Chang Joanne T, Wang Baoguang, Chang Cindy M, Ambrose Bridget K
Center for Tobacco Products, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993 USA.
Inj Epidemiol. 2019 Apr 1;6:10. doi: 10.1186/s40621-019-0188-9. eCollection 2019.
An estimated 2 million youth (in 2017) and 7.9 million adults (in 2015) reported currently using electronic nicotine delivery systems (ENDS). Reports of poisoning events related to liquid nicotine (e-liquids) in ENDS have been on the rise, but current, nationally-representative estimates of hospital-treated poisoning cases related to e-liquid nicotine exposure in the United States (US) are lacking.
We used National Electronic Injury Surveillance System (NEISS) data from 2013 to 2017 to calculate national estimates with 95% confidence intervals (CIs) of poisoning incidents related to e-liquid nicotine exposure. From 2013 to 2017, an estimated 4745 poisoning cases related to e-liquids among children under age five were treated in US hospital emergency departments; the number of cases increased from 181 (95% CI: 0-369) in 2013 to 1736 (95% CI, 871-2602) in 2015 and then decreased to 411 (95% CI, 84-738) in 2017. Most of the cases were treated and released; 4.1% were admitted to the hospital. The most common route of exposure was through ingestion (96.9%), and 2.6% of the cases were through dermal exposure. The highest amounts of e-liquids or nicotine ingested were 118.2mL, 1 bottle, and 100 mg, and the most common symptoms (63.6%) related to nicotine poisoning were nausea and vomiting.
This study provides national estimates of poisoning cases associated with nicotine exposure from e-liquids among children under age five. Findings on e-liquid volume or nicotine dose, when available, provide important insights into exposures associated with toxicity in children. Since NEISS data do not include product codes specific to ENDS or provide information on poisoning severity, we used general keywords to capture these events, which might underestimate the population burden. Information from this study may complement efforts, such as public education, to prevent unintended exposure to nicotine in e-liquids among children.
据估计，2017年有200万青少年以及2015年有790万成年人报告目前正在使用电子尼古丁传送系统（ENDS）。与ENDS中的液态尼古丁（电子烟液）相关的中毒事件报告一直在增加，但目前缺乏美国全国范围内与电子烟液尼古丁暴露相关的医院治疗中毒病例的代表性估计。
我们使用了2013年至2017年的国家电子伤害监测系统（NEISS）数据来计算与电子烟液尼古丁暴露相关的中毒事件的全国估计数及95%置信区间（CI）。2013年至2017年期间，美国医院急诊科估计有4745例5岁以下儿童与电子烟液相关的中毒病例接受治疗；病例数从2013年的181例（95%CI：0 - 369）增加到2015年的1736例（95%CI，871 - 2602），然后在2017年降至411例（95%CI，84 - 738）。大多数病例接受治疗后出院；4.1%的病例住院治疗。最常见的暴露途径是摄入（96.9%），2.6%的病例是通过皮肤暴露。摄入的电子烟液或尼古丁的最高量分别为118.2毫升、1瓶和100毫克，与尼古丁中毒相关的最常见症状（63.6%）是恶心和呕吐。
本研究提供了5岁以下儿童与电子烟液尼古丁暴露相关的中毒病例的全国估计数。关于电子烟液体积或尼古丁剂量的研究结果（如有）为了解儿童中毒相关暴露提供了重要见解。由于NEISS数据不包括特定于ENDS的产品代码，也不提供中毒严重程度的信息，我们使用通用关键词来捕捉这些事件，这可能低估了人群负担。本研究的信息可能补充诸如公众教育等预防儿童意外接触电子烟液中尼古丁的努力。
