Resource utilization among children presenting with cannabis poisonings in the emergency department - 20/10/23
, Kate Dorney, MD, MHPEd a, c, Gabrielle D'Ambrosi, MPH a, c, Michael C. Monuteaux, ScD a, c, Niloufar Paydar-Darian, MD a, c, Vidya R. Raghavan, MD a, c, Florence T. Bourgeois, M.D., M.P.H a, c, d, Joel Hudgins, M.D., M.P.H a, cAbstract |
Background |
Exploratory pediatric cannabis poisonings are increasing. The aim of this study is to provide a national assessment of the frequency and trends of diagnostic testing and procedures in the evaluation of pediatric exploratory cannabis poisonings.
Methods |
This is a retrospective cross-sectional study of the Pediatric Health Information Systems database involving all cases of cannabis poisoning for children age 0–10 years between 1/2016 and 12/2021. Cannabis poisoning trends were assessed using a negative binomial regression model. A new variable named “ancillary testing” was created to isolate testing that would not confirm the diagnosis of cannabis poisoning or be used to exclude co-ingestion of acetaminophen or aspirin. Ancillary testing was assessed with regression analyses, with ancillary testing as the outcomes and year as the predictor, to assess trends over time.
Results |
A total of 2001 cannabis exposures among 1999 children were included. Cannabis exposures per 100,000 ED visits increased 68.7% (95% CI, 50.3, 89.3) annually. There was a median of 4 (IQR 2.0, 6.0) diagnostic tests performed per encounter. 64.5% of encounters received blood tests, 28.8% received a CT scan, and 2.4% received a lumbar puncture. Compared to White individuals, Black individuals were more likely to receive ancillary testing (OR 1.52 [95% CI, 1.23, 1.89]). Compared to those 2–6 years, those <2 years were more likely to receive ancillary testing (OR 1.55 [95% CI, 1.19, 2.02). We found no significant annual change in the odds of receiving ancillary testing (OR 1.04 [95% CI, 0.97, 1.12]).
Conclusions |
We found no change in the proportion of encounters associated with ancillary testing, despite increases in exploratory cannabis poisonings over the study period. Given the increasing rate of pediatric cannabis poisonings, emergency providers should consider this diagnosis early in the evaluation of a pediatric patient with acute change in mental status. While earlier use of urine drug screening may reduce ancillary testing and invasive procedures, even a positive urine drug screen does not rule out alternative pathologies and should not replace a thoughtful evaluation.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Cannabis exposures per 100,000 ED visits increased by nearly 70% annually over the course of the study. |
• | Encounters by the youngest age group (< 2 years) and Black patients were more likely to be associated with ancillary testing. |
• | We found no significant annual change in the odds of receiving ancillary testing. |
Keywords : Cannabis, Poisoning, Pediatrics, Diagnostic testing
Abbreviations : CT, ECG, ED, ICU, LP, MRI, PHIS, THC, UDS
Plan
Vol 73
P. 171-175 - novembre 2023 Retour au numéro
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