The epidemiology of childhood poisonings in Cyprus

Retrospective Evaluation of Poisoning Cases Followed Up in a Pediatric Intensive Care Unit-A 12-Year Experience in a Single Center

OBJECTIVES

Poisonings constitute an important part of preventable morbidity and mortality in pediatric intensive care units (PICUs) and hospitalizations. However, information on poisoning requiring intensive care is limited. This study aimed epidemiological evaluation of poisoning cases treated in the PICU in a single center.

METHODS

The records of 504 patients admitted to the PICU due to acute poisoning between 2010 and 2022 were retrospectively reviewed. Data were evaluated using descriptive methods and the χ 2 test, and statistical differences with P value <0.05 were considered significant.

RESULTS

The age range of the patients ranged from 1 month to 216 months (18 years), and the rate of girls was 53.2% (n = 268), whereas the rate of boys was 46.8% (n = 236). The mean age was 4.4 ± 4.3 years for boys, 6.7 ± 5.8 years for girls, and 5.6 ± 5.3 years for all patients. It was determined that 79.6% of the cases were poisoned by accident and 20.4% by suicide. A total of 76.7% of the patients who were poisoned for suicide were girls and 23.3% were boys. The mean age of these patients was 14.3 ± 3.0 years. On the other hand, 47.1% of the children who were accidentally poisoned were girls and 52.9% were boys, and the mean age of these children was 3.4 ± 2.9 years. Although 79.9% of poisonings occurred at home, the causative agent was oral poisoning in 97.4% of the cases. Approximately two thirds (69.2%) of the cases were drug-related, whereas 30.8% were related to nondrug substances. In drug-related poisonings, central nervous system drugs (35.8%) were the most common agent, followed by analgesic/antipyretic (20.9%) agents, whereas among the nonpharmaceutical factors, insecticides (agricultural pesticides, rat poison, pesticides, etc) were the most common, followed by poisonous herbs (beetleweed, widow's weed, cannabis, etc). The mean admission time of the patients to the hospital was 6.3 ± 8.4 hours, and the mean length of stay in the intensive care unit was 1.6 ± 1.3 days. In the 12 years of our study, only 3 patients died due to poisoning, and our mortality rate was 0.5%. Four patients (0.7%) were referred to the Alcohol and Drug Addicts Treatment and Research Center.

CONCLUSIONS

In this study, in which we retrospectively analyzed the profiles of poisoning cases hospitalized in the PICU for 12 years, we determined that poisonous weeds were the major factor in accidental poisonings, and suicidal poisonings were above the expected rates even at the young age group such as 8-12 years old. These results show the importance of determining the poisoning profile of the health care service area.

Poisoning among children in Malaysia: A 10-years retrospective study

Background

Poisoning commonly occurs among children due to their curiosity, where they tend to explore and investigate their surroundings. They frequently put what they find into their mouths as they do not understand the danger and probably cannot read the warning label. As this issue has not been extensively studied in Malaysia; hence, a retrospective analysis of records was carried out to determine the profile of phone call enquiries regarding poisoning among children at the National Poison Centre (NPC).

Methodology

The records of all cases of poisoning among children below the age of 18 years were retrospectively reviewed over a period of 10 years from 2006 to 2015. The data on the cases were analysed according to age group and gender, the circumstances and the toxic agent implicated in the poisoning.

Results

During the 10-year study period, 13,583 calls that met the criteria for this study were referred to the NPC. Of these calls, 62.2% involved children between the age of 0 to 5 years, 9% were children aged between 6 to 12 years, and 28.8% were children between 13 to 18 years. Unintentional poisoning accounted for 96.7% of the incidents involving children between the age of 0 to 5 years, although among the children who were between the age of 13 to 18 years, 76% of the cases were intentional. In all the cases involving children, pharmaceutical agents were the most frequent source of the poisoning. More than 95% of the cases were exposed to poisoning through the oral route.

Conclusion

Poisoning in children between the age of 0 to 5 years was mainly unintentional, while poisoning in children between the age of 13 to 18 years was mainly intentional, where pharmaceutical and household agents were responsible for more than two-thirds of the poisoning cases. Most of these incidents could have been prevented if protective measures, such as child-resistant enclosures, had been implemented and if the parents and guardians had been educated about preventive measures, such as keeping poisoning agents out of the reach of children.

Assessment of knowledge and practice of nurses on initial management of acute poisoning in Dessie referral hospital Amhara region, Ethiopia, 2018

Introduction

Poisoning is a major health problem worldwide, and it causes significant morbidity and mortality. It is estimated that 350,000 people died worldwide from unintentional poisoning. The purpose of this study is to assess nurses’ knowledge and practice on the initial management of acute poisoning among nurses in Dessie referral hospital, Amhara region, Ethiopia.

Methods

Hospital based cross sectional study was conducted from January 2018 to June 2018. Simple Random sampling technique was used to select the samples. Data was collected by using self-administered structured questioners. Data were cleansed, checked for completeness and entered into SPSS version 20 for analyses. Statistical measures of Central tendency, T-test and ANOVA were used in determining the association between independent and dependent variables.

Results

Based on the given 13 items to assess the general knowledge of nurses on poisoning, the score ranges from 2 to 9 with the range of 7 with the mean score of 7.48(SD-0. 0.839) for the entire respondents that was 57.5% for the given items that was less than 75% which was unsatisfactory level of knowledge. The mean score of general knowledge on poisoning was high among nurses who had training on initial management of poisoning than those nurses who had not the training.

Conclusion and recommendation

All Dessie referral nurses that participated in this study had unsatisfactory general knowledge on poisoning, knowledge on initial management of acute poisoning and self-reported practice. The major implication of these study findings on the health system is the importance of ensuring support to nurses’ health care services for early detection and management of poisoning.

Epidemiology of paediatric poisoning presenting to a children's emergency department in Singapore over a five-year period

INTRODUCTION

Paediatric poisoning accounts for 1% of daily emergency department presentations. The aim of this study was to review the characteristics and outcomes of paediatric patients who presented with drug overdose over a five-year period.

METHODS

We performed a retrospective review of paediatric poisoning cases at KK Women's and Children's Hospital (KKH), the largest children's public hospital in Singapore, from 1 January 2009 to 31 December 2013.

RESULTS

A total of 1,208 cases of poisoning were seen in KKH's Department of Children's Emergency during the study period. The gender distribution was about equal, with a slight male predominance. The majority of the poisoning cases were accidental. Slightly more than half of the intentional ingestions were of paracetamol and the majority were female patients belonging to the 12-16 year age group. The bulk of poisonings occurred in children aged 1-4 via the oral route, slightly more than half of the oral ingestions consisted of oral medications and a sizeable portion were of household liquids. Mothballs and silica gels accounted for almost a quarter of the solid household products ingested. Slightly less than half of the patients required admission and only a small portion of the admitted patients required intensive or high dependency care.

CONCLUSION

The prognosis of paediatric patients who presented with poisoning in our study was good, with a short median length of stay for those admitted and no fatalities being reported across the span of five years.

Poisoning due to household products: A ten years retrospective analysis of telephone calls to the National Poisons Information Centre, All India Institute of Medical Sciences, New Delhi, India

Extensive use of different chemicals in various fields and their easy availability has led to an increased incidence of accidental and intentional poisoning in developing countries including India. A diverse range of household products commonly used for domestic purposes comprise pesticides, household cleaners, thermometer mercury, antiseptics, kerosene, paint thinners etc. Any of these products, if misused or mishandled can cause poisoning. In India, the National Poisons Centre (NPIC) at the All India Institute of Medical Sciences, New Delhi, provides information on management of poisoning to treating physicians. Analysis of data based on telephone calls received by the NPIC (April 2006-March 2016) has highlighted a high incidence of poisoning due to household products, followed by pharmaceuticals, agricultural pesticides and industrial chemicals. The objective of the present retrospective study was to determine the incidence of poisoning due to various household products as reported to the NPIC during the ten years period. The total number of calls received by the Centre was 16,420. There were 7114 calls (45.5%) due to household products with adults (>18yrs.) and children (<1-18yrs.) constituting 38.7% and 61.2% calls respectively. Males outnumbered females (M = 62.4%, F = 37.5%). The mode of poisoning was mainly unintentional (66.8%) followed by intentional mode (33.2%). The commonest route of exposure was oral (95.6%). Household pesticides were commonly implicated (43.7%) followed by household cleaners (21.8%), thermometer mercury (5.2%) naphthalene balls (5%), antiseptics (3%), kerosene (2%) and paint thinner (2%). Miscellaneous products comprising of camphor, silica gel, hair dye, nail polish remover, cosmetics, adhesives etc were also involved in poisoning (17.1%). The trend and pattern of poisoning varies in different parts of the country, because all calls on poisoning are not reported to the Centre. So the data as such may not be a true reflection of the scenario in India. However, the results do indicate an increasing incidence of poisoning due to household products especially in children. The probable reasons for high incidence could be careless storage, ignorance, non compliance with prescribed instructions for use and negligible parental supervision in case of children. The results of the study highlight, an urgent need to identify high risk circumstances, common toxic products involved and implementation of prevention and awareness programmes, to achieve poisons control at home.

A systematic review on human exposure to organophosphorus pesticides in Iran

Human exposure to organophosphorus (OP) pesticides is a serious health challenge. We conducted a systematic review by searching international and national databases for published literature on any human exposure to OPs in Iran from 1990 to March 2015. Qualified papers were in two categories including studies in which biomarkers of exposure were assessed (n = 13; total no. of subjects = 759) and studies that had reported prevalence of OPs-induced poisoning (OPP) and mortality (n = 26; total no. of subjects = 5428). The mean level of activity of acetyl-cholinesterase and butyryl-cholinesterase were 68.65% and 74.2%, respectively. Overall proportion (%) of OPP was estimated (16; 95% CI, 14 to 19).

The Comparison of Accidental Poisonings Between Pharmaceuticals and Nonpharmaceuticals in Children Younger than 3 Years

INTRODUCTION

The management of pediatric poisoning is dependent on the type of toxicant ingested; however, little information has been published regarding the difference in poisoning by pharmaceuticals and nonpharmaceuticals in children. We compared the accidental poisoning of children younger than 3 years who had ingested pharmaceuticals or nonpharmaceuticals using emergency medical information center data.

METHODS

We retrospectively reviewed the records of the poisonings of children younger than 3 years who were evaluated by the Seoul Emergency Medical Information Center in 2011. The demographic data and detailed information regarding the poisonings were investigated. The substances that caused the poisonings were divided into the following 2 groups: pharmaceuticals and nonpharmaceuticals, and their characteristics and the differences between the 2 types of poisonings were investigated.

RESULTS

A total of 1279 cases were collected, most of which involved children who were 13 to 24 months old. Boys (51.3%) were involved more than girls. Exposure to nonpharmaceuticals (60.7%) was more common than exposure to pharmaceuticals. Personal care products and respiratory agents were the most commonly implicated substances. There were several significant differences between the pharmaceutical and nonpharmaceutical groups. Poisoning by pharmaceuticals occurred more frequently in older children and more frequently at night. Although the exact exposure of the children in the pharmaceutical group was known and they required more treatment in the emergency department, they were not given extra immediate first aid than the children in the nonpharmaceutical group.

CONCLUSIONS

Because there were several significant differences in the characteristics of accidental pediatric poisonings between the pharmaceutical and nonpharmaceutical groups, preventive strategies and educational programs should be implemented on the basis of the causative agent.

[Epidemiological profile of exogenous poisoning in children and adolescents from a municipality in the state of Mato Grosso]

OBJECTIVE:

To study the epidemiology of exogenous intoxications in children and adolescents of Barra Garças, Mato Grosso, from January 2008 to September 2013.

METHOD:

This was a cross-sectional, retrospective, and descriptive epidemiological study. Data were collected from the Disease Notification System (Sistema de Informação de Agravos de Notificação [SINAN]) of the municipality, processed using Microsoft Excel, and evaluated through BIOESTAT statistical software. The variables included were: sex; age; toxic agent; time and place of service; route of administration; circumstance; and classification of intoxication. The age range was established according to the Brazilian Institute of Geography and Statistics, comprising children aged from 0 to 9 years old and adolescents aged from 10 to 19 years old.

RESULTS:

A total of 125 cases of accidental exogenous poisoning was registered, including 77 children and 48 adolescents. Food and beverages (38.4%) and drugs (24.0%) were the most common groups of toxic agents responsible for the poisoning. The largest age group affected by intoxication was composed of children aged from 0 to 4 years old (43.2%) and adolescents aged from 10 to 14 years old (19.7%). Regarding the circumstances, intoxication occurred due to suicide attempts (16.8%) and accidental events (23.2%) in adolescents and children, respectively. The study revealed a higher frequency of poisoning in girls.

CONCLUSION:

Exogenous intoxications occurred predominantly in children up to 4 years old, through the accidental consumption of food or drinks. Thus, the adoption of educational prevention programs for children's family members and caregivers is necessary.

Epidemiological profile of exogenous poisoning in children and adolescents from a municipality in the state of Mato Grosso

OBJECTIVE: To study the epidemiology of exogenous intoxications in children and adolescents of Barra Garças, Mato Grosso, from January 2008 to September 2013.METHOD: This was a cross-sectional, retrospective, and descriptive epidemiological study. Data were collected from the Disease Notification System (Sistema de Informação de Agravos de Notificação [SINAN]) of the municipality, processed using Microsoft Excel, and evaluated through BIOESTAT statistical software. The variables included were: sex; age; toxic agent; time and place of service; route of administration; circumstance; and classification of intoxication. The age range was established according to the Brazilian Institute of Geography and Statistics, comprising children aged from 0 to 9 years old and adolescents aged from 10 to 19 years old.RESULTS: A total of 125 cases of accidental exogenous poisoning was registered, including 77 children and 48 adolescents. Food and beverages (38.4%) and drugs (24.0%) were the most common groups of toxic agents responsible for the poisoning. The largest age group affected by intoxication was composed of children aged from 0 to 4 years old (43.2%) and adolescents aged from 10 to 14 years old (19.7%). Regarding the circumstances, intoxication occurred due to suicide attempts (16.8%) and accidental events (23.2%) in adolescents and children, respectively. The study revealed a higher frequency of poisoning in girls.CONCLUSION: Exogenous intoxications occurred predominantly in children up to 4 years old, through the accidental consumption of food or drinks. Thus, the adoption of educational prevention programs for children's family members and caregivers is necessary.

Acute poisoning in children under the age of six: a two-decade study of hospital admissions and trends

AIM

To evaluate the incidence, clinical features and outcome of acute poisoning in children of less than 6 years of age in northern Finland.

METHODS

Children hospitalized with acute poisoning at the Oulu University Hospital between 1991 and 2010 were retrospectively evaluated from hospital records.

RESULTS

There were 334 hospital admissions due to acute poisoning during the study period, with an overall incidence rate of 5.2 per 10 000 per year, decreasing slightly from 6.7 in 1991-1995 to 4.5 in 2006-2010. Mean length of a hospital stay was 1.2 (SD ± 1.26) days. The most common substances ingested were terbutaline (12.3%), benzodiazepines (12.0%) and dishwasher powder (9.3%). Almost half of the patients were admitted to the paediatric intensive care unit, but most only required supportive care. Specific antidotes were administered in 16 cases. Three patients suffered from aspiration pneumonia as a result of ingesting poison, but no children died during the study.

CONCLUSION

Poisoning is a fairly common cause of hospital admission in children under the age of six. In most cases, their clinical condition is good, and they can be discharged after a short surveillance period.