A cross-sectional study of children with acute poisoning: A three-year retrospective analysis

doi:10.5847/wjem.j.1920-8642.2015.04.003

Abstract

Abstract:

BACKGROUND: There is a lack of evidence on description of burden and cases of childhood poisoning in developing countries. This study aimed to assess the characteristics of children with acute poisoning, and factors for time of presentation to health facility and nature of poisoning.
METHODS: A cross-sectional study was conducted at three major pediatric referral hospitals in Addis Ababa, Ethiopia. Description of demographics of children with acute poisoning and factors associated with time to presentation and nature of poisoning were analyzed. Data were entered to Epi info 3.5.3 and analyzed with SPSS version 20.
RESULTS: Over three years, we retrieved records of a total of 128 children admitted for acute poisoning. The mean age of victims was 5.46 (SD, standard deviation=4.48) years. The majority (29.7%) were poisoned by prescribed drugs. Most poisoning incidents (73.5%) were unintentional in nature. The median time to health facility visit was 15.5 hours. Age less than 2 years was related to earlier presentation to health facility (P=0.010, OR=0.28, 95%CI=0.10-0.74). Children with age more than 5 years was more likely to have intentional poisoning (χ²=25.06, P<0.0001). None of the victims was provided psychosocial evaluation and counseling.
CONCLUSION: Most poisoning incidents are unintentional. Prescribed drugs are the commonest causes. Psychosocial counseling and care for the affected children is lacking. Family and community education should be given on prevention of poisoning. We recommend that caregivers take the required action in keeping prescribed drugs at home. Psychosocial support should be part of care and treatment of children with poisoning.

Key words: Poisoning, Children, Ethiopia

Tigist Bacha, Birkneh Tilahun. A cross-sectional study of children with acute poisoning: A three-year retrospective analysis[J]. World Journal of Emergency Medicine, 2015, 6(4): 265-269.

Figures/Tables 4

Table 1

Table 2

Table 3

Table 4

References 19

1	Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Heard SE, et al. 2007 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 25th Annual Report. Clin Toxicol (Phila) 2008; 46:927-1057.
2	Hyder AA, Wali S, Fishman S, Schenk E. The burden of unintentional injuries among the under-five population in South Asia. Acta Paediatrica 2008; 97:267-275. pmid: 18298772
3	Peden MK, Sharma G. The Injury Chart Book: A graphical overview of the global burden of injuries. Geneva: World Health Organization, 2002.
4	Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL. Measuring the Global Burden of Disease and Risk Factors, 1990-2001. In: Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL, editors. Global Burden of Disease and Risk Factors. Washington (DC): World Bank; 2006. Chapter 1.
5	Eddleston M. Patterns and problems of deliberate self poisoning in the developing world. QJM 2000; 93:715-731. pmid: 11077028
6	The global burden of disease: A comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Murray, CJ and Lopez, AD, eds. Harvard School of Public Health (on behalf of the World Health Organization and The World Bank), 1996: 120-122.
7	Desalew M, Aklilu A, Amanuel A, Addisu M, Ethiopia T. Pattern of acute adult poisoning at Tikur Anbessa specialized teaching hospital, A retrospective study, Ethiopia. Hum Exp Toxicol 2011; 30:523-527. doi: 10.1177/0960327110377520 pmid: 20630913
8	Abula T, Wondmikun Y. The pattern of acute poisoning in a teaching hospital, north-west Ethiopia. Ethiop Med J 2006; 44:183-189. pmid: 17447382
9	Lin YR, Liu TH, Liu TA, Chang YJ, Chou CC, Wu HP. Pharmaceutical poisoning exposure and outcome analysis in children admitted to the pediatric emergency department. Pediatr Neonatol 2011; 52:11-17. pmid: 21385651
10	Yang CC, Wu JF, Ong HC, Kuo YP, Deng JF, Ger J. Children poisoning in Taiwan. Indian J Pediatr 1997; 64:469-483. doi: 10.1007/BF02737751 pmid: 10771876
11	Lamireau T, Lanas B, Kennedy A, Fayon M, Penouil F, Favarell-Garrigues JC, et al. Epidemiology of poisoning in children: a 7-year survey in a paediatric emergency care unit. Eur J Emerg Med 2002; 9:9-14. pmid: 11989508
12	Andiran N, Sarikayalar F. Pattern of acute poisonings in childhood in Ankara: what has changed in twenty years? Turk J Pediatr 2004; 46:147-152. pmid: 15214744
13	Demorest RA, Posner JC, Osterhoudt KC, Henretig FM, Poisoning prevention education during emergency department visits for childhood poisoning. Pediatr Emerg Care 2004; 20:281-284. pmid: 15123897
14	Hincal F, Hincal AA, Müftü Y, Sarikayalar F, Ozer Y, Cevik N, et al. Epidemiological aspects of childhood poisonings in Ankara: a 10-year survey. Hum Toxicol 1987; 6:147-152. pmid: 3557472
15	Mintegi S, Fernández A, Alustiza J, Canduela V, Mongil I, Caubet I, et al. Emergency visits for childhood poisoning: a 2-year prospective multicenter survey in Spain. Pediatr Emerg Care 2006; 22:334-338. pmid: 16714960
16	Oguche S, Bukbuk DN, Watila IM. Pattern of hospital admissions of children with poisoning in the Sudano-Sahelian North eastern Nigeria. Niger J Clin Pract 2007; 10:111-115. pmid: 17902501
17	Riordan M, Rylance G, Berry K. Poisoning in children: painkillers. Arch Dis Child 2002; 87:397-399. pmid: 12390909
18	Paudyal BP. Poisoning: pattern and profile of admitted cases in a hospital in central Nepal. J Nepal Med Assoc 2005; 44:92-96.
19	Demorest RA, Posner JC, Osterhoudt KC, Henretig FM. Poisoning prevention education during emergency department visits for childhood poisoning. Pediatr Emerg Care 2004; 20:281-284.

Variables	Frequency	%
Age in years
Less than 2 years	42	32.8
2-5 years	38	29.7
Beyond 5 years	47	36.7
Sex
Male	61	47.7
Female	66	51.6
Hospital
Yekatit 12	68	53.1
Tikur Anbessa	15	11.7
Zewditu	43	33.6
Place where poisoning happened
Home	95	74.2
Out of home	8	6.3
Unknown	25	19.5
Vital signs at presentation
Tachycardia	22	17.2
Tachypnia	6	4.7
Both tachycardia and tachypnia	8	6.3
Normal	65	50.8
Temperature
Normal	27	21.1
Temperature<36.5 °C	9	7.0
Temperature>37.5 °C	44	34.4
Odor of poison
Yes	22	17.2
None	50	39.1
Unknown	56	43.8
GCS^a at presentation
Full consciousness	109	85.2
GCS<15	19	14.8
Neurologic deficit
Present	11	8.6
Absent	117	91.4
Seizure
Present	2	1.6
Absent	126	98.4
Pupillary size
Normal	114	91.1
Abnormal^b	14	8.9
Systemic findings
Present	78	60.9
Absent	50	39.1
Presentation
Vomiting	48	37.5
Diarrhea	5	3.9
Secretion	2	1.6
Loss of consciousness	9	7.0
Systems affected
Central nervous system	23	18.0
Gastrointestinal	5	3.9
Renal	2	1.6
Respiratory	5	3.9
Central nervous system and GI^c	5	3.9
Respiratory and CNS^d	1	0.8
Respiratory, CNS, and GI	1	0.8
Child illness
Yes	6	4.7
No	122	95.3
Reason for poisoning
Intentional	20	15.6
Accidental	100	79.1
Non-documented	8	6.3

Types of poisoning	Frequency	%
Drug	38	29.7
Hydrocarbon	23	18.3
Organophosphate	19	14.8
Sodium hypochlorite	16	12.5
Alcohol	11	8.7
Carbon monoxide	6	4.7
Hair products	3	2.3
Mushroom	2	1.6
Snake bite	2	1.6
Other agents	4	3.1
Undocumented	4	3.1
Total	128	100

Variables	Nature of poisoning		χ2	Pvalue
Variables	Intentional (%)	Unintentional (%)	χ2	Pvalue
Age			25.06	0.000
Less than 2 years	1 (2.7)	36 (97.3)
2-5 years	2 (5.4)	35 (94.6)
Beyond 5 years	16 (41.0)	29 (59.0)
Time to presentation			0.80	0.370
In 2 hours	9 (23.7)	29 (76.3)
Later than 2 hours	10 (16.4)	51 (83.6)
Gender			0.09	0.769
Female	9 (15.8)	48 (84.2)
Male	10 (17.9)	46 (82.1)
GCS at presentation			0.48	0.533
Normal (15/15)	17 (17.9)	78 (82.1)
Less than 15	2 (11.1)	16 (88.9)
Neurologic deficit			0.36	0.546
Yes	1 (10.0)	9 (90.0)
No	18 (17.5)	85 (82.5)
Place for poisoning			0.74	0.689
Home	14 (15,9)	74 (84.1)
Out of home	2 (28.6)	5 (71.4)
Unknown	3 (16.7)	15 (83.3)
Visited another facility			1.52	0.218
Yes	6 (27.3)	16 (72.7)
No	13 (15.9)	69 (84.1)
Vital signs at presentation			1.48	0.224
Abnormal	4 (18.2)	18 (81.8)
Normal	0 (0.0)	7 (100.0)
Children taking medication			0.85	0.357
Yes	0	4 (100.0)
No	19 (17.6)	89 (82.4)

Variables	Arrival in 2 hours	Arrival in >2 hours	Pvalue	OR (95%CI)
Age of children (years)
Less than 2	17 (51.5)	16 (48.5)	0.010	0.28 (0.10-0.74)
Between 2 and 5	12 (36.4)	21 (63.6)	0.193	0.52 (0.19-1.40)
Above 5	10 (22.7)	34 (77.3)		1
Gender
Female	20 (37.0)	34 (63.0)	0.683	0.85 (0.39-1.85)
Male	19 (33.3)	38 (66.7)		1
Neurologic morbidity
Present	1 (11.1)	8 (88.9)	0.149	4.75 (0.57-39.46)
Absent	38 (37.3)	64 (62.7)		1
Systemic findings
Present	5 (29.4)	12 (70.6)	0.592	1.36 (0.44-4.49)
Absent	24 (36.2)	60 (63.8)		1
Where incident happened
At home	30 (35.3)	55 (64.7)	0.949	0.97 (0.39-2.44)
Unknown or out of home	9 (34.6)	17 (65.4)		1

[1]	Ning Dong, Zhe-xi Lu, Xing-liang Li, Wei Li, Li Pang, Ji-hong Xing. Clinical correlates of hypotension in patients with acute organophosphorus poisoning [J]. World Journal of Emergency Medicine, 2021, 12(1): 24-28.
[2]	Muhammad Akhter Hamid, Ruqiya Afroz, Uqba Nawaz Ahmed, Aneela Bawani, Dilnasheen Khan, Rabia Shahab, Asim Salim. The importance of visualization of appendix on abdominal ultrasound for the diagnosis of appendicitis in children: A quality assessment review [J]. World Journal of Emergency Medicine, 2020, 11(3): 140-144.
[3]	Yun-fei Jiang, Jian Kang, Pei-pei Huang, Jia-xi Yao, Zhong-he Wang, Lei Jiang, Jun Wang, Li Qiao, Bao-li Zhu, Hao Sun, Jin-song Zhang. Evaluation of gastric lavage efficiency and utility using a rapid quantitative method in a swine paraquat poisoning model [J]. World Journal of Emergency Medicine, 2020, 11(3): 174-181.
[4]	Shi-yuan Yu, Yan-xia Gao, Joseph Walline, Xin Lu, Li-na Zhao, Yuan-xu Huang, Jiang Tao, An-yong Yu, Na Ta, Ren-ju Xiao, Yi Li. Role of penehyclidine in acute organophosphorus pesticide poisoning [J]. World Journal of Emergency Medicine, 2020, 11(1): 37-47.
[5]	Shahin Shadnia, Nasim Zaman, Hossein Hassanian-Moghaddam, Hamed Shafaroodi, Mina Padandar, Mohammad Hasan Rezaeizadeh. Prognostic value of cortisol and thyroid function tests in poisoned patients admitted to toxicology ICU [J]. World Journal of Emergency Medicine, 2018, 9(1): 51-55.
[6]	Peyman Erfantalab, Kambiz Soltaninejad, Shahin Shadnia, Nasim Zamani, Hossein Hassanian-Moghaddam, Arezou Mahdavinejad, Behrooz Hashemi Damaneh. Trend of blood lactate level in acute aluminum phosphide poisoning [J]. World Journal of Emergency Medicine, 2017, 8(2): 116-120.
[7]	Chun Tat Lui. Prescription practice of antihistamines for acute upper respiratory tract infections in pediatric patients in a local emergency department in Hong Kong [J]. World Journal of Emergency Medicine, 2017, 8(1): 47-54.
[8]	Eyosias Teklemariam, Shibiru Tesema, Awol Jemal. Pattern of acute poisoning in Jimma University Specialized Hospital, South West Ethiopia [J]. World Journal of Emergency Medicine, 2016, 7(4): 290-293.
[9]	Ertugrul Kaya, Aylin Yilmaz, Ayhan Saritas, Serdar Colakoglu, Davut Baltaci, Hayati Kandis, Ismail Hamdi Kara. Acute intoxication cases admitted to the emergency department of a university hospital [J]. World Journal of Emergency Medicine, 2015, 6(1): 54-59.
[10]	Suat Zengin, Behcet A, Sahin Karta, Basri Can, Mustafa Orkmez, Abdullah Taskın, Ugur Lok, Bediha Gulen, Cuma Yildirim, Seyithan Taysi. An assessment of antioxidant status in patients with carbon monoxide poisoning [J]. World Journal of Emergency Medicine, 2014, 5(2): 91-95.
[11]	Zhi-qiang Cheng, Ji-yuan Han, Peng Sun, Yu-ying Weng, Jiao Chen, Guo-yan Wu, Hong-xia Ma. Edaravone attenuates paraquat-induced lung injury by inhibiting oxidative stress in human type II alveolar epithelial cells [J]. World Journal of Emergency Medicine, 2012, 3(1): 55-59.
[12]	Chang-bin Li, Xin-hua Li, Zhen Wang, Cheng-hua Jiang, Ai Peng. Serum paraquat concentration detected by spectrophotometry in patients with paraquat poisoning [J]. World Journal of Emergency Medicine, 2011, 2(3): 179-184.
[13]	Yi-min Zhu, Fang Liu, Xiao-yu Zhou, Xi-rong Gao, Zhi-yue Xu, Yu-kai Du. Clinical and pathologic characteristics of pancreatic necrosis in critically ill children [J]. World Journal of Emergency Medicine, 2011, 2(2): 111-116.
[14]	Zhi-jian Zhang, Cong-yang Zhou, Ya-juan Luo, Hua-wei Xiong. Expression of heat shock protein 70 in lung tissues of acute paraquat poisoned rats and intervention of ulinastatin [J]. World Journal of Emergency Medicine, 2010, 1(3): 229-233.
[15]	Yu-ping Sun, Chao-ping Wei, Wen-di Wang, Xing-chang Zheng, Ye-jun Wang, Shao-chun Ma, Ying-jun Xu. Serum brain natriuretic peptide in children with Kawasaki disease [J]. World Journal of Emergency Medicine, 2010, 1(2): 114-117.