Pediatric Emergency Medicine Fellow Akron Children's Hospital Akron Children's Hospital Cuyahoga Falls, Ohio, United States
Background: In the American Academy Poison Control Center 2016 Annual Report 2 million calls were due to ingestions. Pediatrics accounted for 60% of those calls. When evaluating these patients histories can be difficult to obtain due to age, level of altered mental status, or truthfulness of the patient. This makes prediction of the clinical course difficult. So many are admitted to the pediatric ICU(PICU) based on suspected exposure. In a review of Virtual Pediatric Systems(VPS) data of over 12,000 ingestions admitted to the PICU, only 29% required critical care intervention. This suggests over-utilization of the PICU. Further evaluation of our admitted population is needed to determine the neccesisty for ICU care and the demographics of our admitted population.
Objective: To describe patient characteristics for intentional and accidental ingestions admitted to a children’s hospital PICU from June 2012-May 2018. The secondary outcomes are: patient disposition variables, geographic regions and incidence of symptomatic admissions.
Design/Methods: A retrospective review was conducted for patients admitted for ingestion. Demographic data, intent, medications ingested, lab results, vitals, and GCS were collected. Descriptive statistics for demographic and clinical variables were summarized and intentional and accidental ingestions were compared by the Student’s t-test, Wilcoxon Sum Rank, and Chi-square. Multivariable logistic regression was used to investigate characteristics of patient disposition.
Results: There were 733 total patients included in this study. Mean age was 12 years (standard deviation: 5.8 years), and 437 were female. The majority of admissions were for self-harm (60%). Seizures occurred in 9.8% of patients, 14.7% required intubation or non-invasive support, 0.4% required dialysis and 6.3% urine alkalinization. By ingestion intent, mean ages were 2.7 years for accidental, 15.8 years for recreational and 15 years for self-harm. Conclusion(s): In conclusion, over a 6 year period, the majority of admissions to the PICU were for self-harm and females had a higher ingestion incidence in our patient population. Most patients did not receive critical care interventions during the admission, suggesting that some ingestions may not require PICU admission and could be managed on an acute care floor. The next step is to compare data to the VPS and PHIS databases.
Figure 1. Pediatric Critical Care Admissions for ingestions by intent over a 6 year period from June 2012 to May 2018
Age on admission to the Pediatric Critical Care unit by ingestion intent
Table 2: Pediatric critical care interventions patients received following admissions for ingestions
Authors/Institutions: Kara Weichler, Akron Children's Hospital, Cuyahoga Falls, Ohio, United States; Martha Blackford, Akron Children's Hospital, Akron, Ohio, United States; John Pope, Akron Children's Hospital, Akron, Ohio, United States
