The Growing Impact of Pediatric Pharmaceutical Poisoning

  • G. Randall Bond
    Correspondence
    Reprint requests: G. Randall Bond, MD, Emergency Medicine ML 2008, 3333 Burnet Avenue, Cincinnati, OH 45229.
    Affiliations
    Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, and Department of Pediatrics, University of Cincinnati, Cincinnati, OH

    Drug and Poison Information Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
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  • Randall W. Woodward
    Affiliations
    Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, and Department of Pediatrics, University of Cincinnati, Cincinnati, OH
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  • Mona Ho
    Affiliations
    Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, and Department of Pediatrics, University of Cincinnati, Cincinnati, OH
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Published:September 16, 2011DOI:https://doi.org/10.1016/j.jpeds.2011.07.042

      Objective

      To understand which medications, under which circumstances, are responsible for the noted increase in pediatric medication poisonings, resource use, and morbidity.

      Study design

      Patient records from 2001-2008 were obtained from the National Poison Data System of the American Association of Poison Control Centers for children aged ≤5 years evaluated in a health care facility following exposure to a potentially toxic dose of a pharmaceutical agent. Pharmaceutical agents were classified as over-the-counter or prescription and by functional category. Exposures were classified as child self-ingested the medication or as therapeutic error. For the 8-year period, emergency visits, admissions, significant injuries, and trends in these events were calculated for each substance category.

      Results

      We evaluated 453 559 children for ingestion of a single pharmaceutical product. Child self-exposure was responsible for 95% of visits. Child self-exposure to prescription products dominated the health care impact with 248 023 of the visits (55%), 41 847 admissions (76%), and 18 191 significant injuries (71%). The greatest resource use and morbidity followed self-ingestion of prescription products, particularly opioids, sedative-hypnotics, and cardiovascular agents.

      Conclusions

      Prevention efforts have proved to be inadequate in the face of rising availability of prescription medications, particularly more dangerous medications.
      AAPCC ( American Association of Poison Control Centers), ARCOS ( Automation of Reports and Consolidated Orders System), ED ( Emergency department), OTC ( Over-the-counter), NPDS ( National Poison Data System)

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      Linked Article

      • The Last Mile: Taking the Final Steps in Preventing Pediatric Pharmaceutical Poisonings
        The Journal of PediatricsVol. 160Issue 2
        • In Brief
          The dramatic reduction in pediatric deaths from unintentional poisonings in the last half of the 20th century is a model of the successful application of injury prevention theory and practice. The increases in hospitalizations, emergency department (ED) visits, and persistence of deaths caused by unintentional pediatric pharmaceutical poisonings in the first decade of this century are described by Bond et al1 in this issue of The Journal and remind us that this effort is not yet complete. Hopefully the findings in this study can help catalyze targeted efforts to reverse the rise in injuries from pediatric pharmaceutical poisonings and push the number of pediatric deaths closer to zero.
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      • Correction
        The Journal of PediatricsVol. 160Issue 5
        • In Brief
          In the article, “The Growing Impact of Pediatric Pharmaceutical Poisoning,” by Bond et al, J Pediatr 2012;160:265-70, the authors submitted incorrect versions of Tables I and II for publication. The corrected versions of Tables I and II are below. Additionally, the number of significant injuries listed in the Abstract and Results section should be 18 192 (not 18 191).
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