Pitetti Raymond D, Whitman Emily, Zaylor Abigail
Department of Pediatrics, Children's Hospital of Pittsburgh, 3705 Fifth Ave, Pittsburgh, PA 15213, USA.
Pediatrics. 2008 Aug;122(2):e359-62. doi: 10.1542/peds.2007-3729.
Apparent life-threatening events are a relatively common event in children for which there may be a number of causes. Previous reports have suggested that poisonings, either accidental or intentional, may be causes of some events. However, this theory has not been systematically studied.
We conducted a prospective, descriptive study of infants aged <2 years presenting to a pediatric emergency department of a large, urban tertiary care children's hospital with signs and symptoms of an apparent life-threatening event. All of the children presenting with an apparent life-threatening event were to undergo a standardized evaluation, which included obtaining a comprehensive urine toxicology screen. A positive toxicology screen result was defined as follows: a clinically insignificant screen result (identification of a medication that would not cause an apparent life-threatening event) or a clinically significant screen result (identification of a medication that could cause apnea or other event consistent with an apparent life-threatening event, even if it was a medication that the child was known to be taking).
During the study period, 596 children presented to the emergency department with an apparent life-threatening event, and 274 (46.0%) had a toxicology screen performed. Of 274 toxicology screen results, 50 were considered truly positive (18.2%), and 23 positive screen results were considered clinically significant (23 of 274 [8.4%]). Thirteen toxicology screen results were positive for an over-the-counter cold preparation (13 of 274 [4.7%]). No parent admitted to having given his or her child an over-the-counter cold preparation.
A substantial number of children presenting to the emergency department with an apparent life-threatening event had a positive toxicology screen result. In particular, a number of children were found to have been given an over-the-counter cold preparation. We would recommend that toxicology screens be included as part of the routine evaluation of children who present with an apparent life-threatening event.
明显危及生命事件在儿童中相对常见，其病因可能有多种。既往报告提示，意外或故意中毒可能是部分此类事件的病因。然而，该理论尚未得到系统研究。
我们对一家大型城市三级儿童专科医院急诊科收治的2岁以下有明显危及生命事件体征和症状的婴儿进行了一项前瞻性描述性研究。所有出现明显危及生命事件的儿童均接受标准化评估，包括进行全面的尿液毒理学筛查。毒理学筛查阳性结果定义如下：临床意义不显著的筛查结果（识别出不会导致明显危及生命事件的药物）或临床意义显著的筛查结果（识别出可导致呼吸暂停或其他与明显危及生命事件相符的事件的药物，即使该药物是已知患儿正在服用的药物）。
在研究期间，596名儿童因明显危及生命事件到急诊科就诊，其中274名（46.0%）进行了毒理学筛查。在274份毒理学筛查结果中，50份被认为是真正阳性（18.2%），23份阳性筛查结果被认为具有临床意义（274份中的23份[8.4%]）。13份毒理学筛查结果显示非处方感冒药呈阳性（274份中的13份[4.7%]）。没有家长承认给孩子服用过非处方感冒药。
大量因明显危及生命事件到急诊科就诊的儿童毒理学筛查结果呈阳性。特别是，发现一些儿童服用了非处方感冒药。我们建议将毒理学筛查纳入对出现明显危及生命事件儿童的常规评估之中。
