Accidental pharmacological poisonings in young children: population-based study in three settings

Abstract

Introduction: Pharmacological poisonings in young children are avoidable. Previous studies report calls to poisons centres, presentations to emergency departments (ED) or hospital admissions. There are limited data assessing concurrent management of poisonings across all three settings. We aimed to describe accidental pharmacological poisonings in young children across our Poisons Information Centre (PIC), EDs and hospitals.

Methods: A population-based study in New South Wales, Australia, of PIC calls, ED presentations and hospital admissions for accidental pharmacological poisoning in children aged <5 years, 2007–2013. We examined trends, medicines responsible and subsequent management. Medicines were coded using ICD10-AM diagnosis codes (T36-50).

Results: Over 2007–2013, pharmacological poisonings accounted for 67,816 PIC calls, 7739 ED presentations and 2082 admissions. Rates (per 10,000 children) of PIC calls declined from 220 to 178; ED presentations were stable (∼22–24), with a decrease in emergency cases offset by an increase in semi- or non-urgent presentations; hospital admissions declined (8–5). Most PIC calls related to “non-opioid analgesics” (25%), and “topical agents” (18%). Nearly every day, one child aged <5 years was admitted to hospital for poisoning. “Benzodiazepines”, “other and unspecified antidepressants”, “uncategorised antihypertensives”, and “4-aminophenol derivatives” accounted for over one-third of all admissions. Most PIC calls (90%) were advised to stay home, 6% referred to hospital. One-quarter of ED presentations resulted in admission.

Conclusions: Poisonings reported to PIC and hospitals declined, however, non-urgent ED presentations increased. Strategies to reduce therapeutic errors and access to medicines, and education campaigns to improve Poisons Centre call rates to prevent unnecessary ED presentations are needed.

Keywords:

• Poisons centers
• children
• pharmacological poisonings

Acknowledgements

This research was supported by the use of population data from the NSW Ministry of Health and the NSW Poisons Information Centre. The authors thank both the NSW Ministry of Health and the NSW Poisons Information Centre for providing access to data, and the NSW Centre for Health Record Linkage for linking the datasets. The findings and views reported in this study, however, are those of the authors and should not be attributed to the NSW Ministry of Health or the NSW Poisons Information Centre.

Disclosure statement

Annette Katelaris is a co-inventor and owner of Juno Childsafe, a childproof bag for medications. No potential conflict of interest was reported by other authors.

Additional information

Funding

Mr Bentley was supported by an Australian Postgraduate Award Scholarship, Sydney University Merit Award, and a Northern Clinical School Scholarship Award. Dr Cairns and Prof Buckley were supported by an Australian National Health and Medical Research Council (NHMRC) Program grant (APP1055176) and Prof Nassar was supported by a National Health and Medical Research Council Career Development Fellowship (APP1067066).