Dubinin Alexandra, Bialostozky Mario, Richardson Andrew, Laub Natalie
From the University of California, San Diego, CA.
Rady Children's Hospital, San Diego, CA.
Pediatr Emerg Care. 2024 Jun 1;40(6):443-448. doi: 10.1097/PEC.0000000000003145. Epub 2024 Mar 13.
Rates of cannabis ingestion among young children are increasing. Small studies have evaluated symptomatology of these children. The literature lacks research regarding factors influencing medical management. Our goal was to 1) understand circumstances leading to exposure over time and 2) gain insight into factors that may influence emergency room management and Child Protective Services reporting over time.
Retrospective cross-sectional study on children younger than 10 years with cannabis-positive urine drug screens in the emergency room setting. Single-factor analysis of variance and Fisher exact tests were used to assess for trends. Two-tailed t tests and Fisher exact tests were used to compare management of children presenting to the emergency room with chief complaint (CC) "ingestion" versus those without.
Of the 179 children, the mean age was 3.7 years and 48% were boys. We observed a significant increase over time in cannabis-positive children. The most common location of exposure was the primary residence (54%), with parents as the most frequent users (46%). In the emergency department, the most common CC was ingestion followed by altered mental status and fatigue. Children with an "ingestion" CC were managed with less testing than those with other CCs. They received fewer needle sticks (43% vs 91%), less imaging (5% vs 56% computed tomography heads), and fewer procedures (0% vs 8% lumbar punctures). Children with "ingestion" CC were less likely to be reported to Child Protective Services.
Pediatric cannabis exposures are increasing and have a wide array of clinical presentations that complicate emergency room management. Parental report of cannabis ingestion seems to impact and reduce potentially unnecessary testing.
幼儿大麻摄入率正在上升。小型研究已对这些儿童的症状学进行了评估。文献中缺乏关于影响医疗管理因素的研究。我们的目标是：1）了解随时间推移导致接触大麻的情况；2）深入了解可能随时间影响急诊室管理和儿童保护服务报告的因素。
对急诊室环境中10岁以下尿液药物筛查大麻呈阳性的儿童进行回顾性横断面研究。采用单因素方差分析和Fisher精确检验来评估趋势。使用双尾t检验和Fisher精确检验比较以“摄入”为主诉就诊于急诊室的儿童与无此主诉儿童的管理情况。
179名儿童中，平均年龄为3.7岁，48%为男孩。我们观察到尿液大麻呈阳性的儿童数量随时间显著增加。最常见的接触地点是主要住所（54%），父母是最常见的使用者（46%）。在急诊科，最常见的主诉是摄入，其次是精神状态改变和疲劳。以“摄入”为主诉的儿童接受的检查比其他主诉的儿童少。他们接受的针刺检查更少（43%对91%），影像学检查更少（5%对56%头部计算机断层扫描），操作更少（0%对8%腰椎穿刺）。以“摄入”为主诉的儿童被报告给儿童保护服务机构的可能性较小。
儿科大麻暴露情况正在增加，且有一系列临床表现，使急诊室管理变得复杂。父母报告大麻摄入情况似乎会影响并减少潜在的不必要检查。
