Evaluation of pediatric poisoning cases admitted to the emergency department

Objective: As poisoning during childhood carries a significant risk of mortality, the appropriate management of these patients is of paramount importance. The objective of this study is to evaluate the age distribution, diversity of agents, mechanisms of poisoning, the frequency of calls to the Poison Consultation Centre (PCC) and the appropriateness of their recommendations, and the length of stay in the paediatric intensive care unit. Methods: In the present study, a retrospective analysis was conducted on 209 patients diagnosed with acute poisoning who were treated in a second-level paediatric intensive care unit (PICU) between 01.12.2020 and 01.06.2023. The analysis was conducted using SPSS-25 software. The age and gender of the cases, the time of admission to the paediatric emergency department, the type and route of exposure to the substances, the time between the event and hospital admission, physical examination findings, presenting symptoms, mode of transportation to the hospital, interventions performed at home or at another healthcare facility before admission, PCC data, laboratory results, comorbidities, treatments administered in our hospital, and the length of stay in the paediatric intensive care unit (PICU) were retrospectively evaluated and recorded on case data forms. Results: Of the 209 cases of poisoning that were admitted to the intensive care unit, 139 (66.5%) were female and 70 (33.5%) were male, with a median age of 154 months (25th-75th percentile: 27.5-185 months). The most prevalent route of poisoning was oral ingestion in 191 cases (91.4%), and the most common mechanism of poisoning was accidental exposure in 113 cases (54.1%). The research revealed that a substantial proportion of poisonings (93.77%) occurred within the home environment. The most prevalent cause of poisoning was drug-related in 78.9% of cases, with analgesic-antipyretic drugs being the most frequent group, found in 62 patients (29.6%). In the context of non-drug agents, the most prevalent agent identified was rodenticide (rat poison), which was detected in 10 cases, accounting for 4.8% of the total. Admissions occurred during working hours in 23.4% of cases and outside working hours in 76.6%. Antidotes were administered to 42 patients (20%). With respect to the mode of admission to the emergency department, 142 (67.9%) cases were transported by ambulance (112 emergency services), while 67 (32.1%) patients arrived on foot. In the 76 cases (36.3%) for which the PCC was consulted, intensive care was required for all but 39.4% of these, with monitoring taking place for less than 24 hours in 39.4% of cases. The average duration of stay in the Paediatric Intensive Care Unit (PICU) was 24 hours (range 17-36.5), and no fatalities were observed. Conclusion: In this study of poisoning cases, analgesic-antipyretic agents were identified as the most common cause among drug poisonings, and rodenticide among non-drug causes. The preponderance of accidental poisonings indicates potential shortcomings in the storage or management of hazardous substances by families, as well as a lack of adherence to adequate preventive measures. Furthermore, it was determined that a significant proportion of the poisoned patients had previously been attended at another healthcare institution, where they could have been managed with simple medical treatment. The organisation of the PCC, the utilisation of 112 emergency services and emergency departments, and the prevention of unnecessary occupation of tertiary emergency services could enhance the efficiency of healthcare services in poisoning cases. Moreover, the provision of accurate information to healthcare personnel and the general public regarding cases of poisoning has the potential to contribute to a reduction in costs and the assurance of effective treatment. Keywords: Poisoning, emergency service, child,