General unintentional exposures and dosing errors together accounted for 87.4% of poison control center calls for infants aged 6 months and younger in the United States from 2004 to 2013, with quantitative and nonquantitative dosing errors being of equal concern, according to a study published in Pediatrics.
“The etiology of pediatric poisonings varies by age group such that adolescent exposures are more often intentional whereas younger children and toddlers have a greater rate of unintentional exposures,” A. Min Kang, MD, and Daniel E. Brooks, MD, both of the Banner–University Medical Center Phoenix and the University of Arizona College of Medicine, wrote. “Because these exposures are assumed to be due to the exploratory behavior of young children, anticipatory guidance provided by pediatricians encourages parents to keep medications and chemicals inaccessible.”
Reasoning that the cause of exposures would have implications on the effectiveness of prevention efforts, and that an infant who is not yet sitting upright would have a limited ability for exploration, the researchers conducted a 10-year retrospective review of poison calls for children aged up to 6 months. Data were obtained through the National Poison Data System, a near real-time directory containing electronic records from all U.S. poison control centers.
Focusing on calls from Jan. 1, 2004 to Dec. 31, 2013, the researchers pulled information including patient age, gender, exposure acuity, products involved, doses, reason for exposure, scenarios, route of exposure, medical acuity, signs and symptoms related to exposure, exposure and caller site, management site, treatments and medical outcome.
According to the researchers, 271,513 exposures were reported for infants aged 6 months and younger throughout the United States from 2004 to 2013. Of those, 96.7% were unintentional. The two most frequent varieties of unintentional exposure were general unintentional — which included exploratory ingestions, scenarios involving access and unintentional exposures that failed to fit in another category — with 50.7%, and therapeutic, or dosing, errors, with 36.7%.
Among therapeutic errors, 47% involved quantitative dosing errors, in which a different amount than intended was administered, and 42.8% involved nonquantitative errors, in which a medication was given twice or too soon, or the infant was given the wrong medication or through the wrong route. Although 97.5% of exposures occurred in the home, only 85.2% of poison calls were made from the same location. In cases of self-referral to a health care facility, 80.4% were released and 13.3% were admitted to the hospital.
“A retrospective review of 10 years of U.S. [poison control center] data showed that exposures in infants ≤6 months of age were almost all unintentional and primarily due to either general unintentional exposures (including exploratory ingestions) or therapeutic errors,” Kang and Brooks wrote. “… There was also a discrepancy between the number of exposures occurring at home compared to the number of calls originating from the home, suggesting self-referral to a [health care facility] prior to [poison control center] consultation. These findings may help guide future poison education and prevention efforts.” – by Jason Laday
Disclosure: The authors report no relevant financial disclosures.