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Gastrointestinal decontamination inappropriate in 55% of pediatric poisonings
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Gastrointestinal decontamination for the treatment of pediatric poisonings differ greatly around the world, with significant variations in the use and appropriateness of the procedure observed in different regions, according to a study published in Pediatrics.
“To our knowledge, no study has evaluated international practice variation regarding the treatment of poisoning — specifically gastrointestinal decontamination (GID) — or evaluated if its management across countries is consistent with international guidelines,” Santiago Mintegi, MD, PhD, from the pediatric ED in Cruces University Hospital at the University of the Basque Country. “It is pressing to establish whether variation exists and measure practice against standards of care to guide local and global poisoning knowledge-translation endeavors.”
The researchers note that this step is critical to the improvement of care for children who are poisoned worldwide.
To examine the variation and suitability of GID treatments for children and teenagers for poisonings, Mintegi and colleagues conducted an international, multicenter, cross-sectional prospective study that included children younger than 18 years old who presented to 105 EDs in 20 countries in eight regions with poisonings. The researchers began gathering data in January and September 2013, and the process lasted for 1 year.
The adequacy of the procedures performed for GID were assessed through the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists’ guidelines. Independent risk factors associated with performing GID procedures were identified through multivariate logistic regression.
Of the 1,688 patients in the study, 338 underwent a GID procedure, including activated charcoal (166, 49.1%), activated charcoal and gastric lavage (122, 36.1%), gastric lavage (47, 13.9%) and ipecac (3, 0.9%). These procedures were considered appropriate for 45.8% of children (40.5%-51.2%), and different regions of the world were more likely to use different GID procedures.
Age, toxin category, mechanism of poisoning, absence of symptoms and region where the intoxication occurred were the independent risk factors associated with GID procedures.
“Nevertheless, all of these recommendations to improve the quality of care — such as harmonized best practices for childhood poisoning, specifically GID, better access to and utilization of poison control centers, availability of prehospital medical services and advice hotlines, more mental health evaluation referrals, and better antidote stocking — require specific resources that have to be allocated by countries, and they need political and social will power to be realized,” Mintegi and colleagues wrote. — by Katherine Bortz
Disclosure: The researchers provide no relevant financial disclosures.
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