International variability in gastrointestinal decontamination with acute poisonings

on behalf of the Pediatric Emergency Research Networks (PERN) Poisoning Working Group

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

BACKGROUND AND OBJECTIVES: Identifying international differences in the management of acute pediatric poisonings may help improve the quality of care. The objective of this study was to assess the international variation and appropriateness of gastrointestinal decontamination (GID) procedures performed in children and adolescents who present with acute poisonings to emergency departments. METHODS: This was an international, multicenter, cross-sectional prospective study including children <18 years with poisoning exposures presenting to 105 emergency departments in 20 countries from 8 global regions belonging to the Pediatric Emergency Research Networks. Data collection started between January and September 2013 and continued for 1 year. The appropriateness of GID procedures performed was analyzed using the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists' recommendations. Multivariate logistic regression was performed to identify independent risk factors for performing GID procedures. RESULTS: We included 1688 patients, 338 of whom (20.0%, 95% confidence interval 18.1%-22.0%) underwent the following GID procedures: activated charcoal (166, 49.1%), activated charcoal and gastric lavage (122, 36.1%), gastric lavage (47, 13.9%), and ipecac (3, 0.9%). In 155 (45.8%, 40.5%-51.2%), the GID procedure was considered appropriate, with significant differences between regions. Independent risk factors for GID procedures included age, toxin category, mechanism of poisoning, absence of symptoms, and the region where the intoxication occurred (P < .001). CONCLUSIONS: Globally, there are substantial differences in the use and appropriateness of GID procedures in the management of pediatric poisonings. International best practices need to be better implemented.

Original languageEnglish (US)
Article numbere20170006
JournalPediatrics
Volume140
Issue number2
DOIs
StatePublished - Aug 1 2017

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Decontamination
Poisoning
Gastric Lavage
Charcoal
Pediatrics
Hospital Emergency Service
Ipecac
Quality of Health Care
Poisons
Practice Guidelines
Emergencies
Cross-Sectional Studies
Logistic Models
Prospective Studies
Confidence Intervals
Research

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

on behalf of the Pediatric Emergency Research Networks (PERN) Poisoning Working Group (2017). International variability in gastrointestinal decontamination with acute poisonings. Pediatrics, 140(2), [e20170006]. https://doi.org/10.1542/peds.2017-0006

International variability in gastrointestinal decontamination with acute poisonings. / on behalf of the Pediatric Emergency Research Networks (PERN) Poisoning Working Group.

In: Pediatrics, Vol. 140, No. 2, e20170006, 01.08.2017.

Research output: Contribution to journalArticle

on behalf of the Pediatric Emergency Research Networks (PERN) Poisoning Working Group 2017, 'International variability in gastrointestinal decontamination with acute poisonings', Pediatrics, vol. 140, no. 2, e20170006. https://doi.org/10.1542/peds.2017-0006
on behalf of the Pediatric Emergency Research Networks (PERN) Poisoning Working Group. International variability in gastrointestinal decontamination with acute poisonings. Pediatrics. 2017 Aug 1;140(2). e20170006. https://doi.org/10.1542/peds.2017-0006
on behalf of the Pediatric Emergency Research Networks (PERN) Poisoning Working Group. / International variability in gastrointestinal decontamination with acute poisonings. In: Pediatrics. 2017 ; Vol. 140, No. 2.
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abstract = "BACKGROUND AND OBJECTIVES: Identifying international differences in the management of acute pediatric poisonings may help improve the quality of care. The objective of this study was to assess the international variation and appropriateness of gastrointestinal decontamination (GID) procedures performed in children and adolescents who present with acute poisonings to emergency departments. METHODS: This was an international, multicenter, cross-sectional prospective study including children <18 years with poisoning exposures presenting to 105 emergency departments in 20 countries from 8 global regions belonging to the Pediatric Emergency Research Networks. Data collection started between January and September 2013 and continued for 1 year. The appropriateness of GID procedures performed was analyzed using the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists' recommendations. Multivariate logistic regression was performed to identify independent risk factors for performing GID procedures. RESULTS: We included 1688 patients, 338 of whom (20.0{\%}, 95{\%} confidence interval 18.1{\%}-22.0{\%}) underwent the following GID procedures: activated charcoal (166, 49.1{\%}), activated charcoal and gastric lavage (122, 36.1{\%}), gastric lavage (47, 13.9{\%}), and ipecac (3, 0.9{\%}). In 155 (45.8{\%}, 40.5{\%}-51.2{\%}), the GID procedure was considered appropriate, with significant differences between regions. Independent risk factors for GID procedures included age, toxin category, mechanism of poisoning, absence of symptoms, and the region where the intoxication occurred (P < .001). CONCLUSIONS: Globally, there are substantial differences in the use and appropriateness of GID procedures in the management of pediatric poisonings. International best practices need to be better implemented.",
author = "{on behalf of the Pediatric Emergency Research Networks (PERN) Poisoning Working Group} and Santiago Mintegi and Dalziel, {Stuart R.} and Beatriz Azkunaga and Javier Prego and Eunate Arana-Arri and Yordana Acedo and Lorea Martinez-Indart and Javier Benito and Nathan Kuppermann and Yehezkel Waisman and Martin Osmond and David Johnson and James Chamberlain and Macias, {Charles G.} and Anupam Kharbanda and Babl, {Franz E.} and Sutter, {Mark E} and Daniel Cohen and Julia Lloyd and Elizabeth Duffy and Prashant Mahajan and Wang, {George Sam} and Bradin, {Stuart A.} and Jose Ramirez and Samuel Stephenson and Anna Carison and Simon Craig and Andis Graudins and John Cheek and Megan Bonish and {Van De Voorde}, Patrick and Idrissi, {Said Hachimi} and Alexandra Petrovska and Mercier, {Jean Christophe} and Laurence Morin and Gerard Cheron and Eva Szabo and Richard Nagy and Zsolt Bognar and Gabor Simon and Gyorgy Balla and Eva Juhasz and Ciara Martin and Rincy Koshy and {Mc Namara}, Roisin and Waisman, {Yehezkel Hezi} and Lisa Amir and {Da Dalt}, Liviana and Carlo Moretti and Stefania Norbedo",
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AU - on behalf of the Pediatric Emergency Research Networks (PERN) Poisoning Working Group

AU - Mintegi, Santiago

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AU - Azkunaga, Beatriz

AU - Prego, Javier

AU - Arana-Arri, Eunate

AU - Acedo, Yordana

AU - Martinez-Indart, Lorea

AU - Benito, Javier

AU - Kuppermann, Nathan

AU - Waisman, Yehezkel

AU - Osmond, Martin

AU - Johnson, David

AU - Chamberlain, James

AU - Macias, Charles G.

AU - Kharbanda, Anupam

AU - Babl, Franz E.

AU - Sutter, Mark E

AU - Cohen, Daniel

AU - Lloyd, Julia

AU - Duffy, Elizabeth

AU - Mahajan, Prashant

AU - Wang, George Sam

AU - Bradin, Stuart A.

AU - Ramirez, Jose

AU - Stephenson, Samuel

AU - Carison, Anna

AU - Craig, Simon

AU - Graudins, Andis

AU - Cheek, John

AU - Bonish, Megan

AU - Van De Voorde, Patrick

AU - Idrissi, Said Hachimi

AU - Petrovska, Alexandra

AU - Mercier, Jean Christophe

AU - Morin, Laurence

AU - Cheron, Gerard

AU - Szabo, Eva

AU - Nagy, Richard

AU - Bognar, Zsolt

AU - Simon, Gabor

AU - Balla, Gyorgy

AU - Juhasz, Eva

AU - Martin, Ciara

AU - Koshy, Rincy

AU - Mc Namara, Roisin

AU - Waisman, Yehezkel Hezi

AU - Amir, Lisa

AU - Da Dalt, Liviana

AU - Moretti, Carlo

AU - Norbedo, Stefania

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N2 - BACKGROUND AND OBJECTIVES: Identifying international differences in the management of acute pediatric poisonings may help improve the quality of care. The objective of this study was to assess the international variation and appropriateness of gastrointestinal decontamination (GID) procedures performed in children and adolescents who present with acute poisonings to emergency departments. METHODS: This was an international, multicenter, cross-sectional prospective study including children <18 years with poisoning exposures presenting to 105 emergency departments in 20 countries from 8 global regions belonging to the Pediatric Emergency Research Networks. Data collection started between January and September 2013 and continued for 1 year. The appropriateness of GID procedures performed was analyzed using the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists' recommendations. Multivariate logistic regression was performed to identify independent risk factors for performing GID procedures. RESULTS: We included 1688 patients, 338 of whom (20.0%, 95% confidence interval 18.1%-22.0%) underwent the following GID procedures: activated charcoal (166, 49.1%), activated charcoal and gastric lavage (122, 36.1%), gastric lavage (47, 13.9%), and ipecac (3, 0.9%). In 155 (45.8%, 40.5%-51.2%), the GID procedure was considered appropriate, with significant differences between regions. Independent risk factors for GID procedures included age, toxin category, mechanism of poisoning, absence of symptoms, and the region where the intoxication occurred (P < .001). CONCLUSIONS: Globally, there are substantial differences in the use and appropriateness of GID procedures in the management of pediatric poisonings. International best practices need to be better implemented.

AB - BACKGROUND AND OBJECTIVES: Identifying international differences in the management of acute pediatric poisonings may help improve the quality of care. The objective of this study was to assess the international variation and appropriateness of gastrointestinal decontamination (GID) procedures performed in children and adolescents who present with acute poisonings to emergency departments. METHODS: This was an international, multicenter, cross-sectional prospective study including children <18 years with poisoning exposures presenting to 105 emergency departments in 20 countries from 8 global regions belonging to the Pediatric Emergency Research Networks. Data collection started between January and September 2013 and continued for 1 year. The appropriateness of GID procedures performed was analyzed using the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists' recommendations. Multivariate logistic regression was performed to identify independent risk factors for performing GID procedures. RESULTS: We included 1688 patients, 338 of whom (20.0%, 95% confidence interval 18.1%-22.0%) underwent the following GID procedures: activated charcoal (166, 49.1%), activated charcoal and gastric lavage (122, 36.1%), gastric lavage (47, 13.9%), and ipecac (3, 0.9%). In 155 (45.8%, 40.5%-51.2%), the GID procedure was considered appropriate, with significant differences between regions. Independent risk factors for GID procedures included age, toxin category, mechanism of poisoning, absence of symptoms, and the region where the intoxication occurred (P < .001). CONCLUSIONS: Globally, there are substantial differences in the use and appropriateness of GID procedures in the management of pediatric poisonings. International best practices need to be better implemented.

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