Pattern of acute poisonings in childhood in Ankara: what has changed in twenty years?

Poisoning represents one of the most common medical emergencies in childhood, and epidemiological properties differ from country to country. Thus, special epidemiological surveillance for each country is necessary to determine the problem according to which preventive measures can be taken. The purpose of this study was to clarify the characteristics of acute poisoning cases admitted to a pediatric referral hospital. All poisoned patients under 17 years of age, except for cases food poisoning, presenting to the Emergency Department (ED) from January 1995 to December 2000 were determined. The information about each case was recorded on standardized forms and a retrospective chart review survey was done. Complete epidemiological and clinical data were obtained for 489 patients. The mean age of all poisoned patients (mean +/- standard deviation) was 5.96 +/- 4.87 years, and the age range was 0.01 to 17 years. Three hundred and thirty-one children, forming 63.6% of all patients, were under five years of age. Slightly more boys (52.3%) than girls were intoxicated at ages less than 10 years, after which more girls (79%) than boys were involved. The majority of all cases were due to accidental poisoning (78.1% of all poisonings) which occurred mostly in children under five years of age (73.3%). While accidental poisonings (97.1%) were the most common mode of poisoning between 1-5 years, self-poisonings (67.3%) had the highest ratio in cases over 10 years of age. In patients younger than one year of age, 74.2% of all poisonings were due to therapeutical error. Drugs were the most frequent offending agent (57.7%), followed by ingestion of a caustic/corrosive substance (16.8%) and carbon monoxide (CO) intoxication (9.4%). Analgesics were the most common agents, forming 23.7% of all poisonings due to drugs, followed by ingestion of multiple drugs and tricyclic antidepressants at ratios of 21.6% and 9.6%, respectively. The most common route of poisoning was ingestion of the poison (437/489 patients, 89.4%) and most were ingested inside the house (93.3%). About half of all poisoned patients (50.9%) were admitted to the ED within the first two hours of ingestion, and gastric lavage was performed on about half of the poisoned children (48.7%). In most of the cases, hospital treatment was non-specific, including general measures of decontamination and supportive-symptomatic therapy. During the six-year study period, two patients were lost due to acute poisoning, yielding an overall mortality rate of 0.4%. While most of the poisonings were due to accidental ingestions in infancy and primary school ages without sex predilection, the incidence of self-poisonings, especially in girls, was found to be increased. Analgesics, tricyclic antidepressant drugs (which seemed to form a new and dangerous group) and caustic/corrosive substances were the most commonly ingested agents. The early awareness of poisoning and appropriate therapeutic measures taken seemed to be efficacious with a very low mortality rate. The epidemiological and preventive properties of childhood poisonings should be further searched by prospectively designed multicentered studies throughout our country.