Use of single-dose activated charcoal among Canadian pediatric emergency physicians.
OBJECTIVE
Gastric decontamination with single-dose activated charcoal (SDAC) is a mainstay in emergency department (ED) treatment of ingestions. Guidelines updated in 2005 encourage practitioners to use SDAC only in toxic ingestions presenting within 1 hour. Despite these guidelines, adult studies demonstrate a significant lack of consensus. This study examined the proposed use of SDAC for gastric decontamination in common pediatric ingestion scenarios by emergency physicians working in Canadian pediatric EDs.


METHODS
A standardized survey consisting of 5 clinical scenarios was mailed to all physicians with a primary clinical appointment to the ED at 9 Canadian children's hospitals.


RESULTS
One hundred thirty-one physicians were surveyed, and 95 (72%) responded. The majority of respondents were pediatricians (68.1%) with a mean of 15.0 years of experience (SD, 6.8 years). Of those surveyed; 91 (97.8%) would use SDAC for a toxic ingestion presenting in less than 1 hour; 35 (36.8%) would use SDAC for a toxic ingestion presenting after 3 hours; 61 (64.9%) would use SDAC for a nontoxic exploratory ingestion presenting in less than 1 hour; and 29 (30.5%) would use SDAC for a mildly symptomatic intentional ingestion presenting at an unknown time. Eleven (11.7%) would use SDAC for an ingestion of a substance that does not adsorb to SDAC.


CONCLUSIONS
There is variation in the use of SDAC among emergency physicians working in Canadian pediatric EDs. This variation suggests that optimal management is not clear and that continued education and research are required.
Reid
Sarah M
SM
Division of Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada. Reid_sa@cheo.on.ca
Neto
Gina M
GM
Clifford
Tammy J
TJ
Randhawa
Navdeep
N
Plint
Amy
A
D000082:Acetaminophen / Q000506:poisoning; D000293:Adolescent; D000931:Antidotes / Q000627:therapeutic use*; D002170:Canada; D002606:Charcoal / Q000627:therapeutic use*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004077:Digoxin / Q000506:poisoning; D004636:Emergency Service, Hospital; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D007052:Ibuprofen / Q000506:poisoning; D058085:Iron Compounds / Q000506:poisoning; D008140:Lorazepam / Q000506:poisoning; D008297:Male; D017374:Paroxetine / Q000506:poisoning; D011041:Poisoning / Q000188:drug therapy*; D013997:Time Factors
D000931:Antidotes; D058085:Iron Compounds; D002606:Charcoal; D000082:Acetaminophen; D017374:Paroxetine; D004077:Digoxin; D008140:Lorazepam; D007052:Ibuprofen