Cook County Hospital, Illinois Poison Center, Northshore University, Chicago, IL, USA.
Am J Ther. 2012 Sep;19(5):346-50. doi: 10.1097/MJT.0b013e3181ff7aaf.
Poisoning is a leading cause cause for injury and death in pediatric patients. For this reason, β-blocker ingestion has been an indication for emergency department (ED) referral and evaluation in pediatric patients even though significant clinical effects are uncommonly reported. We sought to determine whether an evidence-based triage guideline developed jointly by the American Association of Poison Control Centers, American Academy of Clinical Toxicology, and American College of Medical Toxicology safely reduces unnecessary pediatric ED visits after unintentional small dose β-blocker overdose. This was a prospective study of patients aged 0-6 years with a β-blocker ingestion managed by a regional poison center pre and postimplementation of the triage guideline. One hundred fifty-three cases met inclusion criteria. Before implementation of an evidence-based triage guideline for out-of-hospital management, 52 (67%) cases were referred for ED evaluation, and 26 (33%) cases were recommended for home observation. After guideline implementation, 38 (51%) cases were referred for ED evaluation, and 37 (49%) were recommended for home observation. No deaths occurred in either group. The triage guideline was accurately followed by poison center staff in 96% of cases after implementation. An out-of-hospital triage guideline for pediatric β-blocker overdose was accurately followed by poison center staff and safely reduced unnecessary ED referrals with a 50% increase in home observation.
中毒是导致儿科患者受伤和死亡的主要原因。因此，β受体阻滞剂摄入已成为儿科患者急诊（ED）转诊和评估的指征，尽管很少有报道有显著的临床影响。我们旨在确定由美国中毒控制中心协会、美国临床毒理学协会和美国医学毒理学学院联合制定的基于证据的分诊指南是否能安全地减少因意外小剂量β受体阻滞剂过量摄入而导致的不必要的儿科 ED 就诊。这是一项前瞻性研究，研究对象为年龄在 0-6 岁之间、由区域中毒中心管理的β受体阻滞剂摄入患者，在实施分诊指南前后进行了研究。符合纳入标准的有 153 例。在实施院外管理的基于证据的分诊指南之前，有 52 例（67%）被推荐进行 ED 评估，26 例（33%）被推荐进行家庭观察。实施指南后，有 38 例（51%）被推荐进行 ED 评估，37 例（49%）被推荐进行家庭观察。两组均未发生死亡。实施后，中毒中心工作人员准确遵循分诊指南的比例为 96%。儿科β受体阻滞剂中毒的院外分诊指南得到了中毒中心工作人员的准确遵循，并通过增加 50%的家庭观察，安全地减少了不必要的 ED 转介。
