Epidemiological aspects of poisoning in children observed over a 10-year period

A retrospective study on non-drug related poisoning in the community among children from south India

OBJECTIVES

This retrospective study was performed to determine the incidence, demographic distribution, types and outcomes across various non-drug related poisonings among children attending a tertiary care center in south India.

METHODS

All children from 0-16 years who presented to the Paediatric Emergency Department, Christian Medical College, Vellore with non-drug related poisoning from October 2004 to September 2013 were included.

RESULTS

Out of the total 997 cases of poisoning, 629 (63.1%) cases were contributed by chemicals and plants: mainly hydrocarbons (kerosene) 309 (49.1%); organophosphates 72 (11.5%); corrosive acids and alkalis 57 (9.1%); insecticides 51 (8.1%); and plant poisons 20 (3.2%). Males (62.79%) and children < 5 years (77.42%) were mostly affected. Although many children developed complications requiring intensive care unit admissions, the total mortality was only 9 (1.4%). The incidence of poisoning showed a decreasing trend over the last 4 years.

CONCLUSION

This study for the first time gives an elaborative insight on non-drug related pediatric poisoning from a tertiary care center in south India for almost a decade.

Drug poisoning in the community among children: a nine years' experience from a tertiary care center in south India

OBJECTIVES

This study was performed to determine the incidence, demographic distribution, types and outcomes across various drug poisonings among children from south India.

METHODS

This retrospective study included children less than 16 years who presented to the Pediatric Emergency Department with drug poisoning from the 1st of October 2004 to the 30th of September 2013.

RESULTS

Out of the total 997 poisoning cases, 366 (36.71%) were contributed by drugs; mainly antiepileptics, central nervous system depressants, psychotropics, analgesic-antipyretics and natural drugs. Males and children of < 5 years were mostly affected. Although many children developed complications and required intensive care unit admissions, the total mortality rate was less than 1%. The incidence of drug poisoning showed a decreasing trend over the last 4 years.

CONCLUSION

This study for the first time gives an elaborative insight into pediatric drug poisoning over a nine-year period from a Pediatric Emergency Department tertiary care center in south India.

Profile of childhood poisoning at a tertiary care centre in North India

OBJECTIVES

To determine the profile and outcome (discharge from emergency room after observation, admission or death) of pediatric patients presenting with acute poisoning to a tertiary care centre in north India.

METHODS

We retrospectively reviewed the last 2 year (July, 2004 to July, 2006) hospital records of pediatric emergency room to profile all cases of pediatric poisoning during that period and noted their outcome. All cases age < or = 12 years with definite history of poisoning were included.

RESULTS

111 patients presented to the pediatric emergency during the study period. Mean age of our patients was 3.12 +/- 2.04 yrs (SD). Majority of our patients (63.9%) was in the 1-3 yr age group. Males outnumbered females by a factor of two; majority of our patients resided in urban areas. Kerosene (27.9%), drugs (19.8%) and insecticides (11.7%) were the agents most frequently implicated. Almost all (96.9%) ingestions were accidental in nature. Thirty six patients (32.4%) were asymptomatic after 6 hr of observation in the emergency ward; 75 patients (67.6%) developed symptoms related to toxic ingestion. The common serious symptoms included altered sensorium, respiratory distress, seizures, ataxia, hypotension, cyanosis and burns; three patients required intubation and mechanical ventilation. Almost one third of our patients underwent gastric lavage; no patient with kerosene poisoning or any other inappropriate indication underwent the same.

CONCLUSION

The trends for pediatric poisoning noted at our centre are not very different from those observed in hospital-based studies conducted more than a decade ago, despite the rapid socioeconomic development in our country. In sharp contrast to developing countries, where majority of poisonings are due to common non-toxic household products, most of our patients require hospitalization because of severe symptoms related to dangerous nature of toxins ingested. Consultation with the poison cell results in improved patient management.

Epidemiological aspects of childhood poisonings in Ankara: a 10-year survey

In the 10-year period 1975-1984, 1188 children were admitted to the Children's Hospital of Hacettepe University in Ankara with a diagnosis of poisoning. Retrospective analysis of their medical records showed that the incidence of poisoning with medicinal drugs was 64.0%, while pesticides accounted for 17.8% and plants for 6.7% of total cases. The majority (69.9%) of cases were due to accidental poisoning, 70.6% of which occurred in children under 5 years of age; 15.1% of the poisonings were diagnosed as therapeutic mishaps of which 68.3% involved children under 5 years of age. Analgesics (186 cases), barbiturates (176 cases) and tranquilizers (37 cases) were the most common drugs encountered, however, the two drugs most frequently overused were aspirin (146 cases) and Optalidon (175 cases). Overall mortality was 4.9% (58 cases). Fifty per cent of fatalities were due to accidental poisoning while 41.4% (24 cases) were due to therapeutic mishaps. This study is presented as a background to the need for the development of a Poison Information Service for Ankara.

Self poisoning in children: a ten year survey

All children, 17 years of age or less, admitted to the Children's Hospital of Hacettepe University Medical Center in Ankara during the period of 1975 to 1984 with a diagnosis of poisoning were studied. Of the 1188 cases reviewed, mode of poisoning was deliberate self-poisoning in a total of 152 cases (12.8%). Drugs accounted for 95.4%, insecticides for 3.9% and carbon monoxide for only 0.7% of the overall suicide attempts or gestures. Analgesics and tranquilizers were the most common agents encountered, however the major drug used for self-poisoning was a barbiturate containing analgesic, Optalidon. The incidence of self-poisoning was 79.0% in the age group 13-17 of the overall poison admissions and in all of the age groups self-poisoning showed a significant (p less than 0.001) sex difference with definite prevalence of girls.

Accidental poisoning in childhood: five year urban population study with 15 year analysis of fatality

Patterns of accidental poisoning in children are changing dramatically. A five year population study (1977-81) was undertaken in urban children from Brisbane (population 1 000 000). A total of 2098 children were poisoned during this period with only one fatality, which represents a dramatic reduction in mortality. Over the past 15 years (1968-82) 13 children have died from accidental poisoning from this population, and two were murdered with drugs. A study of secular trends has indicated that peak incidence occurred in 1979, and the rate has been falling progressively since. The current age corrected rate of poisoning is 393 per 100 000 children per year (0-5 year olds). The rank order of poisons, drugs, and chemicals causing hospital admission and death is: petroleum distillates 13%; antihistamines 9%; benzodiazepines 9%; bleach and detergents 7%; and aspirin 6%. The ratio of fatalities to ingestions requiring hospital admission was calculated to give an index of a practical danger of noxious agents to which children are currently exposed and the rank order is: cardiotoxic drugs, one fatality to 25 ingestions; tricyclic antidepressants, one to 44; sympathomimetic drugs, one to 54; caustic soda, one to 68; aspirin, one fatality to 350 ingestions. Accidental poisoning of children leading to death has been reduced because patterns of drug prescriptions have changed, packaging of dangerous drugs has been made safer, and substances such as kerosene have been coloured blue.

Acute poisonings of children in Oslo. A one year prospective study

A one year prospective study of all children under 15 years of age presenting for acute poisoning in Oslo is reported. There were 181 admissions in 179 children, of which 97 (54%) were boys, giving an annual incidence of 2.3%. All children survived without sequelae. Most poisonings were accidental and only two suicidal attempts were recorded. Of all poisonings 68 per cent occurred between the age of 1 and 2 years. The dominating toxic agents were drugs (44%), tobacco (22%) and petroleum products (9%). Most poisonings were mild and only 7 (4%) classified as severe. Seventy-two per cent of all children were admitted within the second hour after the ingestion of the toxic agent. Therapy should therefore be directed towards emptying the stomach with emetics or gastric lavage, unless corrosives or petroleum products are ingested. Childhood poisonings still call for better preventive measures since the toxic agent was found inappropriately stored in 86% of the accidental poisonings.