Transcript Accident data from Germany

Accident data from Germany
Drug poisonings in childhood:
An analysis of the inquiries reported
to a regional poisons unit from 1995
to 2004
Dr. Marc-Alexander von Mach
Poison Center and Clinical Toxicology
University Hospitals
Mainz - Germany
Study design
-Explorative data analysis of our poisons unit database
-ADAM-Dok, based on Microsoft® Access® as previously described*
-Study period:
1.1.1995 – 31.3.2004 (9 ¼ years)
-Study population:
Children aged < 6 years
-Number of patients: 17,553
-Follow-up:
8,590 (48.9%)
-Sex:
53.4% male – 46.6% female
*von Mach et al. Dtsch Med Wochenschr 2002, 127: 2053-6
*von Mach et al. Int J Clin Pharmacol Ther 2004, 42: 277-80
*von Mach et al. Exp Clin Endocrinol Diabetes 2004, 112: 187-90
Age distribution of children with
drug intoxication
Number of children (percent)
40%
35%
30%
25%
20%
15%
10%
5%
0%
0-<1
1-<2
2-<3
3-<4
Age (years)
4-<5
5-<6
6-<7
Body-weight of the affected children
0-10
10-20
20-30
30-40
unknown
Delay between intoxication and
inquiry to the poisons unit
Number of children
14000
12000
10000
8000
6000
4000
2000
0
<1 h 1-2 h 2-3 h 3-4 h 4-5 h 5-6 h
6-12 12-24 >24 h
h
h
?h
Top ten of ingested substances
1. Oral contraceptives
7,5%
2. Homeopathic medications
6,1%
3. Nonsteroidal anti-inflammatory drugs
5,3%
4. Natriumfluoride
4,5%
5. Paracetamol
4,0%
6. Ambroxol
4,0%
7. Imidazoline-derivates
3,3%
8. Antihistaminics
3,3%
9. Antibiotics
3,3%
10. β-receptor blockers
1,8%
n = 17,553
Symptoms in children with drug
intoxication
Number of children (percent)
60%
50%
40%
30%
20%
10%
0%
neuro
gastro
unspec
derma
cardial
metab
resp
Severity of the observed symptoms
none
minor
medium
serious
unknown
The severity of the observed symptoms was ranked using the Poisoning Severity Score which was
developed by the American Academy of Clinical Toxicology (AACT) in cooperation with the
European Association of Poison Centers and Clinical Toxicologists (EAPCCT) for the clinical
evaluation of poisonings.
Top ten of substances causing medium
or serious symptoms
1. Neuroleptics
6,4%
2. Antihistaminics
4,9%
3. Nonsteroidal anti-inflammatory drugs
4,2%
4. β2-sympathomimetics
3,8%
5. Paracetamol
3,4%
6. Benzodiazepines
3,4%
7. Imidazoline-derivates
2,7%
8. Digitalis glykosides
1,9%
9. Tricyclic antidepressants
1,5%
10. β-receptor blocker / theophylline
1,5%
n = 264
Fatal drug poisonings
• 1 fatal accident:
2 year old boy (13 kg)
12 tablets of
Acetylsalicylic acid
500 mg each
Total amount: 6000 mg
Boy was found dead after an less than 12 hours
• All other poisonings showed a complete cure
Treatment of children with drug
intoxication
Number of children (percent)
70%
60%
50%
40%
30%
20%
10%
0%
none
layperson outpatient inpatient intensive
care
?
Top ten of recommended therapies
1. Oral fluids
47.3%
2. Observation
33.7%
3. Activated charcoal
32.0%
4. Oral calcium / milk
5.8%
5. Vomiting
5.6%
6. Symptomatic therapy
3.3%
7. Decontamination
2.7%
8. Sweatened fluids
1.6%
9. Acetylcystein
0.8%
10. Gastric lavage
0.7%
n = 17,553
Duration of
hospital stay
Days
0
1
2
3
4
5
6
7
8
17
18
Patients
16,748
573
157
39
10
4
1
3
1
1
1
Conclusions (1)
• Fortunately, severe symptoms have rarely been
observed in drug poisonings
• In most children a treatment by nonprofessionals was sufficient
• The gold standard for primary poison
elimination is currently the application of
activated charcoal
• We suggest an early involvement of a poison
centre in drug intoxications in order to prevent
invasive and high risk therapeutical measures.
Conclusions (2)
•
Child-resistant packaging would be helpful for
selected substances
In view of the present investigation these substances
should include in Germany at least:
•
Neuroleptics, Antihistaminics, Nonsteroidal anti-inflammatory drugs, β2sympathomimetics, Paracetamol, Benzodiazepines, Imidazoline-derivates,
Digitalis glykosides, Tricyclic antidepressants, β-receptor blockers and
theophylline
•
An effective child-resistance packaging of these
substances should lead to a significant reduction in:
–
–
Symptomatic drug poisonings in childhood
Number of children with the requirement for hospitalization
after accidental drug poisonings