Evolving Trends and Treatment Advances in Pediatric Poisoning

Liebelt, Erica L.

doi:10.1001/jama.282.12.1113

Cited by 58 publications

(47 citation statements)

References 19 publications

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“…There is substantial health care utilization and morbidity associated with these events among children of all ages, The Poisoning Prevention Packaging Act of 1970 mandated the use of childresistant packaging for prescription medications and is credited with making pediatric fatalities from medication exposures and poisonings relatively uncommon in the United States. 6,25,26 The 2008 Preventing Overdoses and Treatment Exposures Task Force has further promoted the development of a new generation of safety packaging. 6,27 Our work suggests that even though these programs may be effective, child exposures and poisonings continue to be a significant and increasing problem, and interventions need to take into account the increases in adult prescriptions available to children.…”

Section: Discussionmentioning

confidence: 99%

Adult Prescription Drug Use and Pediatric Medication Exposures and Poisonings

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Medication ingestions are increasing among children despite a number of public health interventions. The majority of these poisonings are related to prescription as opposed to over-the-counter medications. WHAT THIS STUDY ADDS:Rising rates of poisonings in children are strongly correlated with rising use of hypoglycemics, antihyperlipidemics, b-blockers, and opioids among adults. These events are associated with considerable health care utilization, both in terms of emergency department visits and hospital admissions. abstract BACKGROUND AND OBJECTIVES: Nontherapeutic medication ingestions continue to be a major pediatric health problem, with recent increases in ingestions despite a number of public health interventions. It is unknown how changes in adult prescription drug use relate to pediatric medication poisonings. The objective of the study was to measure the association between changing adult prescription drug patterns and pediatric medication exposures and poisonings and identify high-risk classes of medications and pediatric age groups. METHODS:We measured monthly pediatric exposures and poisonings using the National Poison Data System and prescriptions written for adults using the National Ambulatory Medical Care Surveys for 2000 through 2009. Associations between adult prescriptions for oral hypoglycemics, antihyperlipidemics, b-blockers, and opioids and exposures and poisonings among children 0 to 5, 6 to 12, and 13 to 19 years were analyzed by using multiple time-series analysis. Emergency department visits, serious injuries, and hospitalizations stemming from these associations were described.RESULTS: Adult medication prescriptions were statistically significantly associated with exposures and poisonings in children of all ages, with the strongest association observed for opioids. Across medications, the greatest risk was among children 0 to 5 years old, followed by 13-to 19-year-olds. Rates of emergency department visits were highest for events related to hypoglycemics (60.1%) and b-blockers (59.7%), whereas serious injuries and hospitalizations occurred most frequently with opioids (26.8% and 35.2%, respectively) and hypoglycemics (19.5% and 49.4%, respectively). CONCLUSIONS:Increasing adult drug prescriptions are strongly associated with rising pediatric exposures and poisonings, particularly for opioids and among children 0 to 5 years old. These associations have sizable impacts, including high rates of serious injury and health care use. Dr Burghardt contributed to study conception and design, data acquisition, analysis and interpretation of data, drafting, and revising the article; Dr Ayers contributed to data acquisition, analysis and interpretation of data, and revising the article; Dr Brownstein contributed to study conception and design, data acquisition and analysis, and revision; Dr Bronstein contributed to study conception and design and revision; Dr Burns Ewald contributed to study conception and design, data acquisition, and revision; and Dr Bourgeois con...

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Section: Discussionmentioning

confidence: 99%

Adult Prescription Drug Use and Pediatric Medication Exposures and Poisonings

et al. 2013

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“…These estimates most likely reflect the ubiquitous nature of household cleaning products and the ease of accessibility to children. 8 Household cleaning products are alluring to children because of their color, scent, and brightly colored packaging. 4 In our study, children 1 to 3 years of age accounted for the largest proportion of cases, which may be a reflection of their unique developmental stages, with emphasis on exploration, and general inquisitiveness about their environment.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] In recent decades, cleaning products have consistently been in the top 5 categories of pediatric poisoning exposure. 8 Fortunately, the high frequency of exposure to these toxic products has not resulted in concomitant high mortality rates for children Յ5 years of age (29 deaths [2.0% of all poisoning fatalities] in 2006). In 2006, however, 10 318 children required some form of medical treatment as a result of poisoning attributable to exposure to household cleaners, and 744 of those children exhibited symptoms that were lifethreatening or that resulted in significant residual disability.…”

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confidence: 99%

“…1 Other reasons for the decreases in mortality rates include product reformulation, increased parental awareness of toxic product effects, and the development of poison control centers. 8 Despite the aforementioned changes and the variety of existing poisoning-prevention strategies, children still account for the majority of unintentional poisoning exposures. The proportions of childhood injuries and poisonings resulting from household cleaning products remained constant in previous decades.…”

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confidence: 99%

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Household Cleaning Product-Related Injuries Treated in US Emergency Departments in 1990–2006

et al. 2010

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WHAT'S KNOWN ON THIS SUBJECT:Household cleaning products are responsible for many unintentional poisonings in children and are consistently in the top 5 categories for pediatric poisoning exposure. WHAT THIS STUDY ADDS:Rates of cleaning product-related injuries among children treated in EDs decreased 46% during the 17-year study period. The products associated most often with injuries were bleach (37.1%) and low-molecular weight hydrocarbons, acids/alkalis, and detergents (30.4%). abstract OBJECTIVE:The goal was to examine comprehensively the patterns and trends of household cleaning product-related injuries among children treated in US emergency departments. METHODS:Through use of the National Electronic Injury Surveillance System database, cases of unintentional, nonfatal, household cleaning product-related injuries were selected by using product codes for drain cleaners, ammonia, metal polishes/tarnish removers, turpentine, dishwasher detergents, acids, swimming pool chemicals, oven cleaners, pine oil cleaners/disinfectants, laundry soaps/detergents, toilet bowl products, abrasive cleaners, general-purpose household cleaners, noncosmetic bleaches, windshield wiper fluids, caustic agents, lye, wallpaper cleaners, room deodorizers/fresheners, spot removers, and dishwashing liquids. Products were categorized according to major toxic ingredients, mode of action, and exposure. RESULTS:An estimated 267 269 children Յ5 years of age were treated in US emergency departments for household cleaning product-related injuries. The number of injuries attributable to household cleaning product exposure decreased 46.0% from 22 141 in 1990 to 11 964 in 2006. The product most-commonly associated with injury was bleach (37.1%). Children 1 to 3 years of age accounted for 72.0% of cases. The primary mechanism of injury was ingestion (62.7%). The most common source or container was spray-bottles (40.1%). Although rates of household cleaner-related injuries from regular bottles or original containers and kitchenware decreased during the study period, spraybottle injury rates showed no decrease. CONCLUSION:Although national rates of household cleaning productrelated injuries in children decreased significantly over time, the number of injuries remains high. Pediatrics 2010;126:509-516

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“…Regional poison centers are a good example of an effective method to reduce hospital visits and healthcare costs [12][13][14]. In addition, the impact of previously enacted legislation mandating child-resistant packaging for hazardous household products and prescription drugs and the more recent labeling changes for pediatric over the counter cough and cold medications are also important methods of prevention that may help explain the fall in pediatric visits [15][16][17].…”

Section: Discussionmentioning

confidence: 99%

Trends in Emergency Department Resource Utilization for Poisoning-Related Visits, 2003–2011

et al. 2016

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In recent years, there has been an increase in poisoning-related emergency department (ED) visits. This study examines trends in ED resource utilization for poisoning-related visits over time. A retrospective review of data from the National Hospital Ambulatory Medical Care Survey, 2003-2011, was conducted. All ED visits with a reason for visit or ICD-9 code related to poisoning were included. We examined the number of ED visits and resources used including diagnostic studies and procedures performed, medications provided, admission rates, and length of stay. The proportion of visits involving resource use was tabulated and trends analyzed using survey-weighted logistic regression, grouping into 2-year periods to ensure adequate sample size. Of an estimated 843 million ED visits between 2003 and 2011, 8 million (0.9 %) were related to poisoning. Visits increased from 1.8 million (0.8 %) visits in [2003][2004] to 2.9 million (1.1 %) visits in 2010-2011, p = 0.001. Use of laboratory studies, EKGs, plain radiographs, and procedures remained stable across the study period. CT use was more than doubled, increasing from 5.2 to 13.7 % of visits, p = 0.001. ED length of stay increased by 35.5 % from 254 to 344 min, p = 0.001. Admission rates increased by 45.3 %, from 15.0 to 21.8 %, p = 0.046. Over the entire study period, 52.0 % of poisoned patients arrived via ambulance, and 3.0 % of patients had been discharged from the hospital within the previous 7 days. Poisoning-related ED visits increased over the 8-year study period; poisonings are resource-intensive visits and require increasingly longer lengths of ED stay or hospital admission.

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Evolving Trends and Treatment Advances in Pediatric Poisoning

Cited by 58 publications

References 19 publications

Adult Prescription Drug Use and Pediatric Medication Exposures and Poisonings

Adult Prescription Drug Use and Pediatric Medication Exposures and Poisonings

Household Cleaning Product-Related Injuries Treated in US Emergency Departments in 1990–2006

Trends in Emergency Department Resource Utilization for Poisoning-Related Visits, 2003–2011

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