Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, CT, USA.
Department of Pediatrics, School of Medicine, University of Connecticut, Farmington, CT, USA.
Clin Toxicol (Phila). 2022 Mar;60(3):342-347. doi: 10.1080/15563650.2021.1955913. Epub 2021 Sep 21.
Fatal drug overdoses are predominantly attributed to opioids. Women of childbearing age are among those at greatest risk, underscoring the need to understand the overlapping risk of fatal poisoning in children.
A retrospective analysis of fatal poisonings among decedents aged 0-9 years captured in the National Violent Death Reporting System (NVDRS) from 2012 to 2017 was employed. Poisonings were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes for poisonings (T36-T50, Y10-Y19), toxic effects of substances (T51-T65), and assault (X85-X90). The frequency and types of drugs involved in poisonings were derived from toxicological analysis. Logistic regression was used to model the odds of fatal poisoning by decedent and perpetrator characteristics. Qualitative content analysis was used to contextualize the patterns of fatal poisonings.
1850 violent deaths were identified; 7% ( = 122) were poisoning-related, and 50% of these were attributed to opioids. Next, benzodiazepines (8%), amphetamines (7%), and antidepressants (5%) were most prevalent. Among poisoning-related deaths, 25% involved homicide-suicide. No differences in deaths were observed according to child race/ethnicity, and the risk of fatal poisoning decreased 6% with each year of child age. Following qualitative analysis, three unique categories of fatal poisoning emerged: "intentional administration without documented benign intent", "intentional administration with benign intent", and "unclear administration".
The high proportion of fatal poisonings in children attributed to opioids in this study suggests a need for universal dissemination and training of naloxone in households comprised of children living with parents experiencing, or in recovery for substance misuse. Findings also indicate a needed emphasis on safe storage practices and education to parents about the risk of prescription drug toxicity in children.
致命药物过量主要归因于阿片类药物。生育年龄的妇女处于风险最高之列，这突显了需要了解儿童致命中毒的重叠风险。
本研究采用回顾性分析方法，分析了 2012 年至 2017 年期间全国暴力死亡报告系统（NVDRS）中记录的 0-9 岁死亡者的致命中毒情况。使用国际疾病分类，第十次修订版（ICD-10）中毒（T36-T50、Y10-Y19）、物质毒性效应（T51-T65）和攻击（X85-X90）的编码来识别中毒。从毒理学分析中得出涉及的药物的频率和类型。使用逻辑回归模型来分析死亡者和犯罪者特征与致命中毒的可能性。使用定性内容分析来解释致命中毒模式。
确定了 1850 例暴力死亡事件，其中 7%（122 例）与中毒有关，其中 50%归因于阿片类药物。其次，苯二氮䓬类（8%）、苯丙胺类（7%）和抗抑郁药（5%）最为常见。在与中毒相关的死亡中，25%涉及自杀-他杀。儿童的种族/族裔对死亡无影响，儿童年龄每增加 1 岁，致命中毒的风险降低 6%。经定性分析，出现了三种独特的致命中毒类别：“无明确善意意图的故意给药”、“有善意意图的故意给药”和“给药意图不明确”。
本研究中，儿童致命中毒的高比例归因于阿片类药物，这表明需要在有儿童的家庭中普遍传播和培训纳洛酮，这些家庭的父母正在经历或正在康复中滥用药物。研究结果还表明，需要强调安全储存做法，并对父母进行关于儿童处方药物毒性风险的教育。
