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Pediatrics. 2017 Aug;140(2). pii: e20170006. doi: 10.1542/peds.2017-0006.

International Variability in Gastrointestinal Decontamination With Acute Poisonings.

Collaborators (146)

Waisman Y, Osmond M, Johnson D, Chamberlain J, Macias CG, Kharbanda A, Babl FE, Sutter M, Cohen D, Lloyd J, Duffy E, Mahajan P, Wang GS, Bradin SA, Ramirez J, Stephenson S, Carison A, Craig S, Graudins A, Cheek J, Bonish M, Van de Voorde P, Hachimi-Idrissi S, Petrovska A, Mercier JC, Morin L, Cheron G, Szabo E, Nagy R, Bognar Z, Simon G, Balla G, Juhász É, Martin C, Koshy R, McNamara R, Waisman Y, Amir L, Da Dalt L, Moretti C, Norbedo S, Salvatore R, Debbia C, Arrighini A, Botarelli P, Pisani M, Ponticiello E, Tipo E, Moll H, Bilhota X, Garrido A, Gata L, Mação P, Costa Lima S, Araújo e Sá G, Almeida S, Gafencu M, Babeu A, Moldovan D, Mitrofan DM, Humayor Yanez FJ, Andrés Andrés AG, del Campo Muñoz T, Mendivil R, Baena Olomi I, Fábrega i Sabaté J, Iturralde Orive I, Roca A, Fernández R, Jorda Lope A, Canduela V, Mesa S, García-Vao Bel C, Barasoain Millán A, Herrero L, Campos Calleja C, Molina JC, Herrero MÁG, Canduela C, Gutiérrez PB, Velasco R, Sánchez LM, Mengual LM, Suárez JR, Mintegi S, Salmon N, Bernal JÁM, López J, López PV, May E, Cozar Olmo J, López-Corominas V, Tallón García M, Crespo Rupérez E, Pérez Sáez A, Sancosmed Ron M, Velasco Puyó P, Mesa J, Pociello N, Galán Mercado M, Seiler M, Rey-Bellet Gasser C, Pittet A, Gervaix A, Manzano S, Saz EU, Yurtseven A, Anil M, Oguz S, Kurt F, Ryan M, Hoyle A, Lyttle MD, Potter S, Cagnasia S, Berzel H, Cargnel E, Gordillo E, Gait N, Mendez MM, Haas AI, Quevedo MG, Parot Varela MM, Regnando M, Rino PB, Cerino VT, Tobares H, Bruno F, Godoy L, Pavlicich V, Casella W, Giachetto Larraz GA, Ferreira MI, Pedemonti A, Antúnez E, Dall’Orso P, Torello P, Parodi V, Pandolfo S, Prego J, Gariglio LG, Arreseigor E, Gugliemone H, Yemini L, Qureshi N, Fayyaz J.

Author information

1
Pediatric Emergency Department, Cruces University Hospital, University of the Basque Country, Bilbao, Basque Country, Spain; santiago.mintegi@osakidetza.eus.
2
Children's Emergency Department, Starship Children's Hospital and Liggins Institute, University of Auckland, Auckland, New Zealand.
3
Pediatric Emergency Department, Cruces University Hospital, University of the Basque Country, Bilbao, Basque Country, Spain.
4
Departamento de Emergencia Pediátrica, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay.
5
Clinical Epidemiology Unit, Cruces University Hospital, BioCruces Health Research Institute, Basque Country, Spain; and.
6
Department of Emergency Medicine and Pediatrics, Davis School of Medicine, University of California, Sacramento, California.

Abstract

BACKGROUND AND OBJECTIVES:

Identifying international differences in the management of acute pediatric poisonings may help improve the quality of care. The objective of this study was to assess the international variation and appropriateness of gastrointestinal decontamination (GID) procedures performed in children and adolescents who present with acute poisonings to emergency departments.

METHODS:

This was an international, multicenter, cross-sectional prospective study including children <18 years with poisoning exposures presenting to 105 emergency departments in 20 countries from 8 global regions belonging to the Pediatric Emergency Research Networks. Data collection started between January and September 2013 and continued for 1 year. The appropriateness of GID procedures performed was analyzed using the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists' recommendations. Multivariate logistic regression was performed to identify independent risk factors for performing GID procedures.

RESULTS:

We included 1688 patients, 338 of whom (20.0%, 95% confidence interval 18.1%-22.0%) underwent the following GID procedures: activated charcoal (166, 49.1%), activated charcoal and gastric lavage (122, 36.1%), gastric lavage (47, 13.9%), and ipecac (3, 0.9%). In 155 (45.8%, 40.5%-51.2%), the GID procedure was considered appropriate, with significant differences between regions. Independent risk factors for GID procedures included age, toxin category, mechanism of poisoning, absence of symptoms, and the region where the intoxication occurred (P < .001).

CONCLUSIONS:

Globally, there are substantial differences in the use and appropriateness of GID procedures in the management of pediatric poisonings. International best practices need to be better implemented.

PMID:
28771410
DOI:
10.1542/peds.2017-0006
[Indexed for MEDLINE]
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