveillance System (NEISS). Cases were identified using the NEISS code 1239 (Horseback Riding: Activity, Apparel, or Equipment). Analyses performed included calculation of national injury estimates, relative risks (RRs) with 95% confidence intervals (CIs), and linear regression. RESULTS: From 1990 through 2017, an estimated 1,836,536 (95% CI: 1,494,788-2,178,284) individuals presented to United States EDs with horse-related injuries. The annual injury rate decreased by 30.8% from 1990 to 1996, increased by 33.0% from 1996 to 2000, and then decreased by 46.0% from 2000 to 2017. Among older adults >60 years of age, the annual injury rate increased by 139.6% during the study period. The number of concussion and closed head injury diagnoses increased by 337.2% from 1990 to 2009. The most common mounted mechanism of injury was a fall or being thrown (73.9%), while the most common unmounted mechanism was being kicked (42.1%). Mounted injuries were more likely to lead to hospitalization than unmounted injuries (RR, 2.10, 95% CI: 1.59-2.77). CONCLUSIONS: Despite the recent decline in horse-related injuries, these injuries are still common. Clinicians should be aware of the spectrum of ED presentations of horse-related injuries. Prevention efforts focused on older adults and concussions and closed head injuries warrant special attention.

6.
Acad Pediatr ; 2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31276840

RESUMO

OBJECTIVE: Being asleep at the time of a residential fire increases fire-related fatality risk. This study tested whether children awaken from slow wave sleep and perform an escape procedure better to a voice smoke alarm that uses their mother's voice compared with a female stranger's voice or a low-frequency tone alarm. METHODS: Using a randomized, nonblinded, repeated measures design, 176 children 5 to 12 years old were exposed during stage 4 slow wave sleep to 4 smoke alarm signals: 1) the voice of the child's mother, 2) the voice of a female stranger, 3) low-frequency 500 Hz square wave tone, and 4) conventional residential high-frequency tone. The alarms were assessed regarding their ability to awaken the children and prompt their performance of an escape procedure. RESULTS: Among the 176 subjects, 78.4%, 83.0%, 88.1%, and 49.4% awakened and 78.4%, 81.3%, 85.8%, and 48.3% successfully performed the escape procedure within 5 minutes of alarm onset in response to the mother's voice, stranger's voice, low-frequency tone, and high-frequency tone alarms, respectively; while the median time-to-escape was 23.0, 24.0, 41.5, and >300 seconds for these 4 alarms, respectively. CONCLUSIONS: The 2 voice alarms and low-frequency tone alarm significantly outperformed the high-frequency tone alarm, with the low-frequency tone alarm and female stranger's voice alarm performing best. Compared with the voice of a female stranger, personalizing the alarm message with the voice of the child's mother did not increase alarm effectiveness. These findings provide important information for development of an effective and practical smoke alarm for children.

7.
Pediatrics ; 144(1)2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31160344

RESUMO

OBJECTIVES: To investigate exposures to liquid laundry detergent packets among children <6 years old in the United States and to evaluate the impact of the American Society for Testing and Materials voluntary product safety standard. METHODS: Data from the National Poison Data System involving exposures to liquid laundry detergent packets from 2012 to 2017 were analyzed. RESULTS: From January 2012 to December 2017, there were 72 947 single and polysubstance exposures to liquid laundry detergent packets. Most exposures (91.7%) were documented among children <6 years old. The annual number and rate of exposures for children <6 years old increased by 110.4% and 111.9%, respectively, from 2012 to 2015. From 2015 to 2017, the number and rate of exposures in this age group decreased by 18.0%. Among individuals ≥6 years old, the annual number and rate of exposures increased by 292.7% and 276.7%, respectively, from 2012 to 2017. Annual hospital admissions among children <6 years old increased by 63.4% from 2012 to 2015 and declined by 55.5% from 2015 to 2017. Serious outcomes among children <6 years old increased by 78.5% from 2012 to 2015 and declined by 32.9% from 2015 to 2017. CONCLUSIONS: The number, rate, and severity of liquid laundry detergent packet exposures have decreased modestly in recent years among children <6 years old, likely attributable, in part, to the voluntary product safety standard and public awareness efforts. Exposures among older children and adults are increasing. Opportunities exist to strengthen the current product safety standard to further reduce exposures.


Assuntos
Qualidade de Produtos para o Consumidor , Detergentes/envenenamento , Lavanderia , Acidentes Domésticos/prevenção & controle , Criança , Pré-Escolar , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Envenenamento/epidemiologia , Envenenamento/prevenção & controle , Rotulagem de Produtos , Embalagem de Produtos , Estados Unidos/epidemiologia
8.
Clin Pediatr (Phila) ; 58(11-12): 1262-1270, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31179757

RESUMO

This study investigated characteristics and trends associated with sports- and recreation-related dental injuries among children <18 years old treated in US emergency departments using data from the National Electronic Injury Surveillance System for 2000 to 2017. There were an estimated 198 787 (95% confidence interval = 162 216-235 358) injuries during the study period, averaging 11 044 injuries annually. The rate of dental injuries per 100 000 US population <18 years old fluctuated during the study, starting at 16.9 in 2000 and ending at 13.9 in 2017. Injuries most commonly occurred among males (69.8%) and children 7 to 12 years old (44.6%). Pediatric sports- and recreation-related dental injuries were most commonly associated with bicycles (28.6%), playground equipment (15.3%), and baseball/softball (12.4%). Although emergency department visits for pediatric sports- and recreation-related dental injuries decreased during the study period overall, sports and recreation remain an important source of preventable dental injury, particularly among children 7 to 12 years old.

9.
Pediatr Emerg Care ; 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30829840

RESUMO

OBJECTIVE: The aim of this study was to investigate the epidemiology of nonfatal consumer product- and sports and recreational activity-related injuries among US children. METHODS: National Electronic Injury Surveillance System data regarding children younger than 18 years who were treated in US emergency departments (EDs) for nonfatal consumer product- or sports and recreational activity-related injuries were analyzed. RESULTS: From 1990 through 2012, an estimated 121,489,024 (95% confidence interval, 104,226,323-138,751,726) children younger than 18 years were treated in US EDs for nonfatal injuries meeting study criteria, yielding an average of 5,282,131 children annually, or 74.12 injuries per 1000 children. During 1990 to 2005, the overall annual injury rate decreased by 14.0% (P < 0.001), followed by an increase of 7.3% (P = 0.157) during 2005 to 2012. The concussion/closed head injury rate increased by 199.3% (P < 0.001) from 1996 to 2012. Injury rates were highest among children 0 to 4 years old and lowest among children 5 to 9 years old. Sports and recreational activities accounted for 46.5% of all injuries. Falls (40.2%) and "struck-by" (22.6%) were the leading mechanisms of injury, and 62.3% of all injuries were among boys. Injuries often occurred to the head/neck (37.8%) or upper extremities (31.9%), were frequently diagnosed as lacerations (29.0%) or soft tissue injuries (21.0%), and 2.7% were admitted to the hospital. CONCLUSIONS: On average, a child was treated in a US ED for a nonfatal consumer product- or sports and recreational activity-related injury every 6 seconds. Although injury rates decreased early in the study period, there was a nonsignificant increasing trend from 2005 to 2012. Multilevel injury prevention efforts are recommended.

10.
Clin Toxicol (Phila) ; 57(10): 847-854, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30786220

RESUMO

Context: Kratom, or Mitragyna speciosa, is a plant indigenous to Southeast Asia that has gained national attention in the United States for its increased use in the self-management of opioid withdrawal and pain, as well as for concerns about its safety. Methods: This study analyzes exposures to kratom reported to poison control centers (PCCs) in the United States during 2011-2017 from the National Poison Data System (NPDS). Discussion: From 2011 through 2017, 1807 kratom exposures were reported to United States PCCs. Almost two-thirds (65.0%) of these exposures occurred during 2016-2017. Most exposures occurred among adults ≥20 years (88.9%), males (70.8%), at a residence (86.1%), and were intentional (74.3%). Among first-ranked kratom exposures, 31.8% resulted in admission to a health care facility (HCF) and 51.9% in a serious medical outcome. Multiple-substance exposures were associated with greater odds of admission to a HCF (OR: 2.80; 95% CI: 2.21-3.55) and a serious medical outcome (OR: 2.25; 95% CI: 1.77-2.85) compared with single-substance exposures. There were 11 deaths associated with kratom exposure, including two that occurred after exposure to kratom only. Among kratom-only exposures, 86.1% resulted in one or more clinical effects. The most common clinical effects were agitation/irritability (22.9%) and tachycardia (21.4%). There were seven neonatal exposures, including five experiencing withdrawal. Conclusions: Kratom is associated with a variety of serious medical outcomes, especially when used with other substances. More research is needed to define the human response to kratom. Increased regulation of kratom products would help guarantee product quality and safety. Individuals who choose to use kratom should be educated about its potential risks, including the dangers of using it in combination with other substances.

11.
J Pediatr ; 205: 250-256.e1, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30482491

RESUMO

OBJECTIVES: To test maternal voice alarm effectiveness under residential conditions and determine whether personalizing the maternal voice alarm message with the child's first name improves effectiveness. STUDY DESIGN: Using a randomized, nonblinded, repeated measures design, we compared 3 maternal voice smoke alarms with respect to their ability to awaken 176 children 5-12 years old from stage 4 slow-wave sleep and prompt their performance of an escape procedure. A conventional residential high-frequency tone smoke alarm was used as a comparative reference. Children's sleep stage was monitored in a residence-like research setting. RESULTS: Maternal voice alarms awakened 86%-91% of children and prompted 84%-86% to escape compared with 53% awakened and 51% escaped for the tone alarm. A sleeping child was 2.9-3.4 times more likely to be awakened by each of the 3 voice alarms than the tone alarm. The median time to awaken was 156 seconds for the tone alarm and 2 seconds for each voice alarm. The proportions of children who awakened and escaped differed significantly between the tone alarm and each voice alarm, but no significant differences were found between each pair of the voice alarms, regardless of whether the child's first name was included in the alarm message. CONCLUSIONS: The maternal voice alarms significantly outperformed the tone alarm under residential conditions. Personalizing the alarm message with the child's first name did not increase alarm effectiveness. These findings have important implications for development of an effective and practical smoke alarm for children. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01169155.


Assuntos
Queimaduras/prevenção & controle , Fogo/prevenção & controle , Utensílios Domésticos/instrumentação , Habitação , Equipamentos de Proteção/normas , Sono/fisiologia , Lesão por Inalação de Fumaça/prevenção & controle , Queimaduras/epidemiologia , Criança , Pré-Escolar , Eletroencefalografia , Feminino , Fogo/estatística & dados numéricos , Humanos , Incidência , Masculino , Polissonografia , Fumaça , Lesão por Inalação de Fumaça/epidemiologia , Estados Unidos/epidemiologia
12.
Ophthalmic Epidemiol ; 26(2): 84-94, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30239245

RESUMO

PURPOSE: To investigate the epidemiology of ocular exposures reported to poison control centers in the United States. METHODS: A retrospective analysis of ocular exposures from 2000 to 2016 was conducted using National Poison Data System data. RESULTS: United States poison control centers received 1,436,683 reports of ocular exposures during 2000-2016, averaging 7,043 exposures per month. The annual frequency of ocular exposures declined significantly by 37.2% from 2006 to 2016. The ocular exposure rate per 10,000 US residents was highest among children < 6 years of age (10.7), particularly among 2-year-olds (20.5), and was lowest among adults ≥ 20 years of age (1.9). The majority of the exposures resulted in minor effects (51.4%). Among exposed individuals, 23.0% were treated and released and 0.3% were admitted to a healthcare facility. Household cleaning products (22.2%), cosmetics/personal care products (15.7%), and pesticides (7.4%) were the most common substance categories associated with exposures, but exposures to building and construction products (18.1%), industrial cleaners (14.9%), and chemicals (14.1%) resulted in a higher percentage of moderate or major effects. In addition, exposures to alkaline substances had a higher percentage of moderate or major effects. CONCLUSION: Although the annual frequency of ocular exposures declined during the last decade, the number of exposures remains high, particularly among young children. The commonly associated substance categories identified in this study represent important preventable sources of morbidity.


Assuntos
Cosméticos/efeitos adversos , Oftalmopatias/induzido quimicamente , Oftalmopatias/epidemiologia , Produtos Domésticos/efeitos adversos , Praguicidas/efeitos adversos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Centros de Controle de Intoxicações/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
13.
Pediatrics ; 142(4)2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30224365

RESUMO

OBJECTIVES: To investigate the epidemiologic characteristics of infant walker-related injuries among children <15 months old who were treated in US emergency departments and to evaluate the effect of the 2010 federal mandatory safety standard on these injuries. METHODS: National Electronic Injury Surveillance System data from 1990 to 2014 were analyzed. RESULTS: An estimated 230 676 children <15 months old were treated for infant walker-related injuries in US emergency departments from 1990 to 2014. Most of the children sustained head or neck injuries (90.6%) and 74.1% were injured by falling down the stairs in an infant walker. Among patients who were admitted to the hospital (4.5%), 37.8% had a skull fracture. From 1990 to 2003, overall infant walker-related injuries and injuries related to falling down the stairs decreased by 84.5% and 91.0%, respectively. The average annual number of injuries decreased by 22.7% (P = .019) during the 4-year period after the implementation of the federal mandatory safety standard compared with the 4-year period before the standard. CONCLUSIONS: Infant walker-related injuries decreased after the implementation of the federal mandatory safety standard in 2010. This decrease may, in part, be attributable to the standard as well as other factors, such as decreased infant walker use and fewer older infant walkers in homes. Despite the decline in injuries, infant walkers remain an important and preventable source of injury among young children, which supports the American Academy of Pediatrics' call for a ban on their manufacture and sale in the United States.


Assuntos
Acidentes por Quedas/prevenção & controle , Equipamentos para Lactente/efeitos adversos , Equipamentos para Lactente/tendências , Gestão da Segurança/tendências , Serviço Hospitalar de Emergência/tendências , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Gestão da Segurança/legislação & jurisprudência , Estados Unidos/epidemiologia
14.
Pediatrics ; 142(1)2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29941678

RESUMO

OBJECTIVE: To investigate buprenorphine exposures among children and adolescents ≤19 years old in the United States. METHODS: Data were analyzed from calls to US poison control centers for 2007-2016 from the National Poison Data System. RESULTS: From 2007 to 2016, there were 11 275 children and adolescents ≤19 years old exposed to buprenorphine reported to US poison control centers. Most exposures were among children <6 years old (86.1%), unintentional (89.2%), and to a single substance (97.3%). For single-substance exposures, children <6 years old had greater odds of hospital admission and of serious medical outcome than adolescents 13 to 19 years old. Adolescents accounted for 11.1% of exposures; 77.1% were intentional (including 12.0% suspected suicide), and 27.7% involved multiple substances. Among adolescents, the odds of hospital admission and a serious medical outcome were higher for multiple-substance exposures than single-substance exposures. CONCLUSIONS: Buprenorphine is important for the treatment of opioid use disorder, but pediatric exposure can result in serious adverse outcomes. Manufacturers should use unit-dose packaging for all buprenorphine products to help prevent unintentional exposure among young children. Health providers should inform caregivers of young children about the dangers of buprenorphine exposure and provide instructions on proper medication storage and disposal. Adolescents should receive information regarding the risks of substance abuse and misuse. Suspected suicide accounted for 12% of adolescent exposures, highlighting the need for access to mental health services for this age group.


Assuntos
Buprenorfina/envenenamento , Antagonistas de Entorpecentes/envenenamento , Centros de Controle de Intoxicações/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Masculino , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Estados Unidos/epidemiologia , Adulto Jovem
15.
Pediatrics ; 141(6)2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29784754

RESUMO

: media-1vid110.1542/5754332180001PEDS-VA_2017-3872Video Abstract OBJECTIVES: To describe the characteristics and trends of exposures to attention-deficit/hyperactivity disorder (ADHD) medications among individuals 0 to 19 years old reported to US poison control centers. METHODS: National Poison Data System data from 2000 through 2014 were retrospectively analyzed to examine pediatric ADHD medication exposures. RESULTS: From 2000 through 2014, there were 156 365 exposures reported to US poison control centers related to ADHD medications. The overall rate of reported exposures increased 71.2% from 2000 to 2011, followed by a 6.2% decrease from 2011 to 2014. Three-fourths (76.0%) of exposures involved children ≤12 years old. Methylphenidate and amphetamine medications accounted for 46.2% and 44.5% of exposures, respectively. The most common reason for exposure was therapeutic error (41.6%). Intentional medication exposures (including suspected suicide and medication abuse and/or misuse) were reported most often among adolescents (13-19 years old), accounting for 50.2% of exposures in this age group. Overall, the majority of exposed individuals (60.4%) did not receive health care facility treatment; however, 6.2% were admitted to a hospital for medical treatment, and there were 3 deaths. The increasing number and rate of reported ADHD medication exposures during the study period is consistent with increasing trends in ADHD diagnosis and medication prescribing. Exposures associated with suspected suicide or medication abuse and/or misuse among adolescents are of particular concern. CONCLUSIONS: Unintentional and intentional pediatric exposures to ADHD medications are an increasing problem in the United States, affecting children of all ages.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Estimulantes do Sistema Nervoso Central/efeitos adversos , Centros de Controle de Intoxicações , Adolescente , Distribuição por Idade , Anfetamina/administração & dosagem , Anfetamina/efeitos adversos , Cloridrato de Atomoxetina/administração & dosagem , Cloridrato de Atomoxetina/efeitos adversos , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Estimulantes do Sistema Nervoso Central/administração & dosagem , Criança , Pré-Escolar , Uso Indevido de Medicamentos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Erros de Medicação/estatística & dados numéricos , Metilfenidato/administração & dosagem , Metilfenidato/efeitos adversos , Modafinila/administração & dosagem , Modafinila/efeitos adversos , Admissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Tentativa de Suicídio/estatística & dados numéricos , Estados Unidos/epidemiologia , Adulto Jovem
16.
Pharmacoepidemiol Drug Saf ; 27(8): 902-911, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29740912

RESUMO

PURPOSE: To investigate unintentional therapeutic medication errors associated with antidepressant and antipsychotic medications in the United States and expand current knowledge on the types of errors commonly associated with these medications. METHODS: A retrospective analysis of non-health care facility unintentional therapeutic errors associated with antidepressant and antipsychotic medications was conducted using data from the National Poison Data System. RESULTS: From 2000 to 2012, poison control centers received 207 670 calls reporting unintentional therapeutic errors associated with antidepressant or antipsychotic medications that occurred outside of a health care facility, averaging 15 975 errors annually. The rate of antidepressant-related errors increased by 50.6% from 2000 to 2004, decreased by 6.5% from 2004 to 2006, and then increased 13.0% from 2006 to 2012. The rate of errors related to antipsychotic medications increased by 99.7% from 2000 to 2004 and then increased by 8.8% from 2004 to 2012. Overall, 70.1% of reported errors occurred among adults, and 59.3% were among females. The medications most frequently associated with errors were selective serotonin reuptake inhibitors (30.3%), atypical antipsychotics (24.1%), and other types of antidepressants (21.5%). Most medication errors took place when an individual inadvertently took or was given a medication twice (41.0%), inadvertently took someone else's medication (15.6%), or took the wrong medication (15.6%). CONCLUSIONS: This study provides a comprehensive overview of non-health care facility unintentional therapeutic errors associated with antidepressant and antipsychotic medications. The frequency and rate of these errors increased significantly from 2000 to 2012. Given that use of these medications is increasing in the US, this study provides important information about the epidemiology of the associated medication errors.


Assuntos
Antidepressivos/efeitos adversos , Antipsicóticos/efeitos adversos , Erros de Medicação/estatística & dados numéricos , Centros de Controle de Intoxicações/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Antidepressivos/administração & dosagem , Antipsicóticos/administração & dosagem , Criança , Pré-Escolar , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Humanos , Masculino , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
17.
Pediatrics ; 141(5)2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29686144

RESUMO

OBJECTIVES: To investigate exposures to liquid nicotine (including electronic cigarette devices and liquids) among children <6 years old in the United States and evaluate the impact of legislation requiring child-resistant packaging for liquid nicotine containers. METHODS: Liquid nicotine exposure data from the National Poison Data System for January 2012 through April 2017 were analyzed. RESULTS: There were 8269 liquid nicotine exposures among children <6 years old reported to US poison control centers during the study period. Most (92.5%) children were exposed through ingestion and 83.9% were children <3 years old. Among children exposed to liquid nicotine, 35.1% were treated and released from a health care facility, and 1.4% were admitted. The annual exposure rate per 100 000 children increased by 1398.2% from 0.7 in 2012 to 10.4 in 2015, and subsequently decreased by 19.8% from 2015 to 8.3 in 2016. Among states without a preexisting law requiring child-resistant packaging for liquid nicotine containers, there was a significant decrease in the mean number of exposures during the 9 months before compared with the 9 months after the federal child-resistant packaging law went into effect, averaging 4.4 (95% confidence interval: -7.1 to -1.7) fewer exposures per state after implementation of the law. CONCLUSIONS: Pediatric exposures to liquid nicotine have decreased since January 2015, which may, in part, be attributable to legislation requiring child-resistant packaging and greater public awareness of risks associated with electronic cigarette products. Liquid nicotine continues to pose a serious risk for young children. Additional regulation of these products is warranted.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Exposição Ambiental/estatística & dados numéricos , Nicotina/efeitos adversos , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Lactente , Masculino , Centros de Controle de Intoxicações , Embalagem de Produtos/legislação & jurisprudência , Estados Unidos/epidemiologia
18.
Pediatrics ; 141(2)2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29311358

RESUMO

OBJECTIVES: To investigate the epidemiologic characteristics of sports- and recreation-related eye injuries among children in the United States. METHODS: Data from the National Electronic Injury Surveillance System were analyzed in a retrospective study of children ≤17 years of age treated in US emergency departments for sports- and recreation-related eye injuries from 1990 to 2012. RESULTS: From 1990 through 2012, an estimated 441 800 (95% confidence interval: 378 868-504 733) children were treated in US emergency departments for sports- and recreation-related eye injuries, averaging 26.9 injuries per 100 000 children. Children 10 to 14 and 15 to 17 years old had the highest rate of eye injury. Three-fourths of injuries were sustained by boys. The most common types of injury were corneal abrasion (27.1%), conjunctivitis (10.0%), and foreign body in the eye (8.5%). Most eye injuries were treated and released (94.6%); however, 4.7% were hospitalized. The most common sports and recreation activities and equipment associated with eye injury were basketball (15.9%), baseball and softball (15.2%), and nonpowder guns (10.6%). The overall rate of eye injury decreased slightly during the study period; however, the rate of eye injury associated with nonpowder guns increased by 168.8%, and nonpowder gun-related eye injuries accounted for 48.5% of hospitalizations. CONCLUSIONS: Pediatric sports- and recreation-related eye injuries remain common. Increased prevention efforts are needed, especially for eye injuries associated with nonpowder guns. Increased child, parent, and coach education, as well as adoption of rules that mandate the use of eye protective equipment should be undertaken.


Assuntos
Traumatismos em Atletas/epidemiologia , Serviço Hospitalar de Emergência , Traumatismos Oculares/epidemiologia , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Estudos Retrospectivos , Distribuição por Sexo , Equipamentos Esportivos/efeitos adversos , Estados Unidos/epidemiologia
19.
Pain Med ; 19(12): 2357-2370, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-29186557

RESUMO

Objective: This study investigates the characteristics and trends of medication errors involving analgesic medications. Design and Methods: A retrospective analysis was conducted of analgesic-related medication errors reported to the National Poison Data System (NPDS) from 2000 through 2012. Results: From 2000 through 2012, the NPDS received 533,763 reports of analgesic-related medication errors, averaging 41,059 medication errors annually. Overall, the rate of analgesic-related medication errors reported to the NPDS increased significantly by 82.6% from 2000 to 2009, followed by a 5.7% nonsignificant decrease from 2009 to 2012. Among the analgesic categories, rates of both acetaminophen-related and opioid-related medication errors reported to the NPDS increased during 2000-2009, but the opioid error rate leveled off during 2009-2012, while the acetaminophen error rate decreased by 17.9%. Analgesic-related medication errors involved nonsteroidal anti-inflammatory drugs (37.0%), acetaminophen (35.5%), and opioids (23.2%). Children five years or younger accounted for 38.8% of analgesics-related medication errors. Most (90.2%) analgesic-related medication errors were managed on-site, rather than at a health care facility; 1.6% were admitted to a hospital, and 1.5% experienced serious medical outcomes, including 145 deaths. The most common type of medication error was inadvertently taking/given the medication twice (26.6%). Conclusion: Analgesic-related medication errors are common, and although most do not result in clinical consequences, they can have serious adverse outcomes. Initiatives associated with the decrease in acetaminophen-related medication errors among young children merit additional research and potential replication as a model combining government policy and multisectoral collaboration.


Assuntos
Analgésicos/efeitos adversos , Anti-Inflamatórios não Esteroides/uso terapêutico , Bases de Dados Factuais/estatística & dados numéricos , Erros de Medicação/estatística & dados numéricos , Centros de Controle de Intoxicações/estatística & dados numéricos , Acetaminofen/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/uso terapêutico , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
20.
Pediatrics ; 141(1)2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29229682

RESUMO

OBJECTIVES: To provide an epidemiologic description of fatal and nonfatal window blind-related injuries among US children younger than 6 years of age. METHODS: Data from the Consumer Product Safety Commission's National Electronic Injury Surveillance System and In-Depth Investigation (IDI) databases were retrospectively analyzed. RESULTS: From 1990 to 2015, there were an estimated 16 827 (95% confidence interval: 13 732-19 922) window blind-related injuries among children younger than 6 years of age treated in emergency departments in the United States, corresponding to an injury rate of 2.7 per 100 000 children. The most common mechanism of injury was "struck by" (48.8%). Entanglement injuries accounted for 11.9% of all cases, and among this subgroup, 98.9% involved blind cords, and 80.7% were to the neck. Overall, most injuries (93.4%) were treated and released. In IDI reports for 1996 through 2012, we identified 231 window blind cord entanglement incidents among children <6 years of age, and 98.7% involved the child's neck; entanglements with the window blind's operating cords (76.4%) or inner cords (22.1%) were the most common. Two-thirds of entanglement incidents included in the IDI database resulted in death (67.1%). CONCLUSIONS: Despite existing voluntary safety standards for window blinds, these products continue to pose an injury risk to young children. Although many of the injuries in this study were nonfatal and resulted in minor injuries, cases involving window blind cord entanglements frequently resulted in hospitalization or death. A mandatory safety standard that eliminates accessible window blind cords should be adopted.


Assuntos
Acidentes Domésticos/estatística & dados numéricos , Qualidade de Produtos para o Consumidor , Decoração de Interiores e Mobiliário , Ferimentos e Lesões/epidemiologia , Acidentes Domésticos/prevenção & controle , Pré-Escolar , Estudos de Coortes , Bases de Dados Factuais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Utensílios Domésticos , Humanos , Incidência , Lactente , Masculino , Pediatria , Estudos Retrospectivos , Medição de Risco , Estados Unidos , Ferimentos e Lesões/etiologia
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