Khetarpal Susheel K, Rengasamy Manivel, Adebiyi Ololade, Hsiung Kimberly, Wong Sammi, Shulman Joshua, Pizon Anthony
University of Pittsburgh School of Medicine, Pittsburgh, PA.
Department of Pediatrics, Morgan Stanley Children's Hospital, New York, NY.
J Pediatr X. 2023 Mar 13;9:100086. doi: 10.1016/j.ympdx.2023.100086. eCollection 2023 Summer.
To evaluate the risk factors and clinical correlates of pediatric serotonin syndrome (SS) given that research on SS in adults exists, there is a dearth of literature on pediatric SS.
We conducted a retrospective chart review of 183 pediatric patients who were medically hospitalized after a suicide attempt. We investigated associations between SS and several of its risk factors and clinical correlates. We also assessed the sensitivity/specificity of Hunter's criteria and criterion symptoms in predicting SS.
SS occurred in 21.7% of patients with a serotonergic overdose. Recent marijuana use and overdose on a selective serotonin reuptake inhibitor were significantly associated with SS. Individuals with SS required a greater number of days to be medically stabilized and had a greater likelihood of being placed on a ventilator during treatment. Hunter's criteria had 66.7% sensitivity and 92.3% specificity in diagnosing SS.
Our study reveals both novel risk factors associated with SS (eg, recent marijuana use) and clinical correlates for patients with pediatric SS. In children, Hunter's criteria appeared to have good specificity but poor sensitivity in identifying SS. Our results set the stage for future work aimed at enhancing clinicians' ability to more rapidly identify and treat pediatric SS.
鉴于已有关于成人血清素综合征（SS）的研究，但儿科SS的文献却很匮乏，故评估儿科血清素综合征的危险因素及临床关联因素。
我们对183例自杀未遂后住院治疗的儿科患者进行了回顾性病历审查。我们调查了血清素综合征与其若干危险因素及临床关联因素之间的关联。我们还评估了亨特标准及其标准症状在预测血清素综合征方面的敏感性/特异性。
血清素能药物过量的患者中，21.7%发生了血清素综合征。近期使用大麻及选择性5-羟色胺再摄取抑制剂过量与血清素综合征显著相关。血清素综合征患者需要更多天数才能实现医学稳定，且在治疗期间使用呼吸机的可能性更大。亨特标准在诊断血清素综合征方面的敏感性为66.7%，特异性为92.3%。
我们的研究揭示了与血清素综合征相关的新危险因素（如近期使用大麻）以及儿科血清素综合征患者的临床关联因素。在儿童中，亨特标准在识别血清素综合征方面似乎具有良好的特异性，但敏感性较差。我们的研究结果为今后旨在提高临床医生更快识别和治疗儿科血清素综合征能力的工作奠定了基础。
