title: The utility of the history and clinical signs of poisoning in childhood: a prospective study.
abstract: The authors aimed to evaluate the utility of the history and clinical signs for predicting ingestion of poisons in children. A prospective cohort study was performed of all patients presenting with suspected poisoning to a pediatric emergency department over a 13-month period. Clinical data were collected on a preformatted consultation sheet. Urine drug screens (UDS) were analyzed by gas chromatography/mass spectrometry (GC/MS). Serum toxicologic tests were performed when clinically indicated. The sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) of the history and clinical signs were calculated, first using UDS and, second, using all available toxicologic tests as the gold standards. Of 249 patients, 110 (46%) had a UDS performed. The purported poison ingested was potentially identifiable by GC/MS in 57 (52%) of these UDS. Only the results from these 57 UDS were included in our statistical analysis. Overall, the suspected poison was identified in 33 (58%) of the 57 UDS. Similarly, in the less than 5 years age subgroup, 28 (56%) of 50 UDS were positive. Odor on the breath (PPV 100%), followed by symptoms consistent with poisoning (PPV 92%) and presence of poison on clothes (PPV 86%) were the most useful predictors of a positive UDS. Similar results were obtained when all available toxicologic tests were used as the gold standard. The best clinical predictors of poisonous ingestion in children were found to be odor on the breath, symptoms consistent with poisoning, and presence of poison on the patient's clothes. Approximately 40% of children who present with poisoning have not been exposed to the putative toxin.
authors.affiliation: Emergency Medicine, Mater Children's Hospital, South Brisbane, Queensland, Australia.
authors.forename: Caroline F
authors.initials: CF
authors.lastname: Hwang
authors.forename: Carole L
authors.initials: CL
authors.lastname: Foot
authors.forename: Grant
authors.initials: G
authors.lastname: Eddie
authors.forename: Leslie
authors.initials: L
authors.lastname: Johnson
authors.forename: David M
authors.initials: DM
authors.lastname: Reith
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D007223:Infant; D011041:Poisoning / Q000175:diagnosis*; D011446:Prospective Studies; D012680:Sensitivity and Specificity