Santiago Mintegi1, Stuart R Dalziel2, Beatriz Azkunaga3, Javier Prego4, Eunate Arana-Arri5, Yordana Acedo3, Lorea Martinez-Indart5, Javier Benito3, Nathan Kuppermann6. 1. Pediatric Emergency Department, Cruces University Hospital, University of the Basque Country, Bilbao, Basque Country, Spain; santiago.mintegi@osakidetza.eus. 2. Children's Emergency Department, Starship Children's Hospital and Liggins Institute, University of Auckland, Auckland, New Zealand. 3. Pediatric Emergency Department, Cruces University Hospital, University of the Basque Country, Bilbao, Basque Country, Spain. 4. Departamento de Emergencia Pediátrica, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay. 5. Clinical Epidemiology Unit, Cruces University Hospital, BioCruces Health Research Institute, Basque Country, Spain; and. 6. Department of Emergency Medicine and Pediatrics, Davis School of Medicine, University of California, Sacramento, California.
Abstract
BACKGROUND AND OBJECTIVES: Identifying international differences in the management of acute pediatric poisonings may help improve the quality of care. The objective of this study was to assess the international variation and appropriateness of gastrointestinal decontamination (GID) procedures performed in children and adolescents who present with acute poisonings to emergency departments. METHODS: This was an international, multicenter, cross-sectional prospective study including children <18 years with poisoning exposures presenting to 105 emergency departments in 20 countries from 8 global regions belonging to the Pediatric Emergency Research Networks. Data collection started between January and September 2013 and continued for 1 year. The appropriateness of GID procedures performed was analyzed using the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists' recommendations. Multivariate logistic regression was performed to identify independent risk factors for performing GID procedures. RESULTS: We included 1688 patients, 338 of whom (20.0%, 95% confidence interval 18.1%-22.0%) underwent the following GID procedures: activated charcoal (166, 49.1%), activated charcoal and gastric lavage (122, 36.1%), gastric lavage (47, 13.9%), and ipecac (3, 0.9%). In 155 (45.8%, 40.5%-51.2%), the GID procedure was considered appropriate, with significant differences between regions. Independent risk factors for GID procedures included age, toxin category, mechanism of poisoning, absence of symptoms, and the region where the intoxication occurred (P < .001). CONCLUSIONS: Globally, there are substantial differences in the use and appropriateness of GID procedures in the management of pediatric poisonings. International best practices need to be better implemented.
BACKGROUND AND OBJECTIVES: Identifying international differences in the management of acute pediatric poisonings may help improve the quality of care. The objective of this study was to assess the international variation and appropriateness of gastrointestinal decontamination (GID) procedures performed in children and adolescents who present with acute poisonings to emergency departments. METHODS: This was an international, multicenter, cross-sectional prospective study including children <18 years with poisoning exposures presenting to 105 emergency departments in 20 countries from 8 global regions belonging to the Pediatric Emergency Research Networks. Data collection started between January and September 2013 and continued for 1 year. The appropriateness of GID procedures performed was analyzed using the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists' recommendations. Multivariate logistic regression was performed to identify independent risk factors for performing GID procedures. RESULTS: We included 1688 patients, 338 of whom (20.0%, 95% confidence interval 18.1%-22.0%) underwent the following GID procedures: activated charcoal (166, 49.1%), activated charcoal and gastric lavage (122, 36.1%), gastric lavage (47, 13.9%), and ipecac (3, 0.9%). In 155 (45.8%, 40.5%-51.2%), the GID procedure was considered appropriate, with significant differences between regions. Independent risk factors for GID procedures included age, toxin category, mechanism of poisoning, absence of symptoms, and the region where the intoxication occurred (P < .001). CONCLUSIONS: Globally, there are substantial differences in the use and appropriateness of GID procedures in the management of pediatric poisonings. International best practices need to be better implemented.
Authors: Simon Craig; Franz E Babl; Stuart R Dalziel; Charmaine Gray; Colin Powell; Khalid Al Ansari; Mark D Lyttle; Damian Roland; Javier Benito; Roberto Velasco; Julia Hoeffe; Diana Moldovan; Graham Thompson; Suzanne Schuh; Joseph J Zorc; Maria Kwok; Prashant Mahajan; Michael D Johnson; Robert Sapien; Kajal Khanna; Pedro Rino; Javier Prego; Adriana Yock; Ricardo M Fernandes; Indumathy Santhanam; Baljit Cheema; Gene Ong; Shu-Ling Chong; Andis Graudins Journal: Trials Date: 2020-01-13 Impact factor: 2.279