Pediatric Exposures Reported to the Toxicology Investigators Consortium, 2010–2015

Abstract

Background and Objective: Poisoning is the leading cause of injury death in pediatric patients. Hospital and provider readiness, including pharmacy stocking, depends on reliable surveillance data describing local patterns of age-specific clinically significant exposures and the therapeutic modalities employed in their treatment. We aimed to characterize trends in clinically significant toxic exposures and their management.Methods: We performed a retrospective review of patients 18 years or younger in the American College of Medical Toxicology's Toxicology Investigators Consortium (ToxIC) Registry, a self-reporting database completed by bedside consulting medical toxicologists. We reviewed cases from January 1, 2010, through December 31, 2015. In 2015, ToxIC included 101 health care facilities. Data collected included demographics, geographic region, encounter and exposure details, survival, and therapeutic modalities employed, including antidotes, antivenoms, gastric decontamination, enhanced elimination, hyperbaric oxygen therapy, and extracorporeal membrane oxygenation.Results: From 2010 to 2015, 11,616 consults were recorded in ToxIC. Pediatric consultations increased from 934 (23.7%) in 2010 to 2425 (29.9%) in 2015 ( P < 0.001). Exposures were most commonly reported in females (57.8%) and adolescents (59.4%). Intentional ingestions (55.5%) comprised the majority of cases. The most frequent agents of exposure were analgesics (21.0%). There were 38 deaths reported (0.9%). The antidote used most commonly was N-acetylcysteine (11.0%). Geographic variation was demonstrated in prevalence of envenomations and heavy metal exposures, their respective treatments, and overall use of decontamination.Conclusions: Toxicology consultations for pediatric exposures increased from 2010 to 2015. Understanding which pediatric exposures require toxicologist management, the therapies most frequently employed, and geographical patterns is paramount to facility-level planning, pharmacy stocking, and provider education.

Use of Extracorporeal Membrane Oxygenation in Acutely Poisoned Pediatric Patients in United States: A Retrospective Analysis of the Extracorporeal Life Support Registry From 2003 to 2019

“…However, toxic exposure within this age group is likely from exploratory behavior, rather than self-harm intent, corresponding with their age-associated pediatric developmental milestone/behavior. Whereas among adolescents, selfharm/intentional exposure have been the predominant and increasing cause of poisoning (1,4,22). The overall survival rate of our cohort (65.1%) was similar to the findings of other studies (68-86%) that used different poison center-based data or registry with a wide range of sample size (n = 6 [2], n = 10 [8], n = 14 [7], n = 20 [4], n = 75 [3]).…”

“…However, toxic exposure within this age group is likely from exploratory behavior, rather than self-harm intent, corresponding with their age-associated pediatric developmental milestone/behavior. Whereas among adolescents, self-harm/intentional exposure have been the predominant and increasing cause of poisoning (1, 4, 22).…”

“…Pediatric poisonings have increased in recent years and rank as one of the leading causes of injury-related morbidity and mortality (1–4). Annually, approximately 5% of toxic exposures require PICU admission and critical care interventions such as vasopressor/inotropic support and antidotal therapies (5).…”

“…Currently, data on the use of ECMO for acute pediatric poisoning are limited to observational studies, often including adult patients, case reports, and case series (2)(3)(4)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Thus, indications and timing of ECMO support in this select critically ill population remain controversial (3,6).…”

Consensus Development of a Core Content for a Standardized Medical Toxicology Curriculum for Medical Students

“…Poisoning is the leading cause of unintentional injury-related death [ 1 , 2 ]. In 2019, the nationwide death rate in the USA due to unintentional poisonings was 20 deaths per 100,000, and over 2.1 million calls were made to US poison control centers for human poison exposures [ 3 , 4 ].…”