Kearney Thomas E, Van Bebber Stephanie L, Hiatt Patricia H, Olson Kent R
California Poison Control System-San Francisco, San Francisco, CA 94143-1369, USA.
Pediatr Emerg Care. 2006 Apr;22(4):215-21. doi: 10.1097/01.pec.0000208179.56048.e1.
Most pediatric poisonings have favorable outcomes and are managed in the home by poison control centers utilizing protocols that deem products or substances as nontoxic. We sought to evaluate the validity of protocols for nontoxics.
This is retrospective study in which poison control center case records within a statewide poison control center system during calendar year 2001 were searched for products or substances involved in a pediatric poisoning ingestion and identified in the poison control center nontoxic substance or product list. This was coupled with systematic literature search to ascertain if any significant medical outcomes were associated with ingestion of a nontoxic substance or product.
During the 1-year study period, 20,900 pediatric ingestions involving 46 different nontoxic substances or products were analyzed for significant outcomes. Only 6 cases (0.03%) had a potentially serious clinical effect requiring emergency hospital management. The literature search revealed 2326 ingestion cases of nontoxic products from 635,000 citations in 50 different databases. Of these, 28 cases (1.2%) described an effect, although none was described as significant.
Poisoning protocols for pediatric ingestions of substances or products we deemed as nontoxic were rarely associated with significant outcomes. However, non-dose-related potentially life-threatening effects are possible. Therefore, use of nontoxic protocols by other health care practitioners for telephone triage or by the public directly requires further study to be valid. Our study suggests that the term nontoxic is misleading and recommends that it be replaced with "minimally toxic" as a more appropriate term for identifying the lowest level of risk of toxicity from a substance or product.
大多数儿童中毒事件预后良好，由毒物控制中心依据认定产品或物质无毒的方案在家庭中进行处理。我们试图评估无毒方案的有效性。
这是一项回顾性研究，检索了2001年全州毒物控制中心系统内毒物控制中心的病例记录，查找涉及儿童中毒摄入且在毒物控制中心无毒物质或产品清单中列出的产品或物质。同时进行系统的文献检索，以确定摄入无毒物质或产品是否会导致任何重大医疗后果。
在为期1年的研究期间，对涉及46种不同无毒物质或产品的20900例儿童摄入事件进行了重大后果分析。仅有6例（0.03%）出现了可能需要紧急住院治疗的严重临床效应。文献检索在50个不同数据库的635000条引用中发现了2326例无毒产品摄入病例。其中，28例（1.2%）描述了一种效应，尽管均未被描述为严重。
我们认定为无毒的物质或产品的儿童中毒处理方案很少与重大后果相关。然而，与剂量无关的潜在危及生命的效应是可能存在的。因此，其他医护人员用于电话分诊或公众直接使用的无毒方案是否有效需要进一步研究。我们的研究表明，“无毒”这一术语具有误导性，并建议将其替换为“微毒”，作为识别物质或产品最低毒性风险水平的更合适术语。
