title: Assessing the toxicity and associated costs among pediatric patients admitted with unintentional poisonings of attention-deficit/hyperactivity disorder drugs in the United States.
abstract: BACKGROUND
  Attention-deficit/hyperactivity disorder (ADHD) is widespread, with a national (United States) prevalence of nearly 10%. The 2011 changes in the diagnostic criteria will likely further increase the prevalence of this disorder. Little is known about the incidence of toxicity from unintentional poisonings of ADHD medications. This study attempted to determine the incidence of these ingestions and the corresponding financial impact in the United States.
  
  
  METHODS
  Four geographically different centers were chosen. Subjects with unintentional poisonings due to ADHD medications were included if the admission dates were between 2000 and 2002 (cohort A) or between 2009 and 2010 (cohort B). Using data from the participating hospitals and the number of monitored beds in each corresponding county, data were extrapolated on a national (United States) level.
  
  
  RESULTS
  Sixty-three subjects were admitted at four hospitals (18, cohort A and 45, cohort B). The crude incidence rate ratio increased in the later time frame as compared to that in the earlier time frame (incidence rate ratio, 3.13; 95% CI, 1.80-5.68; p < 0.0001). The median (IQR) charges per patient, adjusted for inflation, were $4780 ($3,895-$8,287) and $5912 ($3,432-$9,433) for cohorts A and B, respectively (p = 0.57). If the subjects in the participating counties were only admitted to the participating hospitals, the annual charges, extrapolated throughout the United States for the two periods, would be $2,419,016 and $8,129,538, respectively. If the subjects were evenly distributed across all pediatric monitored beds in a given county, the annual charges extrapolated throughout the United States for the two periods would be $5,694,232 and $24,126,640, respectively.
  
  
  CONCLUSIONS
  The incidence of unintentional poisonings from ADHD drugs is increasing and is associated with a significant cost.
authors.affiliation: Department of Emergency Medicine, Section of Medical Toxicology, University of Southern California, Los Angeles, CA, USA. michael.levine@bannerhealth.com
authors.forename: M
authors.initials: M
authors.lastname: Levine
authors.forename: B
authors.initials: B
authors.lastname: Froberg
authors.forename: A M
authors.initials: AM
authors.lastname: Ruha
authors.forename: M
authors.initials: M
authors.lastname: Burns-Ewald
authors.forename: M
authors.initials: M
authors.lastname: Yen
authors.forename: I A
authors.initials: IA
authors.lastname: Claudius
authors.forename: A O
authors.initials: AO
authors.lastname: Arthur
authors.forename: L
authors.initials: L
authors.lastname: Tormoehlen
authors.forename: S H
authors.initials: SH
authors.lastname: Thomas
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000191:economics; D000697:Central Nervous System Stimulants / Q000191:economics / Q000506:poisoning*; D002648:Child; D002675:Child, Preschool; D062787:Drug Overdose / Q000191:economics / Q000453:epidemiology; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D014481:United States / Q000453:epidemiology
chemical_list: D000697:Central Nervous System Stimulants