Demografia, óbitos e indicadores de agravamento nas internações por intoxicações medicamentosas entre menores de 5 anos no Brasil

Abstract

RESUMO: Introdução: No Brasil, os medicamentos são os principais agentes causadores de intoxicação, e o maior número de casos desse problema envolve menores de 5 anos. Assim, o objetivo deste estudo foi descrever as internações por intoxicação medicamentosa nessa população quanto a sua demografia, óbitos e indicadores de agravamento. Métodos: Verificou-se a frequência das internações por intoxicação medicamentosa entre 2003 e 2012, utilizando os dados do Sistema de Informação Hospitalar. As variáveis utilizadas foram ano, sexo, idade, município de residência e de internação, evolução do paciente, diagnóstico principal, diagnóstico secundário, natureza do estabelecimento de saúde e valor referente aos gastos de unidade de terapia intensiva. Resultados: Ocorreram 17.725 internações por intoxicação medicamentosa em menores de 5 anos de idade, com o predomínio do sexo masculino e de crianças de 2 anos. As internações fora do município de residência deram-se em 25% dos casos, com predomínio da Região Nordeste. A proporção de óbitos nas internações foi de 0,4%, com maior número de óbitos na Região Sudeste. Conclusão: Apesar da diminuição do número de internações no período, permaneceram disparidades regionais que podem ser atenuadas com a oferta de atenção especializada às intoxicações medicamentosas nos municípios, ampliando o acesso a cuidados de maior complexidade.

Differences in acute childhood poisoning: A single center experience

“…Approximately 17.2% of the patients presenting to emergency services have been reported to result in hospitalization, and 3-3.6% of these cases are admitted in pediatric intensive care unit. 8,9,24 In our study, no difference was found concerning hospitalization and intensive care requirement in both groups. Although mortality in pediatric poisonings varies across different centers, it is reported to be at 0.02-6%, with colchicine and tricyclic antidepressants being the deadliest agents.…”

Exogenous intoxication in patients treated at the Toxicological Information and Assistance Center during the COVID-19 pandemic

“…This is explained by the increased use of this product during the pandemic. This observation did not occur before the pandemic (Maior, Castro, Andrade, 2020).…”

Epidemiology, risk factors, and strategies to prevent and manage poisonings due to pharmaceuticals in children in low income and low-middle income countries: A systematic review

“…Three studies assessed the location of a child’s home as a risk factor for morbidity and/or mortality. A review of Brazilian national hospital data by Maior et al [ 54 ] described children aged 0-5 who presented after poisoning, and demonstrated a higher death to hospitalisation ratio among children from geographically remote regions (0.4% nationally compared to 1.1% and 0.6% in select remote regions, no significance testing done). Authors concluded that delayed access to care resulted in these differences in mortality due to an interplay of the geographic remoteness leading to prolonged travel times, fractured health infrastructure systems, and low socioeconomic resources [ 54 ].…”

“…A review of Brazilian national hospital data by Maior et al [ 54 ] described children aged 0-5 who presented after poisoning, and demonstrated a higher death to hospitalisation ratio among children from geographically remote regions (0.4% nationally compared to 1.1% and 0.6% in select remote regions, no significance testing done). Authors concluded that delayed access to care resulted in these differences in mortality due to an interplay of the geographic remoteness leading to prolonged travel times, fractured health infrastructure systems, and low socioeconomic resources [ 54 ]. Dayasiri et al [ 50 ]in Sri Lanka reported that delayed presentation to care was associated with increased morbidity and mortality among children in their qualitative study, but did not provide statistics regarding this association.…”

“…Delayed access to care is a risk factor for increased morbidity and mortality by impacting the severity of poisoning and related medical management [ 50 , 54 , 65 , 68 , 69 ]. Delayed presentation was associated with inadequate caregiver knowledge as families reported that they did not immediately seek care for their children because they did not appreciate the toxic nature of the ingested agent, while some caregivers who faced barriers in accessing timely medical care attempted harmful first aid interventions at home [ 50 ].…”