A nationwide survey of poison control centers comparing 1999 to 1998 triage and management of asymptomatic children who ingested tricyclic antidepressant.

Triage of asymptomatic, unintentional pediatric (< 6y) tricyclic antidepressant (TCA) exposures has been based upon single cases or small studies involving large dose, symptomatic ingestions. This study evaluated patterns of triage for asymptomatic pediatric TCA exposures as practiced nationally by regional centers and compared them to 1998 patterns. It also evaluated the role of activated charcoal in the management of these exposures. Surveys were sent to the 30 certified regional Poison Control Centers that responded to our 1998 survey. Twenty-two centers responded (73%). Fourteen (63%) referred to a health care facility based upon mg/kg, compared to 6 (20%) in 1998. Of the 14, 6 referred at doses >5 mg/kg compared to 2 (6.6%) in 1998. If referred to an emergency department, 18 (82%) recommended activated charcoal compared to 1 (3.3%) in 1998. The lowest toxic dose reported in the literature is 6.7 mg/kg. This is consistent with poison control data during the past 6y where no child became toxic at doses < 5 mg/kg. This survey demonstrated significant changes in triage patterns for asymptomatic pediatric TCA exposures.