Denver Health and Hospital Authority, Rocky Mountain Poison and Drug Center, Denver, CO, USA.
Child Abuse Negl. 2011 Nov;35(11):924-9. doi: 10.1016/j.chiabu.2011.05.019. Epub 2011 Nov 9.
The objective of this study was to describe malicious nonpharmaceutical exposures in children reported to US poison centers.
We performed a retrospective study of all nonpharmaceutical exposures involving children 7 years old reported to the US National Poison Data System (NPDS) from 2000 to 2008 for which the reason for exposure was coded as "malicious". The American Association of Poison Control Centers definition and categorization of nonpharmaceuticals was used. Data collected for each case included age, gender, month and year of the exposure, the exposed substance or substances, intent, and poison center outcome designation. Fatality abstracts (summaries of the facts reported to the poison center) were reviewed.
Out of approximately 21.4 million exposures reported to NPDS during the study period, 4,053 cases involving 4,232 nonpharmaceuticals were identified. The mean number of cases per year was 450 (range 409-546) with no linear annual trend (p=0.28). The median age was 3 years (1.5, 5) with boys constituting 57%. 4.5% of the cases resulted in moderate or worse outcomes in which the outcome was known. The most commonly reported major categories were household cleaning substances (23%), cosmetics/personal care products (13%), pesticides (8%), other/unknown nondrug substances (6%), foreign bodies/toys/miscellaneous (5%), alcohols (5%), hydrocarbons (4%), lacrimators (4%), chemicals (4%), and deodorizers (3%). Four children died and 18 others had lifethreatening injuries. Among these 22 children, cleaning substances (7) were the most common major category followed by chemicals (4), alcohols (3), fumes/gases/vapors (2) and six other categories with 1 each. In the only case where the presence or absence of associated physical injuries was described, the child had multiple injuries consistent with physical abuse.
Malicious administration of nonpharmaceuticals is an important component of child maltreatment with cases being reported consistently to poison centers.
Clinicians should consider the possibility of child abuse when presented with these exposures.
本研究旨在描述向美国国家毒物数据系统（NPDS）报告的儿童恶意非药物暴露情况。
我们对 2000 年至 2008 年期间向 NPDS 报告的所有涉及 7 岁以下儿童的非药物暴露情况进行了回顾性研究，这些暴露的原因编码为“恶意”。采用美国中毒控制中心协会对非药物的定义和分类。对每个病例收集的数据包括年龄、性别、暴露的月份和年份、暴露的物质或物质、意图以及毒物中心的结果指定。审查了死亡摘要（向毒物中心报告的事实摘要）。
在研究期间向 NPDS 报告的约 2140 万例暴露中，确定了 4053 例涉及 4232 种非药物的病例。每年的平均病例数为 450 例（范围为 409-546），无线性年度趋势（p=0.28）。中位数年龄为 3 岁（1.5，5），男孩占 57%。4.5%的病例导致中度或更严重的后果，已知结果。报告最多的主要类别是家用清洁用品（23%）、化妆品/个人护理用品（13%）、杀虫剂（8%）、其他/未知非药物物质（6%）、异物/玩具/杂项（5%）、酒精（5%）、碳氢化合物（4%）、催泪瓦斯（4%）、化学品（4%）和除臭剂（3%）。有 4 名儿童死亡，另有 18 名儿童有生命威胁的伤害。在这 22 名儿童中，清洁剂（7 例）是最常见的主要类别，其次是化学品（4 例）、酒精（3 例）、烟雾/气体/蒸气（2 例）和其他 6 个类别，每个类别 1 例。在唯一描述了是否存在相关身体伤害的情况下，该儿童有与身体虐待一致的多处伤害。
恶意使用非药物是儿童虐待的一个重要组成部分，这些情况一直向毒物中心报告。
当出现这些暴露情况时，临床医生应考虑虐待儿童的可能性。
