Section of Hospital Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
Combined Anesthesiology and Pediatrics Residency Program, The Johns Hopkins Hospital, Baltimore, MD.
Pediatr Crit Care Med. 2023 Mar 1;24(3):e128-e136. doi: 10.1097/PCC.0000000000003148. Epub 2022 Dec 27.
Ingestions are a prevalent form of self-harm in teenagers and are unfortunately an increasingly common reason for admission to both acute care and critical care services. The goal of this study was to identify characteristics associated with requiring PICU stay among adolescents hospitalized for ingestions.
Retrospective cohort study comparing patients admitted to hospital medicine service and critical care service from January 2019 to December 2019.
Freestanding children's hospital in the midwestern United States.
Adolescents 12-18 years old hospitalized for ingestion.
None.
Out of 209 patients included in the study cohort, 95 required PICU admission. High-risk behaviors (having had sex or usage of alcohol, drugs, tobacco, or vaping) were endorsed by 190 of 209 patients (91%). We compared patient characteristics, ingestion history, workup, and pharmacological and PICU-specific interventions between patients hospitalized on the hospital medicine service and the PICU. We failed to identify an association between reason for ingestion, substance ingested, and previously identified suicide risk factors including previous suicide attempt, previous self-harm, and psychiatric comorbidity and admission to PICU, as opposed to non-PICU admission. PICU stay was associated with longer peak corrected QT interval value, receiving a pharmacological intervention, and longer duration of hospital stay. Fifteen of 95 patients (16% [95% CI, 9-25%]) in the PICU received a PICU-specific intervention.
We failed to identify specific patient demographics or mental behavioral health characteristics associated with PICU stay after ingestion. Therefore, we believe that all adolescents hospitalized due to ingestion-irrespective of disposition-should receive standardized high-risk behavior screening due to the pervasive nature of these behaviors among this patient population. PICU-specific care, beyond observation, could be needed in as high as one-in-four PICU admissions. Further research is needed to inform optimal disposition and resource allocation for this patient population.
摄入是青少年中一种常见的自我伤害形式，不幸的是，这也是导致他们入住急性护理和重症监护病房的一个越来越常见的原因。本研究的目的是确定与因摄入而需要入住儿科重症监护病房（PICU）的青少年相关的特征。
比较 2019 年 1 月至 2019 年 12 月期间收入医院内科服务和重症监护病房的患者的回顾性队列研究。
美国中西部的一家独立儿童医院。
因摄入而住院的 12-18 岁青少年。
无。
在研究队列的 209 名患者中，有 95 名需要入住 PICU。209 名患者中有 190 名（91%）报告有高危行为（有过性行为或使用过酒精、毒品、烟草或电子烟）。我们比较了在医院内科服务和 PICU 住院的患者的患者特征、摄入史、检查、药理学和 PICU 特定干预措施。我们未能确定摄入原因、摄入物质以及先前确定的自杀风险因素（包括先前的自杀企图、先前的自我伤害和精神共病）与入住 PICU 而不是非 PICU 之间的关联。与非 PICU 入院相比，PICU 入院与更长的峰值校正 QT 间隔值、接受药理学干预和更长的住院时间相关。在 PICU 中，有 15 名 95 名患者（16% [95% CI，9-25%]）接受了 PICU 特定的干预措施。
我们未能确定与摄入后入住 PICU 相关的特定患者人口统计学或精神行为健康特征。因此，我们认为，所有因摄入而住院的青少年-无论其处置方式如何-由于这些行为在患者群体中普遍存在，都应接受标准化的高危行为筛查。在多达四分之一的 PICU 入院患者中，可能需要进行超出观察之外的 PICU 特定护理。需要进一步研究为该患者群体提供最佳处置和资源分配。
