Pediatric Poisoning Refresher

Posted by Patrick Lickiss on Jul 13, 2011 in Assessment, General, Research, Treatment | 2 comments

While browsing through recent journal articles, I came across a retrospective study published by the University of California at San Diego Emergency Medicine Department ^[1]. Looking back at eight years worth of EMS documentation (this is one of the limitations of a retrospective study) the researchers attempted to quantity particular information about pediatric poisonings in that time period.  I say that this is a limitation of a retrospective study because the validity of the research relies on the quality of documentation performed before the study was designed.  This can prove to be time consuming and may not yield useful results.

THE FINDINGS

There were more than 40,000 paramedic transport calls for patients 5 years and younger over the study period; 996 (2.5%) of these calls had the chief complaint of poisoning. Of the calls classified as poisonings, 38% involved a 1-year-old and 35% involved a 2-year-old. Fifty-six percent of these poisonings involved either prescription or over-the-counter medications. An additional 16% were due to household cleaners. Eighty-eight percent of all calls were classified as mild in acuity, with 13% of poisoning calls for children under a year of age classified as moderate or acute; 50% of moderate or acute poisoning calls were to children 2 years of age. July and March were the months with the highest incidence of poisoning calls. The fewest calls were received on Saturdays and Sundays^[1].

There are a few items of interest in these findings.  First of all, the vast majority (over 70%) of poisonings take place with patients 2 years old and younger.  It seems like a lot of presentations in that population should including poisoning as a potential differential diagnosis, particularly if you are struggling to find a cause for the symptoms.  Next, the majority of poisoning calls for pediatrics involve medications.  Keep in mind that therapeutic effects in adults are potentially fatal in pediatrics.  This is especially true with regards to medications targeted at the cardiovascular system like digoxin and beta-blockers.  Finally, “moderate” or “acute” poisonings were more likely to occur with patients two years of age.  This is logical as these patients are becoming more active and mobile.  When responding to patients in this age group (for other calls, not for poisonings) take a quick look around on scene and see if there are medications or household cleaners in easy reach of children.  This is the perfect opportunity to provide some education to the family, particularly if you’re not the primary caregiver.

NATIONAL STATISTICS
According to the American Association of Poison Control Centers,  over 52% of poisonings in 2009 occurred in patients aged 0-5 years.  Since 2006, the pediatric ingestion of analgesics has seen a particularly marked increase ^[2].  According to the CDC, children are twice as likely to be seen in the Emergency Department for medication poisoning as they are for poisonings from household cleaners ^[3].

ACTIONS WE CAN TAKE
We discussed earlier about maintaining an elevated index of suspicion for poisoning in pediatric patients.  We also discussed gently providing education to caregivers when an unsafe situation is discovered on scene (though not necessarily during a response for poisoning).  What about treatment options?  Poison Control is a valuable resource and every EMS practitioner should have the number in his or her cell phone.  Poison Control is staffed by medical providers who are able to provide you with valuable information, even if you do not know the exact toxin which has been ingestion.  Often, the individual answering the phone will be able to determine the substance based on partial labels, color, uses, etc.  I have had excellent luck with identifying myself as a paramedic on scene of a 911 call after the line is answered.  I am often transferred to a pharmacist right away and have been able to get treatment suggestions as well as findings (including ECG changes) to watch out for.  After that, it’s as easy as contacting my base hospital, letting them know that I contacted poison control and getting an order to treat as suggested by the pharmacist.

I encourage everyone reading this to stop for a moment and put the following number in your phone:  (800)222-1222.  You can call that number from anywhere in the U.S. and you will be connected to your local poison control center.

So how about it?  Have you used Poison Control on duty?  What about off duty?  What was your experience like?  Are you taught about using Poison Control during annual training?  Let me know in the comments.

CITED ARTICLES
[1] - Vilke GM: “Pediatric Poisonings in Children Younger than Five Years Responded to by Paramedics”. J Emerg Med 2011 Jan 5, [Epub ahead of print].

[2] – American Association of Poison Control Centers – 2009 Detailed Statistics (PDF Link)

[3] – Centers for Disease Control and Prevention – Poisoning Factsheet

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