GI decontamination mishandled in most cases of acute pediatric poisoning worldwide

Last Updated: 2017-07-20

By Rita Buckley

NEW YORK (Reuters Health) - Gastrointestinal decontamination in acute pediatric poisoning is inappropriately handled in more than 50% of cases worldwide, according to a new study.

Dr. Santiago Mintegi from the University of the Basque Country in Bilbao, Spain, and colleagues conducted an international, multicenter, cross-sectional prospective study to assess the variation and appropriateness of GI decontamination procedures performed in 1,688 children and adolescents under 18 who presented to emergency departments with acute poisoning.

The study included 105 emergency departments in 20 countries from eight world regions; all belonged to the Pediatric Emergency Research Network, an international multicenter registry and global consortium. Data collection started in 2013 and continued for one year.

A total of 338 children (20%) underwent GI decontamination in an emergency department during the study period: 49.1% were treated with activated charcoal; 36.1% with activated charcoal and gastric lavage; 13.9% with gastric lavage; and 0.9% with ipecac.

The researchers used the American Academy of Clinical Toxicology Appropriateness and the European Association of Poisons Centres and Clinical Toxicologists' recommendations to determine whether treatment was appropriate.

Emergency department staff completed electronic questionnaires on all patients under the age of 18 who presented for acute poisoning on the fourth, 14th, and 24th days of every month.

Independent risk factors for performing GI decontamination included patient age, toxin category, mechanism of poisoning, method of poisoning, absence of symptoms and geographic region where the poisoning took place.

When GI decontamination was done, the procedure was considered appropriate in only 155 cases (45.8%), as judged by two investigators, with significant regional differences.

Compared with North America, Western Europe, Northern Europe and the Western Pacific Region, the highest odds of inappropriate use were found in Eastern Europe (OR, 12.8), South America (OR, 10.9), Southern Europe (OR, 8.2) and the Eastern Mediterranean (OR, 4.7).

No patients died. Of the 105 emergency departments, only 67 evaluated patients older than 14 years.

"We need to ensure that gastrointestinal decontamination in children and adolescents is performed in an evidence-based fashion all over the world," Dr. Mintegi told Reuters Health by email.

Other experts welcomed the study, which was published online July 20 in Pediatrics.

"This research is vital to advance the worldwide quality of care for children and adolescents who present to emergency departments with acute poisonings," Dr. Jean Klig, associate chief of the Division of Pediatric Emergency Medicine at Massachusetts General Hospital in Boston, told Reuters Health by email.

"International best practices need to be better identified and managed," said Dr. Klig, noting that the findings should change patient management in global regions with high numbers of inappropriate use.

"This study is an eye-opener," said Dr. Jyoti Ramakrishna, chief of Pediatric Gastroenterology and Nutrition at Floating Hospital for Children at Tufts Medical Center in Boston.

She added, "Early recognition and appropriate treatment are crucial to the outcome."

"In the U.S., we have a 1-800 Poison Control number we can reach with a simple phone call," Dr. Ramakrishna said. "In this era of globalization, there should be a system that anyone connected to the Internet anywhere in the world should be able to access."

SOURCE: http://bit.ly/2uCE71f

Pediatrics 2017.