Roversi Marco, Marano Marco, Cautilli Francesca, Garone Giacomo, Cristaldi Sebastian, Pisani Mara, Salvatori Alessandra, Raucci Umberto, Cecchetti Corrado, Spalice Alberto, Raponi Massimiliano, Villani Alberto
Clinical Trial Area, Development and Implementation of Drugs, Vaccines, and Medical Devices for Pediatric Use, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
Clin Toxicol (Phila). 2025 Aug;63(8):534-544. doi: 10.1080/15563650.2025.2513631. Epub 2025 Aug 6.
Early recognition of paediatric poisoning is crucial for timely intervention in emergency settings. This study aims to assess the epidemiological and clinical profiles of paediatric patients presenting with neurological features due to acute poisoning.
Data from children less than 18 years of age admitted to the emergency department of a tertiary paediatric hospital in Rome between 2017 and 2023 were retrospectively reviewed. Clinical variables associated with admission were reported and analysed across the entire study sample and stratified by age group. Logistic regression models were built to assess the association between clinical and/or laboratory signs and hospitalization in the whole study sample and stratified by age.
A total of 276 children developed neurological features and were included in the study. The median age was 15.6 years (IQR: 14.0-16.7 years), with most patients being female. Ethanol was the single most frequently ingested xenobiotic (39.5%). The most commonly observed neurological feature was altered consciousness (74.3%). Most patients (56.9%) were graded as minor neurologically on the International Programme on Chemical Safety/European Association of Poison Centres and Clinical Toxicologists Poisoning Severity Score. Patients more than 10 years of age were significantly ( = 0.017) more frequently females (62.6%) and were significantly ( = 0.001) more likely to have a psychiatric co-morbidity (41.0%) than patients less than 10 years of age (4.1%). In patients more than 10 years of age, 55% of patients ingested a xenobiotic for recreational reasons, whereas none did in those less than 10 years of age ( = 0.001). The main predictor of hospitalization in patients more than 10 years of age was suicidal intent (odds ratio: 10.17; = 0.001).
While no specific neurological feature predicted hospitalization, ingestion of lithium, antipsychotics, and benzodiazepines increased the likelihood of admission. Female adolescents had higher rates of intentional poisoning, often linked to suicidal intent.
Altered consciousness is the most common neurological feature in paediatric poisoning but is not directly linked to hospitalisation. While neurological symptoms are important in assessment, factors such as suicidal intent, mode of emergency access, and age are stronger predictors of hospitalization and should be prioritized in the initial evaluation.
早期识别儿童中毒对于在紧急情况下及时进行干预至关重要。本研究旨在评估因急性中毒出现神经症状的儿科患者的流行病学和临床特征。
回顾性分析2017年至2023年期间罗马一家三级儿科医院急诊科收治的18岁以下儿童的数据。报告并分析了整个研究样本中与入院相关的临床变量，并按年龄组进行分层。建立逻辑回归模型以评估整个研究样本以及按年龄分层后的临床和/或实验室指标与住院之间的关联。
共有276名儿童出现神经症状并纳入研究。中位年龄为15.6岁（四分位间距：14.0 - 16.7岁），大多数患者为女性。乙醇是最常摄入的外源性物质（39.5%）。最常见的神经症状是意识改变（74.3%）。根据国际化学品安全计划/欧洲中毒中心和临床毒理学家协会中毒严重程度评分，大多数患者（56.9%）的神经症状较轻。10岁以上患者中女性比例显著更高（62.6%，P = 0.017），且与10岁以下患者（4.1%）相比，有精神共病的可能性显著更高（41.0%，P = 0.001）。在10岁以上患者中，55%的患者因娱乐原因摄入外源性物质，而10岁以下患者中无人如此（P = 0.001）。10岁以上患者住院的主要预测因素是自杀意图（比值比：10.17；P = 0.001）。
虽然没有特定的神经症状可预测住院情况，但摄入锂、抗精神病药物和苯二氮䓬类药物会增加入院可能性。女性青少年故意中毒的发生率较高，通常与自杀意图有关。
意识改变是儿童中毒最常见的神经症状，但与住院并无直接关联。虽然神经症状在评估中很重要，但自杀意图、急救方式和年龄等因素是住院更强的预测因素，应在初始评估中予以优先考虑。
