Beauchamp Gillian A, Kerrey Benjamin T, Mittiga Matthew R, Rinderknecht Andrea S, Yin Shan
From the *Department of Emergency Medicine, University of Cincinnati; and †Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Pediatr Emerg Care. 2017 Oct;33(10):670-674. doi: 10.1097/PEC.0000000000000858.
Few studies of children with toxicological emergencies describe those undergoing acute resuscitation, and most describe exposures to single agents. We describe a 12-month sample of patients evaluated in the resuscitation area of a pediatric emergency department (ED) for a toxicological emergency.
We conducted a retrospective chart review of patients in a high-volume, academic pediatric ED. We identified patients evaluated in the ED resuscitation area for toxicological exposure and conducted structured chart reviews to collect relevant data. For all variables of interest, we calculated standard descriptive statistics.
Of 2999 patients evaluated in the resuscitation area through 12 months (March 2009 to April 2010), we identified 80 (2.7%) whose primary ED diagnosis was toxicological. The mean age was 11.4 years. Eighty-six percent of patients were triaged to the resuscitation area for significantly altered mental status. The most frequent single exposures were ethanol (25%), clonidine (10%), and acetaminophen (5%). At least 1 laboratory test was performed for almost all patients (97%). Interventions performed in the resuscitation area included intravenous access placement (97%), activated charcoal (20%), naloxone (19%), and endotracheal intubation (12%). Eighty-two percent of patients were admitted to the hospital; 37% to the intensive care unit. No patients studied in this sample died and most received only supportive care.
In a high-volume pediatric ED, toxicological emergencies requiring acute resuscitation were rare. Ethanol and clonidine were the most frequent single exposures. Most patients received diagnostic testing and were admitted. Further studies are needed to describe regional differences in pediatric toxicological emergencies.
关于中毒急症患儿的研究很少描述那些正在接受急性复苏的患儿，并且大多数研究描述的是单一药物暴露情况。我们描述了在一家儿科急诊科（ED）复苏区域接受评估的中毒急症患儿的12个月样本。
我们对一家大型学术性儿科急诊科的患者进行了回顾性病历审查。我们确定了在ED复苏区域因中毒暴露而接受评估的患者，并进行了结构化病历审查以收集相关数据。对于所有感兴趣的变量，我们计算了标准描述性统计量。
在12个月内（2009年3月至2010年4月）在复苏区域接受评估的2999例患者中，我们确定了80例（2.7%），其ED主要诊断为中毒。平均年龄为11.4岁。86%的患者因精神状态明显改变而被分诊到复苏区域。最常见的单一暴露药物是乙醇（25%）、可乐定（10%）和对乙酰氨基酚（5%）。几乎所有患者（97%）都进行了至少一项实验室检查。在复苏区域进行的干预措施包括建立静脉通路（97%）、给予活性炭（20%）、纳洛酮（19%）和气管插管（12%）。82%的患者住院治疗；37%入住重症监护病房。该样本中没有患者死亡，大多数患者仅接受了支持性治疗。
在一家大型儿科ED中，需要急性复苏的中毒急症很少见。乙醇和可乐定是最常见的单一暴露药物。大多数患者接受了诊断检查并住院治疗。需要进一步研究来描述儿科中毒急症的区域差异。
