Conflicts of interest: D. Bogunovic has given lectures for Genentech, Inc, owns stock in Lab11 Therapeutics, LLC, and acknowledges support from the National Institutes of Health (grant nos. AI127372 and AI148963) as well as the March of Dimes. C. Cunningham-Rundles has received consulting fees from CSL Behring, Momenta, Atara, Pharming, and UBC; served on boards for CSL Behring and Takeda Pharmaceutical Company Limited; serves on the Scientific Advisory Board of the Immune Deficiency Foundation; and received support from the National Institutes of Health (grant nos. AI 101093, AI-086037, and AI-48693) and the David S. Gottesman Immunology Chair.
BACKGROUND: Social distancing precautions due to the COVID-19 pandemic have had a detrimental physical and emotional effect. Anecdotally, hospitalizations within our health system for pediatric acetaminophen ingestions increased during the pandemic.
OBJECTIVE:To evaluate the rates of pediatric intentional acetaminophen ingestion and overall self-harm admissions before and during the COVID-19 pandemic.
PARTICIPANTS:All discharges of patients 0 to 23 years of age admitted to the health system between 2016 and 2020 were electronically queried. Patients were identified by a primary International Classification of Disease 10 diagnosis code of acetaminophen ingestion related to self-harm [T39.1X2].
DESIGN:This is a single-centered retrospective observational study. Statistical analysis was performed using a logistic regression model.
MAIN OUTCOME(S) AND MEASURE(S):The primary outcome was rate of hospitalization for acetaminophen ingestion by year. This was defined as the number of hospital discharges for acetaminophen ingestion divided by the total number of discharges per year (excluding obstetric or newborn discharges). Secondary outcomes included age, race/ethnicity, insurance, and gender.
RESULTS:From 2016-2020 there were 25,927 discharges of pediatric patients with 65 acetaminophen ingestion and 148 overall self-harm discharges. Of the 65 acetaminophen patients, 78% identified as female and 54% identified as non-white. The proportion of acetaminophen ingestion admissions increased from 0.13% to 0.28% between 2016 and 2018, decreased to 0.24% in 2019, then increased to 0.44% in 2020. The proportion of self-harm ingestion admissions increased from 0.42% to 0.64% between 2016 and 2018, decreased to 0.55% in 2019, then increased to 0.73% in 2020. We found a significant increasing linear trend. The log-odds of acetaminophen ingestion admission from 2016 through 2020 increased by 28% each additional year (OR=1.28; 95% CI: 1.08-1.53; p=0.01). There was not enough evidence to conclude that the log-odds of a self-harm ingestion admission were linearly related to time (p=0.06).
CONCLUSIONS:Acetaminophen ingestion for self-harm has significantly increased, while overall self-harm has remained stable. It is important to note this trend and to continue to screen for depression.
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