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International Variability in Gastrointestinal Decontamination With Acute Poisonings.

Abstract 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.
PMID
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Authors

Mayor MeshTerms

Gastric Lavage

Internationality

Keywords
Journal Title pediatrics
Publication Year Start




PMID- 28771410
OWN - NLM
STAT- MEDLINE
DA  - 20170803
DCOM- 20170828
LR  - 20170828
IS  - 1098-4275 (Electronic)
IS  - 0031-4005 (Linking)
VI  - 140
IP  - 2
DP  - 2017 Aug
TI  - International Variability in Gastrointestinal Decontamination With Acute
      Poisonings.
LID - e20170006 [pii]
LID - 10.1542/peds.2017-0006 [doi]
AB  - 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.
CI  - Copyright (c) 2017 by the American Academy of Pediatrics.
FAU - Mintegi, Santiago
AU  - Mintegi S
AD  - Pediatric Emergency Department, Cruces University Hospital, University of the
      Basque Country, Bilbao, Basque Country, Spain; [email protected]
FAU - Dalziel, Stuart R
AU  - Dalziel SR
AD  - Children's Emergency Department, Starship Children's Hospital and Liggins
      Institute, University of Auckland, Auckland, New Zealand.
FAU - Azkunaga, Beatriz
AU  - Azkunaga B
AD  - Pediatric Emergency Department, Cruces University Hospital, University of the
      Basque Country, Bilbao, Basque Country, Spain.
FAU - Prego, Javier
AU  - Prego J
AD  - Departamento de Emergencia Pediatrica, Centro Hospitalario Pereira Rossell,
      Montevideo, Uruguay.
FAU - Arana-Arri, Eunate
AU  - Arana-Arri E
AD  - Clinical Epidemiology Unit, Cruces University Hospital, BioCruces Health Research
      Institute, Basque Country, Spain; and.
FAU - Acedo, Yordana
AU  - Acedo Y
AD  - Pediatric Emergency Department, Cruces University Hospital, University of the
      Basque Country, Bilbao, Basque Country, Spain.
FAU - Martinez-Indart, Lorea
AU  - Martinez-Indart L
AD  - Clinical Epidemiology Unit, Cruces University Hospital, BioCruces Health Research
      Institute, Basque Country, Spain; and.
FAU - Benito, Javier
AU  - Benito J
AD  - Pediatric Emergency Department, Cruces University Hospital, University of the
      Basque Country, Bilbao, Basque Country, Spain.
FAU - Kuppermann, Nathan
AU  - Kuppermann N
AD  - Department of Emergency Medicine and Pediatrics, Davis School of Medicine,
      University of California, Sacramento, California.
CN  - Pediatric Emergency Research Networks (PERN) Poisoning Working Group
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PL  - United States
TA  - Pediatrics
JT  - Pediatrics
JID - 0376422
RN  - 16291-96-6 (Charcoal)
RN  - 8012-96-2 (Ipecac)
SB  - AIM
SB  - IM
MH  - Adolescent
MH  - Charcoal/*administration & dosage
MH  - Child
MH  - Child, Preschool
MH  - Cross-Cultural Comparison
MH  - Cross-Sectional Studies
MH  - Decontamination/*methods
MH  - Emergency Service, Hospital
MH  - Female
MH  - *Gastric Lavage
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - *Internationality
MH  - Ipecac/*administration & dosage
MH  - Male
MH  - Poisoning/*therapy
MH  - Prospective Studies
MH  - Risk Factors
COI - POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential
      conflicts of interest to disclose.
EDAT- 2017/08/05 06:00
MHDA- 2017/08/29 06:00
CRDT- 2017/08/04 06:00
PHST- 2017/05/01 [accepted]
AID - peds.2017-0006 [pii]
AID - 10.1542/peds.2017-0006 [doi]
PST - ppublish
SO  - Pediatrics. 2017 Aug;140(2). pii: e20170006. doi: 10.1542/peds.2017-0006.