Analysis of Interventions Required in 12,021 Children With Acute Intoxications Admitted to PICUs

Abstract

Objectives:

Acute intoxications in children account for 4.6% of annual admissions to the PICU. We aimed to describe the interventions and monitoring required for children admitted to the PICU following intoxications with the ultimate goal of determining patient and intoxication characteristics associated with the need for PICU interventions.

Design:

Retrospective review of prospectively collected data from Virtual Pediatric Systems, LLC.

Setting:

United States PICUs participating in the Virtual Pediatric Systems database from 2011 to 2014.

Patients:

Less than or equal to 18 years old admitted to a PICU with a diagnostic code for poisoning, ingestion, intoxication, or overdose.

Interventions:

None.

Measurements and Main Results:

In total, 12,021 patients were included with a median PICU length of stay of 0.97 days (interquartile range, 0.67–1.60). Seventy-eight percent of the intoxications were intentional. The top five classes of medications ingested were unknown substances (21.6%), antidepressants (11.5%), other chemicals (10.7%), analgesics (7.3%), and antihypertensives (6.2%). Seventy-six (0.61 %) patients died. Any of the interventions reported in the Virtual Pediatric Systems database were performed in only 29.1 % of the total cases.

Conclusions:

The majority of cases (70.9%) admitted to the PICU following an intoxication did not undergo any significant intervention. Future studies should focus on distinguishing patient and intoxication characteristics associated with need for PICU intervention to optimize patient safety and minimize resource burden. ( Pediatr Crit Care Med 2017; 18:e281 -e289)