International variability in gastrointestinal decontamination with acute poisonings

Santiago Mintegi, Santiago Mintegi, Santiago Mintegi, Stuart R. Dalziel, Stuart R. Dalziel, Stuart R. Dalziel, Beatriz Azkunaga, Javier Prego, Javier Prego, Eunate Arana-Arri, Yordana Acedo, Lorea Martinez-Indart, Javier Benito, Javier Benito, Nathan Kuppermann, Nathan Kuppermann, Yehezkel Waisman, Martin Osmond, David Johnson, James ChamberlainCharles G. Macias, Anupam Kharbanda, Franz E. Babl, Franz E. Babl, Mark Sutter, Daniel Cohen, Julia Lloyd, Elizabeth Duffy, Prashant Mahajan, George Sam Wang, Stuart A. Bradin, Jose Ramirez, Samuel Stephenson, Anna Carison, Simon Craig, Andis Graudins, John Cheek, Megan Bonish, Patrick Van De Voorde, Said Hachimi Idrissi, Alexandra Petrovska, Jean Christophe Mercier, Laurence Morin, Gerard Cheron, Eva Szabo, Richard Nagy, Zsolt Bognar, Gabor Simon, Gyorgy Balla, Eva Juhasz, Ciara Martin, Rincy Koshy, Roisin Mc Namara, Yehezkel Hezi Waisman, Lisa Amir, Liviana Da Dalt, Carlo Moretti, Stefania Norbedo, Renna Salvatore, Carla Debbia, Alberto Arrighini, Patrizia Botarelli, Mara Pisani, Eduardo Ponticiello, Enzo Tipo, Henriette Moll, Xavier Bilhota, Ana Garrido, Lia Gata, Patricia MacAo, Sofia Costa Lima, Gabriela Araujo E Sa, Sofia Almeida, Mihai Gafencu, Alina Babeu, Diana Moldovan, Daniela Maria Mitrofan, Francisco Javier Humayor Yanez, Ana Gloria Andres Andres, Tomas Del Campo Munoz, Rocio Mendivil, Irene Baena Olomi, Jordi Fabrega I Sabate, Itziar Iturralde Orive, Andreu Roca, Ramon Fernandez, Ana Jorda Lope, Victor Canduela, Sofia Mesa, Carlos Garcia Vao Bel, Alberto Barasoain Millan, Laura Herrero, Carmen Campos Calleja, Juan Carlos Molina, Maria Angeles Garcia Herrero, Carlos Canduela, Pablo Bello Gutierrez, Roberto Velasco, Lidia Martinez Sanchez, Laura Martinez Mengual

Research output: Contribution to journalArticle

Abstract

© 2017 by the American Academy of Pediatrics. 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.
Original languageEnglish
JournalPediatrics
Volume140
Issue number2
DOIs
Publication statusPublished - Aug 1 2017

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    Mintegi, S., Mintegi, S., Mintegi, S., Dalziel, S. R., Dalziel, S. R., Dalziel, S. R., Azkunaga, B., Prego, J., Prego, J., Arana-Arri, E., Acedo, Y., Martinez-Indart, L., Benito, J., Benito, J., Kuppermann, N., Kuppermann, N., Waisman, Y., Osmond, M., Johnson, D., ... Mengual, L. M. (2017). International variability in gastrointestinal decontamination with acute poisonings. Pediatrics, 140(2). https://doi.org/10.1542/peds.2017-0006