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 Abstract
Objectives - To determine whether there
is a greater role for emergency medicine
in the management of childhood
poisoning. To determine recent trends in
childhood poisoning locally and compare
with national trends.
Methods -
Information was collected for the
preceding seven years from the hospital
computer archive system to determine
demographics and trends.
Results - 50%
of children were discharged on the day
of admission, 95% were discharged within
24 hours and 99% within 48 hours. There
has been a decline in admissions both
locally and nationally since 1997.
Conclusions - There is a role for
emergency medicine in the management of
childhood poisoning. This would be in
large departments with a substantial
paediatric workload and with nursing and
medical staff trained in paediatrics.
This would avoid duplication of work,
reduce inpatient admissions, further
reduce the length of stay for the
children, it would reduce hospital
expenditure although it would have
implications in terms of training and
workload for emergency medicine.
The decreasing
trend of admissions can be explained by
primary prevention campaigns by ROSPA
(The Royal Society for the Prevention of
Accidents) the child accident prevention
trust, as well as a higher threshold for
admission by emergency doctors.
Key words
-childhood, poisoning, child resistant
containers.
Introduction
Childhood
poisoning is a common cause of parental
anxiety and hospital admission. It
presents a considerable workload for the
paediatric department's inpatient
resources. Many emergency departments
have taken full responsibility for the
management of adult poisoning not
requiring intensive care support and
many emergency medicine physicians have
acquired considerable knowledge and
skills in this subspecialty. We plan to
determine whether there is a similar
role for emergency medicine in the
management of childhood poisoning.
Childhood
poisoning is a common cause for
telephone advice either directly to the
department or to NHS direct, (a
telephone helpline service). In this
study we plan to determine how effective
this service is. Child resistant
packaging has been proven to be
effective(1,2) and we also plan to
determine the efficacy of child
resistant containers in our local cohort
of patients.
There have
been many campaigns targeting primary
prevention by regional groups as well as
nationally by ROSPA and the child
accident prevention trust. We plan to
determine recent trends in admissions
due to childhood poisoning and compare
with national trends.
Setting
Altnagelvin Area Hospital, a district
general hospital in Londonderry,
Northern Ireland, with a total catchment
population of approximately 200,000 in a
mixed urban/rural environment.
Method
Retrospective
data was collected for the previous
seven years using information collected
on discharge on the Northern Ireland
Paediatric Patient Event Recording
System (NIPPERS) from the first of
January 1993 to the first of January
2001. All possible codes were used.
Results
During the 7
year period there was a total of 674
patients admitted and discharged with a
diagnosis related to poisoning, 59 in
1994, 58 in 1995, 84 in 1996, 116 in
1997, 99 in 1998, 80 in 1999 and 67 in
2000. (See chart 3).
Paracetamol
was the commonest agent, other common
agents included anticonvulsants,
diazepam and analgesics,eg. aspirin
(which has continued to decline as a
cause of poisoning). The average age of
the child was 3 years with a median age
of 2 years. This study showed no
significant seasonal variation or
difference between the sexes. 50% of the
children admitted were discharged the
same day. There had only been 2
admissions to the intensive care unit
during the study period these had been
due to ingestion of alcohol and toxic
gases.
Chart 1 demonstrates
that the more common, less toxic,
poisons have an average length of stay
of less than
24 hours and the less common, more
toxic, poisons have a longer than
average length of stay. Chart 2
demonstrates that 95% of patients are
discharged at 24 hours and 99% at 48
hours.
Discussion
The study demonstrates that most of the
children admitted are clinically well,
have taken agents of low toxicity and
have a short hospital stay. If these
children were managed by emergency
medicine this would reduce duplication
of work, inpatient costs and reduce
length of stay in hospital. This would
be feasible in large units with a
substantial paediatric workload and
appropriately trained medical and
nursing staff. Emergency medicine has
already taken responsibility for
management of adult poisoning admissions
not requiring intensive care and many
emergency medicine physicians have
acquired a wealth of knowledge and
experience in this subspecialty.
Chart 3 demonstrates the decrease in
number of admissions since 1997, this
correlates with the national UK trends.
The figures for home accidents involving
poisoning for the UK are as follows
47890 in 1994, 36415 in 1995, 36000 in
1996, 40406 in 1997, 36521 in 1998,
31203 in 1999 (ROSPA). There are
statistics available for number of
deaths only for the past three years 9
in 1998, 12 in 1999, 10 in 2000 from the
register of births and deaths. 10 of
these deaths were in the 10-14 age group
and 12 in the 1-4 age group.
There have been initiatives within the
region involving ROSPA and local
voluntary groups to increase awareness
of child poisoning. Specifically a dump
campaign, poison cabinets and safety aid
schemes. There has been no specific
national campaign although leaflets have
been produced by the child accident
prevention trust.
The general epidemiological conclusions
were in keeping with other studies both
nationally(5) and internationally(4,6).
Prevention strategies should be directed
towards toddlers especially 2-3 years
old. The more toxic medications should
have this clearly stated with a reminder
to keep well out of children's reach(7).
Continuing education of parents,
targeted at those in the deprived
socio-economic(4,10) groups, so they are
aware of which substances are more
toxic(8,9). Child resistant closures are
efficacious in the preschool population,
if legislation made use mandatory this
would be an effective prevention
measure.
Greater education of both the medical
profession and the public is necessary.
A study by Campbell, et al., showed that
over 50% of general practitioners were
unaware of the toxicity of
anticonvulsants, iron preparations and
digoxin(9). Over 60% of pharmacists were
unaware of the toxicity of paracetamol
and anticonvulsants. In this study the
more toxic substances were iron
preparations, aspirin, benzodiazepines,
antidepressants and anticonvulsants.
The study has several limitations, the
prospective part of the study relies on
the accuracy of the prospective data
collected by the emergency medicine and
paediatric house officers, compliance
was 86%, 5 children had been admitted
without a proforma being completed. The
retrospective part of the study was
limited by the codes available for
specific agents.
Conclusions
Most of the children admitted with
childhood poisoning have taken agents of
low toxicity, are clinically well and
have short length of stay. If they were
managed by emergency medicine this would
reduce duplication of work, inpatient
costs with shorter hospital stays. There
has been a decrease in admissions since
1997 in keeping with national trends due
to primary prevention campaigns by ROSPA,
the child accident prevention trust and
a higher threshold for admission by
emergency doctors.
References
Other
Topics:
Original Study # 2
- Obstetric conditions requiring
intensive care admission: A five
year survey
Original Study # 3
- Eclampsia in Qatar:
Maternal and fetal outcomes, possible
preventive
measures.
Original Study # 4
- Bacterial Keratitis Predisposing
Factors, Clinical and Microbiological
review
of 70 cases.
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