Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
Clin Toxicol (Phila). 2020 Mar;58(3):183-189. doi: 10.1080/15563650.2019.1634272. Epub 2019 Jul 3.
Risk factors for adverse cardiovascular events (ACVE) from drug exposures have been well-characterized in adults but not studied in children. The objective of the present study is to describe the incidence, characteristics, and risk factors for in-hospital ACVEs among pediatric emergency department (ED) patients with acute drug exposures. This is a prospective cohort design evaluating patients in the Toxicology Investigators Consortium (ToxIC) Registry. Pediatric patients (age <18 years) who were evaluated at the bedside by a medical toxicologist for a suspected acute drug exposure were included. The primary outcome was in-hospital ACVE (myocardial injury, shock, ventricular dysrhythmia, or cardiac arrest). The secondary outcome was in-hospital death. Multiple logistic regression analyses were performed to examine novel clinical risk factors and extrapolate adult risk factors (bicarbonate <20 mEq/L; QTc ≥500 ms), for the primary/secondary outcomes. Among the 13,097 patients (58.5% female), there were 278 in-hospital ACVEs (2.1%) and 39 in-hospital deaths (0.3%). Age and drug class of exposure (specifically opioids and cardiovascular drugs) were independently associated with ACVE. Compared with adolescents, children under 2 years old (OR: 0.41, 95% CI: 0.21-0.80), ages 2-6 (OR: 0.37, 95% CI: 0.21-0.80), and ages 7-12 (OR: 0.51, 95% CI: 0.27-0.95) were significantly less likely to experience an ACVE. Serum bicarbonate concentration <20 mEq/L (OR: 2.31, 95% CI: 1.48-3.60) and QTc ≥ 500 ms (OR: 2.83, 95% CI: 1.67-4.79) were independently associated with ACVE. Previously derived clinical predictors of ACVE from an adult drug overdose population were successfully extrapolated to this pediatric population. Novel associations with ACVE and death included adolescent age and opioid drug exposures. In the midst of the opioid crisis, these findings urgently warrant further investigation to combat adolescent opioid overdose morbidity and mortality.
药物暴露导致不良心血管事件（ACVE）的风险因素在成年人中已得到充分描述，但在儿童中尚未研究过。本研究的目的是描述儿科急诊（ED）患者中急性药物暴露的院内 ACVE 的发生率、特征和危险因素。这是一项前瞻性队列设计，评估了毒理学研究人员联合会（ToxIC）注册中心的患者。纳入了由医学毒理学家床边评估疑似急性药物暴露的年龄<18 岁的儿科患者。主要结局是院内 ACVE（心肌损伤、休克、室性心律失常或心脏骤停）。次要结局是院内死亡。进行了多项逻辑回归分析，以检查新的临床危险因素，并推断成人危险因素（碳酸氢盐<20 mEq/L；QTc≥500 ms），用于主要/次要结局。在 13097 名患者（58.5%为女性）中，有 278 例院内 ACVE（2.1%）和 39 例院内死亡（0.3%）。年龄和药物暴露类别（特别是阿片类药物和心血管药物）与 ACVE 独立相关。与青少年相比，2 岁以下儿童（OR：0.41，95%CI：0.21-0.80）、2-6 岁儿童（OR：0.37，95%CI：0.21-0.80）和 7-12 岁儿童（OR：0.51，95%CI：0.27-0.95）发生 ACVE 的可能性显著降低。血清碳酸氢盐浓度<20 mEq/L（OR：2.31，95%CI：1.48-3.60）和 QTc≥500 ms（OR：2.83，95%CI：1.67-4.79）与 ACVE 独立相关。从成人药物过量人群中推断出的 ACVE 的先前临床预测因素成功地推断到了儿科人群。与 ACVE 和死亡相关的新发现包括青少年年龄和阿片类药物暴露。在阿片类药物危机中，这些发现迫切需要进一步调查，以解决青少年阿片类药物过量的发病率和死亡率。
