Abstract
Objective: Acute paediatric poisoning is a global public health concern. This study aimed to describe the characteristics and clinical outcomes of acute paediatric intoxication in Hong Kong and to compare the features of intentional and unintentional intoxication.
Design, setting, patients, and participants: All paediatric intoxications requiring admission to Queen Elizabeth Hospital in Hong Kong from 1 January 2019 to 31 December 2021 were retrospectively reviewed.
Measurements and results: During the study period, 206 children were admitted for acute poisoning. The median age was 15.0 years. A bimodal distribution was observed, with an early peak at 1-2 years and a later peak at 14-16 years. Females were predominant. The vast majority of children were poisoned by ingestion. Therapeutic agents were the most frequent class of agents. The majority of cases were intended for deliberate self-harm, which was more prevalent in middle childhood and early adolescence. Analgesics were the most frequent agents.
While the majority of patients were stable with close observation, 29 patients (14%) required antidote treatment for the intoxication. Thirty-seven patients (18%) were admitted to the Paediatric Intensive Care Unit (PICU). Four of them (1.9%) required intubation and mechanical ventilation, and one received kidney replacement therapy (continuous veno-venous haemodiafiltration).
Intentional poisoning was more common in female patients (p<0.001) and older patients (p<0.001). It was associated with therapeutic agents (p=0.009) and the necessity for antidote treatment (p=0.01). They had a higher mean Poisoning Severity Score (PSS) (p<0.001) and required significantly more extended hospital stays (p<0.001). They were also more commonly associated with preexisting psychiatric conditions or newly diagnosed psychiatric conditions (p<0.001).
Conclusions: The vast majority of acute paediatric poisoning was intentional for deliberate self-harm. Intentional poisoning was associated with female sex, increasing age, more severe disease, need for an antidote or invasive treatment, and longer length of hospitalisation. The significantly higher proportion of children in this group having preexisting or newly diagnosed psychiatric disorders raised concerns about addressing emotions in children.
Elaine Kwong Yi Lee, Manson Kuok Chon In, Winnie Chan Kwai Yu
