Poisoning In Children: A Study Of 1120 Poisoned Patients Younger Than 12 Years At Loghman Hakeem Poison Control Center, Tehran, Iran, 2000-2001
H Joghataee, S Mirakbari, S Moosavi, F Farnaghi
children, epidemiology, medicine, mortality, neonatology, pediatrics, poisoning
H Joghataee, S Mirakbari, S Moosavi, F Farnaghi. Poisoning In Children: A Study Of 1120 Poisoned Patients Younger Than 12 Years At Loghman Hakeem Poison Control Center, Tehran, Iran, 2000-2001. The Internet Journal of Pediatrics and Neonatology. 2001 Volume 2 Number 2.
BACKGROUND: Poisoning remains a threat
to the health of young children despite the improved triage and
management techniques. OBJECTIVE: To determine changes in
the incidence and agents used.Also the cases were considered
for hospital length of stay,mortality,clinical presentations and
some epidemiologic variables. METHODS:All cases younger
than 12 years with a primary or secondary diagnosis of
poisoning referred to this center from April 25,2000 to April
25,2001 were entered into the study.Staff physicians were
provided with a questionnaire and performed a standardized
assessment of the patients. RESULTS: 1120 patients were
enlisted in the study. 36.5% were admitted into the ward .Most
patients (39/02%)were in the range 1-2 years.Pharmaceuticals
were often used.The most common presentation was
drowsiness.The patients mostly stayed for 1 day in the
hospital.Mortality was 0.3%. CONCLUSION:The number of
cases has decreased over time but accidental poisoning in
children remains a significant problem.Pharmaceuticals were
somewhat marked in this study.The type of agent involved
changed over time.Although preventive measures have
contributed to decrease in incidence of child poisoning,efforts
need to be targeted toward family educations,design and
regulatory changes along with improved child resistant
packaging are required.
During the past 30 years, childhood morbidity and mortality due to poisoning have decreased as a result of new prevention strategies, along with improved triage and management techniques. Poisoning nevertheless remains a threat to the health of young children.(1,2)
Poisoning that necessitates hospitalization remains an important source of morbidity in children.(3)
Because of the trend of population increase and the use of pharmaceutical, chemical, and hygienic agents, now we observe the poisoning as a common problem in children. According to data of Loghman Hakeem Hospital, the single center for poisoning in Tehran, accidental poisoning in children is very common. The type of agent involved has been changing over time in children. The number of child poisoning in Iran due to hygienics and cosmetics continue to increase over last 10 years.(1)
In 1995, 3895 patients under 12 years of age with a poison exposure were referred to this center. Of these, 463 cases were intoxicated by hygienic and cosmetic agents.
In 1998, out of total 2686 referral cases under 12 years of age, 501 cases were intoxicated by hygienic and cosmetic agents.
Data from the emergency department are needed to monitor any changing pattern of poisonings and to provide guidance for effective poison prevention programs.(4)
The purpose of this study was to determine the number of hospitalizations due to intoxication among children younger than12 years of age in the pediatrics emergency department of Loghman Hakeem, agents used, hospital length of stay, the route of exposure, clinical presentations and mortality. Other data examined included some demographic variables and past medical history.
All patients under 12 years of age with a suspected poisoning from April 25, 2000 to April 25, 2001 referred to our center were entered into the study. Samples were obtained to analyze for detection of poisoning agents when the history was inexact or obscure. Staff emergency physicians were provided with a questionnaire and performed a standardized assessment of the patients including history of exposure.
Data was analyzed using SPSS software (spss sciences, Chicago, IL).
1120 patients were studied. The results are as follows:
409 patients (36.5%) were admitted to the hospital ward and 711 patients (63.5%) were discharged after 3-6 hours of observation.
625 patients (55.8%) were male and 495 patients (44.2%) were female.
Preschool age patients (under 7 years of age) constitute 85.2% (955 cases) whereas school age patients (older than 7 years) account for 165 cases (14.8%)
Medical conditions recorded revealed neuropsychiatric disorders in 2.8% of patients (31cases) and mental retardation in 0.6% of patients (7 cases) and illnesses such as common cold and congenital anomalies in 2.4% of patients (27 cases). No prior history of diseases accounted for 94.2% of patients (1055 cases).
345 (30.8%) occurred in summer followed by 311 (27.9%) in fall, 281 (25.1%) in spring and 183 (16.2%) in winter.
Pharmaceuticals were involved in 583 cases (52.1%) whereas non-pharmaceuticals were involved in 537 cases (47.9%).
Incidence of poisonings based on type of agent in 2 groups of pharmaceuticals and non-pharmaceuticals are presented in table 1 and table 2.
The number of cases involved was arranged based on age groups: under 1 years of age, 1-2 years, 2-5 years,>5 years old and as shown in Table 3.
Table 4. lists the various symptoms and signs noted by organ system. Neurological signs and symptoms were most common followed by gastrointestinal, cardiovascular, respiratory, ocular and dermal signs and symptoms.
The nature of poisoning was also considered. (Table 5.)
Route of exposure is presented in Table 6
Out of 1120 patients, 710 cases (63.5%) were discharged after 3-6 hours observation and management and 406 cases (36.2%) were admitted to the ward. Mortality was 0.3%. (Table 7.)
Length of stay in the hospital was also determined. The admitted patients were mostly stayed for one day (363,88.7%).
Past medical history revealed that 1108 (98.9%) patients had no prior history of poisoning whereas such a history was present in 12 (1.1%) patients.
Out of 1120 patients, in 1106 cases (98.7%) the parents faced (found out) clinical deterioration in their children and brought them to this center. The others (14,1.3%) were brought by the persons other than parents.
History of addiction was not found in 1095 patients (97.8%) whereas such history was present in 25(2.2%).
*In this cases either the agent was unknown or in cases of co-ingestion, the clinical findings could not be attributed to a specific drug(s).
*opium is used as a traditional medicine in some families
**such as hair colors, lipsticks, deodorants, perfumes, hand creams, aftershaves, toothpastes, soaps, etc.
***organophosphates: 13 cases and carbamates:20 cases
*Voluntary includes all cases of intentional ingestion whether or not a suicidal intent was established.
**Due to complications or overdose of drugs during a treatment
The annual rates of intoxication in children younger than 12 years significantly decreased in this study in comparison with 1995 and comply with the result of a study in the USA.3
Despite difficulties in the interpretation of available data, certain general observations can be made on the epidemiology of poisonings in children.
Childhood poisoning is usually accidental and tends to be associated with a low morbidity and mortality as shown by this study.
In IRAN, it is most often due to household products and pharmaceuticals. Hydrocarbures, Opiate, and neuropsychotropic drugs are more commonly involved.
Male children were involved more than females (55.8% vs 44.2%) and the most common age for poisoning was 1-2 years (39%). Boys have a higher rate than girls in every age group which may be due to higher exposure to risks, as well as their more overactive behavior. Their curiosity, limited knowledge, developmental ability at this certain age increase their poisoning rates.
In 98.7% of cases, the parents were the first persons that determined the poisoning. Under inappropriate adult supervision and unsafe environment, tragedies of poisoning will always happen.
The mortality was low (0.3%). This data accords with the result of a study showing 0.2% for mortality rate in children younger than 19 years 3. In adults, self poisoning is usually voluntary (deliberate, suicide and parasuicide) and has a higher mortality and morbidity.5
This study highlights the unacceptable high rate of preventable accidental poisoning in children younger than 7 years as compared to the children older than 7 years (85.2% vs 14.8%).
The incidence of poisoning in children under 12 years of age was noticed to have dropped by more than half in year 2000-2001 as compared to 1995.This may be due to control of overpopulation and uplifting the knowledge of families.
Certain traditional measures carried out by parents were identified as dangerous. Some families prescribe opium for treatment of children illnesses. For this reason, parents must be educated.
Accidental poisoning accounts for 96.2% of poisonings in this study. This fact emphasizes family educations along with local safe storage for medications, improved labeling and packaging.
At last, without knowledge of how important poisonings are, how they occur, and which population is at risk, one will never find how to prevent poisonings in children.
Seyed Mostafa Mirakbari 3rd floor, NO.87, Davood Asadi St. Shahid Rahimi St. 14518 First square of Sadeqi-yeh Tehran, IRAN Tel.= +98 (21) 4230234 E. mail: firstname.lastname@example.org