Analysis of 207,543 children with acute opioid poisonings from the United States National Poison Data System

Abstract

Introduction: Previous studies using administrative data have demonstrated that the United States opioid epidemic is harming both adults and children, and is straining health care systems. Our objective is to describe the outcomes and trends in resource use among children with acute opioid ingestions using patient-level case report data.

Materials and Methods: This study was a retrospective analysis of prospectively collected data from the 55 poison control centers in the United States which comprise the National Poison Data System (NPDS). Children under 19 years of age with a primary opioid ingestion between 1 January 2005 and 31 December 2018 were included in the analysis. Trends over three eras (2005–2009, 2010–2014, 2015–2018) were assessed using a Cochran-Armitage Trend Test. Yearly trends in the proportion of cases were calculated using generalized linear models. Multi-variable logistic regression analysis was used to calculate the adjusted odds of variables associated with having at least one Pediatric Intensive Care Unit (PICU) level intervention.

Results: Children were involved in 207,543 (27.54%) of a total of 1,002,947 primary exposure-related opioid poisoning cases reported to US poison centers. The percentage of patients admitted to a critical care unit from these exposures increased in each era (6.6%, 8.5%, 9.6%). Suicidal intent increased in each era (14.0%, 15.3%, 21.2%), and was associated with increased adjusted odds of receiving a PICU procedure (OR 9.68, CI 7.97–11.76). Fentanyl (OR 12, CI 9.2–15.7), heroin (OR 11.1, CI 9.4–13.1), and methadone (OR 15, CI 13–17.3) were the opioids most associated with having a PICU procedure.

Discussion and Conclusions: The severity of admissions for acute opioid ingestions, especially following attempted suicide, has increased over the studied time frame. Efforts focused on reducing access, especially to synthetic and illicit opioids, and addressing adolescent suicidality are needed to reduce these serious consequences of the opioid epidemic on children in the United States.

Keywords:

• Opioid
• fentanyl
• heroin
• methadone
• suicide
• pediatric critical care

Acknowledgments

The authors acknowledge the Emory + Children’s Pediatric Research Biostatistics Core for help with statistical analysis. No financial support was provided for this study. Dr. Grunwell is supported by the Atlanta Pediatric Scholars Program grant K12HD072245. The American Association of Poison Control Centers (AAPCC; http://www.aapcc.org) maintains the national database of information logged by the country’s regional Poison Centers (PCs) serving all 50 United States, Puerto Rico, and the District of Columbia. Case records in this database are from self-reported calls: they reflect only information provided when the public or healthcare professionals report an actual or potential exposure to a substance (e.g., an ingestion, inhalation, or topical exposure, etc.) or request information/educational materials. Exposures do not necessarily represent a poisoning or overdose. The AAPCC is not able to completely verify the accuracy of every report made to member centers. Additional exposures may go unreported to PCs and data referenced from the AAPCC should not be construed to represent the complete incidence of national exposures to any substance(s). No endorsement or editorial restriction by AAPCC of the interpretation of these data or opinions of the authors has been implied or stated.

Authors’ contributions

Drs. Grunwell and Kamat conceived and developed the study. Drs. Land and Grunwell wrote the manuscript. Ms. Martha Wetzel conducted statistical analyses, aided with data interpretation and edited the manuscript. Dr. Geller acquired data and edited the manuscript. All authors read and approved the manuscript.

Disclosure statement

Dr. Geller disclosed funding from GA Poison Center (Medical Director), which contributed to data collection. The remaining authors have disclosed that they do not have any potential conflicts of interest.