ABSTRACT

Introduction:

The aim of this study is to analyze the interventions of acute intoxications in pediatric intensive care unit (PICU) admissions and to determine the aspect of critical care support by using the demographic and clinical outcomes.

Methods:

593 PICU admissions due to intoxications between 2013 and 2018 were enrolled in the study. Demographics, drugs/substances received, voluntary or accidental drug intake, time of elapse from drug intake to PICU admission, length of PICU stay and hospitalization, adverse effects (clinically significant and non-clinically significant effects), PICU interventions, PRISM-3 score and clinical findings were extracted from the files.

Results:

Accidental poisonings mainly occurred in 2-5-year-old children, in males (51.2%) at summer season. Antipiretics/analgesics, cardiac medications and insecticides were the most frequent substances. Children with voluntary poisonings had increased multi-drug intake, higher PRİSM-3 scores, longer PICU stay and hospitalization (p<0.001, p=0.046, p=0.001, p<0.001). Thirty-six (6.1%) children presented 82 adverse effects mainly involving cardiovasculary and neurological systems. Tachycardia was frequent with no observed dysrhythmia. Adrenalin infusions were administered to two children for intractable hypotension; another two patients received atropin iv. bolus for bradycardia respectively. One adolescent received mechanical ventilation due to incapability to sustain airway maneuver. None required hemodialysis. The time of elapse from drug intake to PICU admission was 6.21±2.86 hours with total length of PICU stay of 1.38±0.76 days and hospitalization of 3.45±1.49 days.

Conclusion:

Future studies should focus on the prediction of intensive care requirement by the evaluation of the initial clinical signs in childhood intoxicity. Declining unnecessary PICU admission would facilitate the utilization of intensive care beds for the critically ill children and the minimalization of health care costs.

Keywords: Intoxicity, accidental poisoning, voluntary poisoning, children, intensive care, intoxicity severity score

References

Yorulmaz A, Akbulut H, Yahya İ, Aktaş R, Emiroğlu HH, et al. Çocuk Acil Servisine Zehirlenme Nedeni ile Başvuran Olguların Geriye Dönük Olarak Değerlendirilmesi. Pediatr Emerg Intensive Care Med. 2017;4:96-103.

Kondolot M, Akyıldız B, Görözen F, Kurtoğlu S, Patıroğlu. Çocuk acil servisine getirilen zehirlenme olgularının değerlendirilmesi. Çocuk Sağlığı ve Hastalıkları Dergisi. 2009;52:68-74.

Nistor N, Frasinariu OE, Rugină A, Ciomaga IM, Jităreanu C, et al. Epidemiological study on accidental poisonings in children from northeast romania. Medicine (Baltimore). 2018;97:e11469.

Sahin S, Carman KB, Dinleyici EC. Acute poisoning in children: data of pediatric emergency unit. Iran J Pediatr. 2011;21:479-84.

Isac R, Gafencu M, Nastasie IA, et al. Accidental poisoning in paediatric patients—latest folow-up. Arch Dis Child. 2017;102:A178-178.

Kurt İ, Erpek AG, Kurt MN, Gürel A. Adnan Menderes Üniversitesinde izlenen zehirlenme olguları. ADÜ Tıp Fakültesi Dergisi. 2004;5:37-40.

Patel MM, Travers CD, Stockwell JA, Geller RJ, Kamat PP, et al. Analysis of Interventions Required in 12,021 Children With Acute Intoxications Admitted to PICUs. Pediatr Crit Care Med. 2017;18:e281-e289.

Rivero-Martín MJ, Prieto-Martínez S, García-Solano M, Montilla-Pérez M, Tena-Martín E, et al. Results of applying a paediatric early warning score system as a healthcare quality improvement plan. Rev Calid Asist. 2016; 31(Suppl 1):11-9.

Alobaidi R, Joffe AR. Are critical deterioration events the right metric to determine the impact of rapid response systems? JAMA Pediatr. 2014;168:9-10.

Persson HE, Sjoberg GK, Haines JA, Pronczuk de Garbino J. Poisoning severity score. Grading of acute poisoning. J Toxicol Clin Toxicol. 1998;36:205-13.

Böll R, Romanek K, Schmoll S, Stich R, Ott A, et al. Independent validation ofthe ICU requirement score in a cohort of acutely poisoned adults. Clin Toxicol (Phila). 2018;56:664-6.

Brandenburg R, Brinkman S, de Keizer NF, Kesecioglu J, Meulenbelt J, et al. The need for ICU admission in intoxicated patients: a prediction model. Clin Toxicol. 2017;55:4-11.

Fieldston ES, Li J, Terwiesch C, Helfaer MA, Verger J, et al: Direct observation of bed utilization in the pediatric intensive care unit. J Hosp Med. 2012;7:318-24.

Patel MM, Travers CD, Stockwell JA, Numur EA, Geller RJ, et al. Reducing Childhood Admissions to the PICU for Poisoning (ReCAP2) by Predicting Unnecessary PICU Admissions After Acute Intoxication. Pediatr Crit Care Med. 2018;19:e120-29.

Yılmaz HL, Derme T, Yıldızdaş D, Alhan E. Çukurova bölgesi’ndeki çocukluk çağı zehirlenme olgularının değerlendirilmesi. Nobel Med. 2009;5:35-44.

Bozlu GG, Kuyucu N. Çocuk Acil Servise Son Beş Yılda Gelen Zehirlenmeler: 1734 Olgunun Değerlendirilmesi. Adli Tıp Bülteni. 2018;23:106-9.

Centers for Disease Control and Prevention: CDC Childhood Injury Report: Pattern of Unintentional Injuries Among 0-19 Year Olds in the United States, 2000–2006. Atlanta, GA, Centers for Disease Control and Prevention, 2009.

Rodgers GC, Matyunas NJ. Poisonings: Drugs, chemicals, and plants. In: Behrman RE, Kliegmen RM, Jenson HB (eds). Nelson Textbook of Pediatrics. Philadelphia, W.B. Saunders; 2004:2362-74.

Ramos CLJ, Barros HMT, Stein AT, Costa JS. Risk factors contributing to childhood poisoning. J Pediatr. 2010;86:435-40.

Brandenburg R, Brinkman S, de Keizer NF, Meulenbelt J. In-hospital mortality and long-term survival of patients with acute intoxication admitted to the ICU. Crit Care Med. 2014;42:1471-9.

Singh O, Javeri Y, Juneja D, Gupta M, Singh G et al. Profile and outcome of patients with acute toxicity admitted in intensive care unit: experiences from a major corporate hospital in urban India. Indian J Anaesth. 2011;55:370-4.

Peiris-John R, Kool B, Ameratunga S. Fatalities and hospitalisations due to acute poisoning among New Zealand adults. Intern Med J. 2014;44:273-81.

Sorge M, Weidhase L, Bernhard M, Gries A, Petros S. Self-poisoning in the acute care medicine 2005–2012. Anaesthesist. 2015;64:456-62.

Athavale V, Green C, Lim KZ, Wong C, Tiruvoipati R. Characteristics and outcomes of patients with drug overdose requiring admission to Intensive Care Unit. Australas Psychiatry. 2017;25:489-93.

Plumb J, Dudley NC, Herman BE, Kadish HA. Utilization of a pediatric observation unit for toxicologic ingestions. Pediatr Emerg Care. 2012; 28:1169-72.

Even KM, Armsby CC, Bateman ST. Poisonings requiring admission to the pediatric intensive care unit: A 5-year review. Clin Toxicol (Phila). 2014;52:519-24.

Rivero-Martín MJ, Prieto-Martínez S, García-Solano M, Montilla-Pérez M, Tena-Martín E, et al. [Results of applying a paediatric early warning score system as a healthcare quality improvement plan]. Rev Calid Asist. 2016;31(Suppl 1):11-9.

Fenix JB, Gillespie CW, Levin A, Dean N. Comparison of pediatric early warning score to physician opinion for deteriorating patients. Hosp Pediatr 2015;5:474-9.

Judge BS, Ouellette LM, VandenBerg M, Riley BD, Wax PM, Toxicology Investigators Consortium (ToxIC) Case Registry: Utilization of observation units for the care of poisoned patients: Trends from the Toxicology Investigators Consortium Case Registry. J Med Toxicol. 2016;12:111-20.

Maignan M, Pommier P, Clot S, Saviuc P, Debaty G, et al. Deliberate drug poisoning with slight symptoms on admission: Are there predictive factors for intensive care unit referral? A three-year retrospective study. Basic Clin Pharmacol Toxicol. 2014;114:281-7.

Necessity of Intensive Care Requirement in Childhood Intoxicity

ABSTRACT

References