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International variability in gastrointestinal decontamination with acute poisonings

(2017) PEDIATRICS. 140(2).
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Abstract
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.
Keywords
ACTIVATED-CHARCOAL, EMERGENCY-MEDICINE, CHILDREN, SPAIN

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Chicago
Mintegi, Santiago, Stuart R Dalziel, Beatriz Azkunaga, Javier Prego, Eunate Arana-Arri, Yordana Acedo, Lorea Martinez-Indart, et al. 2017. “International Variability in Gastrointestinal Decontamination with Acute Poisonings.” Pediatrics 140 (2).
APA
Mintegi, Santiago, Dalziel, S. R., Azkunaga, B., Prego, J., Arana-Arri, E., Acedo, Y., Martinez-Indart, L., et al. (2017). International variability in gastrointestinal decontamination with acute poisonings. PEDIATRICS, 140(2).
Vancouver
1.
Mintegi S, Dalziel SR, Azkunaga B, Prego J, Arana-Arri E, Acedo Y, et al. International variability in gastrointestinal decontamination with acute poisonings. PEDIATRICS. 2017;140(2).
MLA
Mintegi, Santiago, Stuart R Dalziel, Beatriz Azkunaga, et al. “International Variability in Gastrointestinal Decontamination with Acute Poisonings.” PEDIATRICS 140.2 (2017): n. pag. Print.
@article{8548346,
  abstract     = {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 {\textlangle} 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 {\textlangle}.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.},
  articleno    = {e20170006},
  author       = {Mintegi, Santiago and Dalziel, Stuart R and Azkunaga, Beatriz and Prego, Javier and Arana-Arri, Eunate and Acedo, Yordana and Martinez-Indart, Lorea and Benito, Javier and Kuppermann, Nathan and PERN Poisoning working group, the and Van de Voorde, Patrick and Hachimi Idrissi, Sa{\"i}d},
  issn         = {0031-4005},
  journal      = {PEDIATRICS},
  keyword      = {ACTIVATED-CHARCOAL,EMERGENCY-MEDICINE,CHILDREN,SPAIN},
  language     = {eng},
  number       = {2},
  pages        = {10},
  title        = {International variability in gastrointestinal decontamination with acute poisonings},
  url          = {http://dx.doi.org/10.1542/peds.2017-0006},
  volume       = {140},
  year         = {2017},
}

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