Claudet Isabelle, Le Breton Mathilde, Bréhin Camille, Franchitto Nicolas
Pediatric Emergency Department, Children hospital, CHU Toulouse, Toulouse, France.
University of Toulouse III, Toulouse, France; INSERM U 1027, Toulouse, France.
Eur J Pediatr. 2017 Apr;176(4):553-556. doi: 10.1007/s00431-017-2872-5. Epub 2017 Feb 16.
Pediatricians working in an emergency environment are confronted with children admitted to emergency departments for intoxication on a daily basis. We carried out a retrospective cohort study of children admitted to a pediatric emergency department due to unintentional cannabis exposure over a 10-year period from 2004 to 2014. Twenty-nine children under the age of 3 were admitted with a positive cannabis urine test. Eighty-seven percent of intoxications occurred at the family home. Resin was the main form of ingested cannabis (69%). The mean age was 16.5 ± 5.2 months, and mean weight was 11.1 ± 2.1 Kg. Sixty percent of admissions occurred between 2012 and 2014. More severe presentations, based on Poisoning Severity Score, occurred over the past 2 years. Four children experienced seizures before admission. Ten children (34%) had a decreased level of consciousness (GCS <12) and were admitted to a pediatric intensive care unit for 12-24 h. All of them had ingested hashish (resin). The majority (70%) of children suffering from neurological impairment were admitted in the last year, of whom three required assisted ventilation. There were no cases with major outcomes and no deaths. Parents were not assessed regarding their cannabis consumption.
This study supports the impression that accidental child poisonings with cannabis have been more serious than previously thought for 2 years. This observation may be explained by (1) the increased THC concentration in cannabis and (2) the widespread use in young adults, even after they become parents. Introducing an addiction team inside the PED could help to improve the care links with these parents. What is Known: • Cases of unintentional cannabis intoxication in children have been increasing for many years due to an increase of potency. What is New: • We highlight an increase in more severe presentations in children under the age of 3 occurring over the past 2 years, which will indicate the importance of assessing cannabis abuse in parents by a specialized addiction team.
在急诊环境中工作的儿科医生每天都会面对因中毒而被收治到急诊科的儿童。我们对2004年至2014年这10年间因意外接触大麻而被收治到儿科急诊科的儿童进行了一项回顾性队列研究。29名3岁以下儿童因大麻尿检呈阳性而入院。87%的中毒事件发生在家庭住所。树脂是摄入大麻的主要形式（69%）。平均年龄为16.5±5.2个月，平均体重为11.1±2.1千克。60%的入院事件发生在2012年至2014年期间。根据中毒严重程度评分，更严重的病例出现在过去两年。4名儿童在入院前出现惊厥。10名儿童（34%）意识水平下降（格拉斯哥昏迷评分<12），并被收治到儿科重症监护病房12至24小时。他们都摄入了哈希什（树脂）。大多数（70%）患有神经功能障碍的儿童是在去年入院的，其中3名需要辅助通气。没有出现重大后果的病例，也没有死亡病例。未对家长的大麻消费情况进行评估。
本研究支持这样一种观点，即大麻导致的儿童意外中毒在过去两年比以前认为的更为严重。这一观察结果可能由以下原因解释：（1）大麻中四氢大麻酚浓度增加；（2）即使在年轻成年人成为父母后，大麻在他们中的广泛使用。在儿科急诊科引入一个成瘾治疗团队有助于改善与这些家长的护理联系。已知信息：• 由于效力增加，儿童意外大麻中毒病例多年来一直在增加。新发现：• 我们强调过去两年3岁以下儿童中更严重病例的增加，这将表明由专门的成瘾治疗团队评估家长大麻滥用情况的重要性。
