Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Department of Emergency Medicine, Emory University, Atlanta, GA, USA.
Clin Toxicol (Phila). 2021 Sep;59(9):780-785. doi: 10.1080/15563650.2021.1874404. Epub 2021 Feb 8.
Despite its preventable nature, poisoning remains one of the leading causes of morbidity and mortality in the pediatric population. In Lebanon, this population is poorly studied and there is no poison center to which healthcare providers and the public can refer in case of toxicological exposure, leading to unnecessary Emergency Department (ED) visits. This study describes the pediatric toxicological exposures seen at the largest tertiary care center in Lebanon. It also evaluates the appropriateness of ED visits among confirmed or suspected toxicological exposures in children, in order to assess the role of a national poison center in reducing unnecessary ED visits.
This is a secondary analysis of a database for a telephonic medical toxicology service at the American University of Beirut Medical Center, the largest tertiary care center in Lebanon. Data relating to all pediatric patients aged 0-19 years of age were entered into the database by the medical toxicology team. The cases were independently reviewed by 2 medical toxicologists for the adequacy of referral to the ED and performance of invasive procedures.
Two hundred and nine exposures were recorded between 15 April 2015 and 31 December 2019, of which 53.1% were females. Children aged less than 5 years were involved in 67.0% of cases while adolescents aged 13-19 years were involved in 21.1%. The most commonly involved substances were analgesics (14.8%) and cardiovascular drugs (10.0%). The majority had no (59.3%) or minor (26.3%) effects and were treated and discharged home (67.5%). More than a third of ED visits were deemed unnecessary by the toxicologists (Kappa = 0.705), and when including only unintentional cases, around 45% of the ED visits were deemed unnecessary (Kappa = 0.677).
Our data show that 37% of all pediatric poisoning ED visits and 45% of ED visits due to unintentional pediatric poisonings were unnecessary. Additionally, more often than not lavage suctions were done unnecessarily. Future research investigating the possibility of preventing unnecessary visits by establishing a national poison center is needed.
尽管中毒是可以预防的，但它仍是导致儿科人群发病率和死亡率的主要原因之一。在黎巴嫩，针对这一人群的研究较少，也没有毒理中心供医疗服务提供者和公众在发生毒理学暴露时咨询，导致不必要的急诊科（ED）就诊。本研究描述了在黎巴嫩最大的三级保健中心接诊的儿科毒理学暴露情况。它还评估了在确诊或疑似毒理学暴露的儿童中 ED 就诊的适宜性，以评估国家毒理中心在减少不必要的 ED 就诊方面的作用。
这是对贝鲁特美国大学医学中心（黎巴嫩最大的三级保健中心）的电话医疗毒理学服务的数据库的二次分析。由医学毒理学团队将与所有 0-19 岁儿科患者相关的数据录入数据库。由 2 位医学毒理学家独立审查这些病例，以评估向 ED 转诊的适宜性和是否进行了有创操作。
2015 年 4 月 15 日至 2019 年 12 月 31 日期间共记录了 209 例暴露事件，其中 53.1%为女性。67.0%的患儿年龄小于 5 岁，21.1%的患儿年龄为 13-19 岁。最常涉及的物质是镇痛药（14.8%）和心血管药物（10.0%）。大多数患儿没有（59.3%）或仅有轻微（26.3%）影响，经治疗后出院回家（67.5%）。毒理学家认为超过三分之一的 ED 就诊是不必要的（Kappa = 0.705），如果仅包括非故意中毒病例，大约 45%的 ED 就诊是不必要的（Kappa = 0.677）。
我们的数据显示，所有儿科中毒性 ED 就诊中有 37%，非故意儿科中毒性 ED 就诊中有 45%是不必要的。此外，洗胃抽吸往往是不必要的。需要开展进一步的研究，以探讨通过建立国家毒理中心来防止不必要的就诊。
