From the Department of Family Medicine, NUHS Family Medicine Residency, National University Health System.
Department of Internal Medicine, Singhealth Internal Medicine Residency.
Pediatr Emerg Care. 2021 Dec 1;37(12):e1510-e1514. doi: 10.1097/PEC.0000000000002101.
Poisonings in children are common reasons for presentation to the emergency department and can potentially have serious complications. Our research aims to review risk factors leading to intentional self-poisoning.
A retrospective medical record review of all intentional pediatric poisoning cases presenting to the Children's Emergency at National University Hospital, Singapore between January 2014 and December 2015 was performed.
Eighty-seven cases of intentional poisonings were identified, 31 (36.5%) of which were with suicidal intent. The majority of cases were female (85.1%) and adolescents older than 16 years (93.1%). A known psychiatric history was present in 57.5% and 62 (71.3%) had a history of deliberate self-harm. Being diagnosed with a new psychiatric illness during that presentation was associated with a history of self-harm (adjusted odds ratio [Adj OR], 6.74; 95% confidence interval [CI]; 1.04-43.62; P = 0.045). Twenty-seven (31.0%) patients had a history of intentional poisoning, and 15 (17.2%) went on to have subsequent presentations for poisoning. Recurrent poisoning attempts were strongly associated with a known psychiatric history (Adj OR, 5.91; 95% CI, 1.62-21.58; P = 0.007) and a history of deliberate self-harm (Adj OR, 7.49; 95% CI, 1.38-40.66; P = 0.02). Deliberate overdosing on personal long-term medication was seen in 15 (35.7%) of 42, of which 12 (80%) of 15 were psychiatric medications.
Known psychiatric history or a history of deliberate self-harm are risk factors for intentional poisoning. Appropriate risk stratification and preemptive interventions involving closer surveillance or cognitive behavioral programs are possible measures to prevent intentional self-poisoning, especially in these at-risk groups.
儿童中毒是急诊科常见的就诊原因，可能会导致严重并发症。我们的研究旨在分析导致儿童故意自我中毒的风险因素。
对 2014 年 1 月至 2015 年 12 月期间在新加坡国立大学医院儿童急诊就诊的所有故意儿童中毒病例进行回顾性病历回顾。
共发现 87 例故意中毒，其中 31 例（36.5%）有自杀企图。大多数病例为女性（85.1%）和 16 岁以上的青少年（93.1%）。57.5%有已知的精神病史，62 例（71.3%）有故意自残史。在该就诊期间被诊断出患有新的精神疾病与自残史相关（调整后的优势比[Adj OR]，6.74；95%置信区间[CI]；1.04-43.62；P=0.045）。27 例（31.0%）患者有故意中毒史，15 例（17.2%）随后因中毒再次就诊。反复中毒尝试与已知精神病史（Adj OR，5.91；95%CI，1.62-21.58；P=0.007）和故意自残史（Adj OR，7.49；95%CI，1.38-40.66；P=0.02）密切相关。42 例故意超量服用个人长期药物中，15 例（35.7%）为精神科药物，其中 15 例（80%）为精神科药物。
已知的精神病史或故意自残史是故意中毒的危险因素。适当的风险分层和预防干预措施，包括更密切的监测或认知行为方案，可能是预防故意自我中毒的措施，尤其是针对这些高危人群。
