MANAGEMENT OF ACUTE CHILDHOOD POISONINGS IN PEDIATRIC EMERGENCY
DEPARTMENTS: IMPACT OF A SOCIETY’S GUIDELINES
Introduction: In a multicenter study conducted in 2001-2002 in 17 Spanish Pediatric Emergency
Departments (PED) integrated in the Spanish Society of Pediatric Emergency Medicine (SEUP), great
management variability was detected. In this way, decontamination procedures were not always
adequated. This fact conducted SEUP to elaborate protocols and guidelines of management of acute
childhood poisoning in PEDs. The aim of the study was to analyse the impact of the guidelines in the
management of acute childhood poisonings in Spanish PEDs
Methods: We underwent a comparative study including all the children admitted in different Spanish
PEDs with an acute poisoning in two periods of time
 2001 Jan – 2002 Dec: group A (2157 children)
 2007 Oct – 2008 Apr: group B (612 children)
Physicians completed a questionnaire with each patient including age and sex; attending hospital;
circumstances associated with the poisoning; toxic compound type; time between exposure and arrival
to the emergency department; symptoms and signs; type of medical assistance before admittance to
the emergency room; treatment at the emergency department (basic life support, gastrointestinal
decontamination, antidote, or symptomatic therapy); laboratory tests and other investigations including
toxicological analysis; and patient’s final outcome.
Results: Of the 2157 children included in group A, 1116 received any treatment in the PED (51.7% vs
273 of patients included in group B, 44.8%, p=0.002), mostly decontamination procedures (733 in
group A, 33.9%, vs 170 in group B, 27.8%, p=0.004). Among patients in which any decontamination
procedure was practiced, 594 (80.4%) in group A received activated charcoal (vs 159 in group B,
93.5%, p=0.0001), 209 gastric lavage (28.5% vs 46, 27.1%, in group B, p>0.05) and 164 (22.3%)
ipecac syrup (vs 3, 1.8%, in group B, p<0.00001)
Conclusions: development and distribution of guidelines supported by the Spanish Society of Pediatric
Emergency Medicine has been associated with a significant improvement of management of acute
childhood poisonings in Spanish PEDs.