成人处方药使用与儿科药物暴露和中毒。
Adult prescription drug use and pediatric medication exposures and poisonings.
机构信息
Division of Emergency Medicine, Children's Hospital Boston, Boston, MA 02115, USA.
出版信息
Pediatrics. 2013 Jul;132(1):18-27. doi: 10.1542/peds.2012-2978. Epub 2013 Jun 3.
BACKGROUND AND OBJECTIVES
Nontherapeutic medication ingestions continue to be a major pediatric health problem, with recent increases in ingestions despite a number of public health interventions. It is unknown how changes in adult prescription drug use relate to pediatric medication poisonings. The objective of the study was to measure the association between changing adult prescription drug patterns and pediatric medication exposures and poisonings and identify high-risk classes of medications and pediatric age groups.
METHODS
We measured monthly pediatric exposures and poisonings using the National Poison Data System and prescriptions written for adults using the National Ambulatory Medical Care Surveys for 2000 through 2009. Associations between adult prescriptions for oral hypoglycemics, antihyperlipidemics, β-blockers, and opioids and exposures and poisonings among children 0 to 5, 6 to 12, and 13 to 19 years were analyzed by using multiple time-series analysis. Emergency department visits, serious injuries, and hospitalizations stemming from these associations were described.
RESULTS
Adult medication prescriptions were statistically significantly associated with exposures and poisonings in children of all ages, with the strongest association observed for opioids. Across medications, the greatest risk was among children 0 to 5 years old, followed by 13- to 19-year-olds. Rates of emergency department visits were highest for events related to hypoglycemics (60.1%) and β-blockers (59.7%), whereas serious injuries and hospitalizations occurred most frequently with opioids (26.8% and 35.2%, respectively) and hypoglycemics (19.5% and 49.4%, respectively).
CONCLUSIONS
Increasing adult drug prescriptions are strongly associated with rising pediatric exposures and poisonings, particularly for opioids and among children 0 to 5 years old. These associations have sizable impacts, including high rates of serious injury and health care use.
背景和目的
非治疗性药物摄入仍然是一个主要的儿科健康问题，尽管采取了许多公共卫生干预措施，最近的摄入量仍有所增加。目前尚不清楚成人处方药使用的变化与儿科药物中毒之间的关系。本研究的目的是衡量成人处方药模式变化与儿科药物暴露和中毒之间的关联，并确定高危药物类别和儿科年龄组。
方法
我们使用国家中毒数据系统测量了 2000 年至 2009 年期间每月儿童的暴露和中毒情况，并使用国家门诊医疗保健调查测量了成人的处方情况。使用多时间序列分析，分析了口服降糖药、降血脂药、β受体阻滞剂和阿片类药物的成人处方与 0 至 5 岁、6 至 12 岁和 13 至 19 岁儿童暴露和中毒之间的关系。描述了这些关联导致的急诊科就诊、严重伤害和住院情况。
结果
成人药物处方与所有年龄段儿童的暴露和中毒具有统计学显著相关性，阿片类药物的相关性最强。在所有药物中，风险最大的是 0 至 5 岁儿童，其次是 13 至 19 岁儿童。与降糖药（60.1%）和β受体阻滞剂（59.7%）相关的事件急诊科就诊率最高，而与阿片类药物（分别为 26.8%和 35.2%）和降糖药（分别为 19.5%和 49.4%）相关的严重伤害和住院率最高。
结论
成人药物处方的增加与儿科暴露和中毒的增加密切相关，特别是阿片类药物和 0 至 5 岁儿童。这些关联具有较大的影响，包括严重伤害和卫生保健利用率高的情况。
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