Accidental and nonaccidental poisonings as a cause of apparent life-threatening events in infants.
BACKGROUND
Apparent life-threatening events are a relatively common event in children for which there may be a number of causes. Previous reports have suggested that poisonings, either accidental or intentional, may be causes of some events. However, this theory has not been systematically studied.


METHODS
We conducted a prospective, descriptive study of infants aged <2 years presenting to a pediatric emergency department of a large, urban tertiary care children's hospital with signs and symptoms of an apparent life-threatening event. All of the children presenting with an apparent life-threatening event were to undergo a standardized evaluation, which included obtaining a comprehensive urine toxicology screen. A positive toxicology screen result was defined as follows: a clinically insignificant screen result (identification of a medication that would not cause an apparent life-threatening event) or a clinically significant screen result (identification of a medication that could cause apnea or other event consistent with an apparent life-threatening event, even if it was a medication that the child was known to be taking).


RESULTS
During the study period, 596 children presented to the emergency department with an apparent life-threatening event, and 274 (46.0%) had a toxicology screen performed. Of 274 toxicology screen results, 50 were considered truly positive (18.2%), and 23 positive screen results were considered clinically significant (23 of 274 [8.4%]). Thirteen toxicology screen results were positive for an over-the-counter cold preparation (13 of 274 [4.7%]). No parent admitted to having given his or her child an over-the-counter cold preparation.


CONCLUSIONS
A substantial number of children presenting to the emergency department with an apparent life-threatening event had a positive toxicology screen result. In particular, a number of children were found to have been given an over-the-counter cold preparation. We would recommend that toxicology screens be included as part of the routine evaluation of children who present with an apparent life-threatening event.
Pitetti
Raymond D
RD
Department of Pediatrics, Children's Hospital of Pittsburgh, 3705 Fifth Ave, Pittsburgh, PA 15213, USA. piterd@chp.edu
Whitman
Emily
E
Zaylor
Abigail
A
D000061:Accidents, Home / Q000706:statistics & numerical data*; D017677:Age Distribution; D001774:Blood Chemical Analysis; D016638:Critical Illness / Q000453:epidemiology* / Q000628:therapy; D004630:Emergencies / Q000453:epidemiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D004366:Nonprescription Drugs / Q000008:administration & dosage / Q000506:poisoning*; D010414:Pennsylvania; D011041:Poisoning / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016482:Urinalysis
D004366:Nonprescription Drugs