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      An epidemiological snapshot of toxicological exposure in children 12 years of age and younger in Riyadh

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          ABSTRACT

          BACKGROUND:

          Poisoning among the pediatric population is an important public health concern that is responsible for frequent pediatric emergency department visits and hospital admissions. Surveillance of poisoning cases is essential for designing and implementing effective preventive strategies.

          OBJECTIVE:

          Describe the characteristics of acute poison exposure and related therapeutic interventions in children aged 12 years and younger.

          DESIGN:

          Prospective, descriptive cross-sectional study.

          SETTING:

          Two pediatric emergency departments in Riyadh.

          PATIENTS AND METHODS:

          We prospectively reviewed pediatric poisonings that presented to emergency departments over a period of two years.

          MAIN OUTCOME MEASURES:

          Epidemiological aspects of pediatric poisoning Riyadh.

          SAMPLE SIZE:

          1035 patients.

          RESULTS:

          The median (IQR) age at the time of exposure was 27 (23–42) months. The most frequently involved substance class was toxic household products in children younger than 6 years and pesticides in children 6 years or older. A frequently involved single agent was paracetamol in younger and older children. The majority of patients (78.7%) were completely asymptomatic at the time of presentation and during the observation period. Almost half of the exposure incidents (47.8%) needed no intervention. Most exposure incidents (95%) did not require any pharmacological support and most (87%) did not require nonpharmacological intervention. Eight (0.7%) patients required intubation and mechanical ventilation. Activated charcoal was administered for 27% of cases. Gastric lavage, whole bowel irrigation, and ipecac were used in a few cases (1%, 0.3%, and 0.1%, respectively). Enhanced elimination interventions were performed for only 0.5% of exposure cases. Only two patients died.

          CONCLUSIONS:

          Household products were the commonest reason for pediatric poisonings in Saudi Arabia and most of them were asymptomatic. Our results suggest a need for strategic plans for prevention and care.

          LIMITATIONS:

          May not be representative of the experiences and practices of smaller hospitals in remote regions of the country.

          CONFLICT OF INTEREST:

          None.

          Abstract

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          Most cited references29

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          2015 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 33rd Annual Report.

          This is the 33rd Annual Report of the American Association of Poison Control Centers' (AAPCC) National Poison Data System (NPDS). As of 1 January 2015, 55 of the nation's poison centers (PCs) uploaded case data automatically to NPDS. The upload interval was 9.52 [7.40, 13.6] (median [25%, 75%]) minutes, creating a near real-time national exposure and information database and surveillance system.
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            Unintentional child poisonings treated in United States hospital emergency departments: national estimates of incident cases, population-based poisoning rates, and product involvement.

            The goals were to develop national estimates of unintentional child poisoning cases treated in US hospital emergency departments, to determine population-based poisoning rates, and to evaluate characteristics of the victims and the products involved. Cases reported through the US Consumer Product Safety Commission National Electronic Injury Surveillance System, involving a national probability sample of US hospital emergency departments, were used as a basis for developing national estimates of product-related poisonings involving children<5 years of age treated in US hospital emergency departments in 2004. There were an estimated 86194 child poisoning incidents treated in US hospital emergency departments in 2004, amounting to 429.4 poisonings per 100000 children. Approximately 70% of the poisonings involved children 1 or 2 years of age, slightly more than one half involved boys, and 13.3% resulted in hospital admission. Approximately 59.5% of the poisonings involved oral prescription drugs, oral nonprescription drugs, or supplements. Other major product categories resulting in poisonings included cleaning products (13.2%), drugs and ointment preparations intended for external use (4.9%), and personal care products (4.7%). Approximately 54.7% of the poisonings involved products already subject to child-resistant packaging requirements under the Poison Prevention Packaging Act. Despite advances in recent years, unintentional child poisonings remain an important public health concern. The circumstances surrounding poisonings need to be evaluated further, and intervention strategies need to be developed.
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              The growing impact of pediatric pharmaceutical poisoning.

              To understand which medications, under which circumstances, are responsible for the noted increase in pediatric medication poisonings, resource use, and morbidity. 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. 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. Prevention efforts have proved to be inadequate in the face of rising availability of prescription medications, particularly more dangerous medications. Copyright © 2012 Mosby, Inc. All rights reserved.
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                Author and article information

                Journal
                Ann Saudi Med
                Ann Saudi Med
                asm
                Annals of Saudi Medicine
                King Faisal Specialist Hospital and Research Centre
                0256-4947
                0975-4466
                July-August 2019
                05 August 2019
                : 39
                : 4
                : 229-235 (pp. 229-235)
                Affiliations
                [a ] From the Department of Emergency Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
                [b ] From the Department of Environmental and Occupational Health, Ministry of Health, Muscat, Oman
                [c ] From the Department of Pediatric Emergency, King Saud Medical City, Riyadh, Saudi Arabia
                [d ] From the Department of Pediatrics, King Saud Medical City, Riyadh, Saudi Arabia
                Author notes
                Correspondence: Dr. Nahar Dakeel Alruwaili · Department of Emergency Medicine, King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh 11211, Saudi Arabia · T: +966-11-4424425 nalrowaily@ 123456kfshrc.edu.sa
                Author information
                https://orcid.org/0000-0002-3485-0332
                Article
                0256-4947.2019.229
                10.5144/0256-4947.2019.229
                6838645
                31381368
                dda31a30-4c2a-4448-b70b-2400139e8f66
                Copyright © 2019, Annals of Saudi Medicine, Saudi Arabia

                This is an open access article under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND). The details of which can be accessed at http://creativecommons.org/licenses/bync-nd/4.0/

                History
                : 9 December 2018
                : 28 April 2019
                Funding
                None.
                Categories
                Original Article

                Medicine
                Medicine

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