Home syrup of ipecac use does not reduce emergency department use or improve outcome.
BACKGROUND
The usefulness of syrup of ipecac as a home treatment for poisoning and the need to keep it in the home has been increasingly challenged. Many poison centers do not recommend any use of syrup of ipecac.


OBJECTIVE
To determine if use of syrup of ipecac in children at home is associated with reduced utilization of emergency department (ED) resources or improved outcome after unintended exposure to a pharmaceutical.


METHODS
Cohort comparison.


METHODS
American Association of Poison Control Centers' Toxic Exposure Surveillance System Database.


METHODS
Blinded data for each of the 64 US poison centers included ED referral recommendation rate, actual rate of ED use, actual home use of syrup of ipecac, and outcome. These data were derived from cases in 2000 and 2001 involving children <6 years of age who unintentionally ingested a pharmaceutical agent and in which the call to a poison center came from home (752 602 children).


METHODS
Correlation between rate of home use of syrup of ipecac and rate of recommendation for ED referral was the primary outcome sought. Rate of adverse outcome was also compared. In addition, the actual ED use and home syrup of ipecac utilization rates at 7 specific centers were identified and compared with the published rates from these same centers from 1990 data to look for the trend in practice for this subgroup.


RESULTS
Mean rate of referral to ED was 9% (range: 3%-18%). Mean home use of syrup of ipecac was 1.8% (range: 0.2%-14%). Increased home use of syrup of ipecac was not associated with referral to ED (r = 0.18; 95% confidence interval of r = -0.06-0.41). Adverse outcome was rare: 0.6% (range: 0.2%-2.1%). There was no difference in referral rate or adverse outcome rate between 2 groups of 32 centers divided by relative syrup of ipecac use. In the 7 centers, ED use decreased from a mean of 13.5% in 1990 to a mean of 8.1% in 2000-2001. Ipecac use decreased from a mean of 9.6% to 2.1%.


CONCLUSIONS
This study suggests there is no reduction in resource utilization or improvement in patient outcome from the use of syrup of ipecac at home. Although these data cannot exclude a benefit in a very limited set of poisonings, any benefit remains to be proven.
Drug and Poison Information Center, Department of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. randy.bond@cchmc.org
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D002675:Child, Preschool; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004639:Emetics / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007223:Infant; D007486:Ipecac / Q000627:therapeutic use*; D008297:Male; D011039:Poison Control Centers / Q000706:statistics & numerical data*; D011041:Poisoning / Q000188:drug therapy*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012651:Self Medication; D016037:Single-Blind Method; D016896:Treatment Outcome
D004639:Emetics; D007486:Ipecac