BPSU study - Acute severe poisonings

Commencing in July 2018, this surveillance study aims to determine the incidence of accidental poisoning; identify trends in severe poisonings that might inform public health interventions; describe the demographics of presenting populations; and calculate the severity of the poisoning event as determined by the EAPCCT poisoning severity score. The study is led by Dr Elizabeth Starkey, winner of the Sir Peter Tizard Bursary 2014-15.

Lead investigator

Dr Elizabeth Starkey
Derbyshire Children's Hospital
Uttoxeter Road
Derby DE22 3DE
Email: elizabeth.starkey@nhs.net

About the study

Overview

Poisoning occurs when someone is exposed to a substance that can affect his or her health. Accidental or unintentional poisonings involve people poisoning themselves or others without wanting to cause harm. Accidental poisoning in children is a common reason for attendance at healthcare providers. Young children, especially those under five, have an inquisitive nature, and frequently put things found in their environment into their mouths. Teenagers involved in taking illicit drugs or alcohol are also in danger of poisoning themselves unintentionally because of their risk-taking behaviour.

Serious consequences are rare after an accidental poisoning and most children are either discharged or observed for a few hours. Child-resistant containers for medicines and other dangerous substances have contributed significantly to a reduction in serious harm. However, a number of children continue to suffer significant harm, with between 5 and 10 deaths each year and around 50 children admitted to intensive care within the UK. In particular, there are a number of medications in which a single adult dose unit is potentially fatal to a toddler. The majority of these are packaged in blister packs, which are not subject to current child resistant closure legislation. Accidental poisoning is essentially an avoidable problem and, as a result, remains an important public health issue.

There is very little detailed data regarding serious poisoning in children in the UK. This study, for the first time, will determine the incidence and identify the circumstances surrounding severe accidental poisoning in children under 15 years in the UK and Republic of Ireland resulting in death, or signs and symptoms of poisoning defined as needing significant monitoring or support.

Accidental poisoning is an avoidable problem and remains an important public health issue. It is well recognised that blanket approaches to public health campaigns are often ineffective. By identifying specific trends in severe poisonings, in particular including specific substances that frequently cause significant harm, it is hoped that these can be subsequently be targeted.

You can download the protocol card, including references, below.

Case definition

Any accidental or unintentional poisoning in children <15 years resulting in:

  1. death and/or
  2. signs and symptoms defined as needing any of the interventions below.

A. Further monitoring

  • Continuous Oximetry plus Oxygen plus ECG monitoring
  • Arterial / CVP (central venous pressure) monitoring
B. Further airway and respiratory support
  • Invasive ventilation
  • Non-invasive ventilation, eg CPAP (continuous positive airway pressure)
  • Use of an adjunctive airway, eg NPA (nasopharyngeal airway)
  • Nebulised adrenaline for airway obstruction
  • Intravenous bronchodilators
C. Cardiovascular support
  • 40 mls/kg fluid resuscitation
  • > 80 mls/kg resuscitation over 24 hours
  • Inotropic/vasopressor treatment
  • Arrhythmia needing treatment or acute cardiac pacing
D. Neurological support
  • GCS < 12 and frequent GCS monitoring (1 hour or less)
  • Prolonged epileptic seizure requiring continuous IV infusions
E. Other support
  • Acute renal replacement, eg CVVH (continuous veno-venous haemofiltraion / HD (haemodialysis) / PD (peritoneal dialysis)
  • Plasma filtration or exchange transfusion
  • Extracorporeal Liver Support (MARS) Admission to a Paediatric Liver Unit
  • CPR in the last 24 hours

Reporting instructions

Please report any cases seen within the last month which meet the case definition.

Please report to the BPSU even if you believe the case may have been reported from elsewhere.

Duration

July 2018 to July 2019 (13 months of surveillance).

How will the information be collected?

Medical doctors across the UK and the Republic of Ireland will fill in a questionnaire for any child less than 15 years of age who dies or is very unwell needing large amounts of monitoring and support as a result of the poisoning.

The questionnaire will ask details about the poisoning including how the poisoning occurred, what poisons were involved, what tests and treatment were needed and finally what happened after the poisoning episode. This information will be sent onto the study team in Derby who will then look at the findings. The results will be then presented in medical journals and on various websites for parents and families.

How will they use the information?

By collecting patient information it is hoped that the investigators will increase our understanding about severe poisonings among children in the UK and Republic of Ireland. This may help to improve poisoning prevention within the home and reduce problems that can follow from a child being poisoned. BPSU researchers do not contact families or children who have been poisoned.

Derby Teaching Hospitals NHS Foundation Trust (DHFT) is the sponsor for this study based in the UK. They will be using information from case medical records to undertake this study and will act as the data controller for this study. This means that they are responsible for looking after patient  information and using it properly. Identifiable clinical information  including  age in months (taken from date of birth), sex and ethnicity are retained securely five years as a paper record and then electronically for 20 years, by DHFT.
 
Rights to access, change or move your patient information are limited, as the investigator needs to manage patient information in specific ways in order for the research to be reliable and accurate. If you withdraw from the study, they will keep the information about you that the investigator has already obtained. To safeguard your rights, they will use the minimum personally-identifiable information possible.
 
You can find out more about the study group use your information by contacting Dr Elizabeth Starkey, principal investigator.

Funding

The study is being funded through the Sir Peter Tizard Bursary.

Approval

This study has been approved by Nottingham 1, East Midlands REC Research Ethics Committee 2 (REC reference: 17/EM/0464; IRAS project ID: 191072); HRA Confidentiality Advisory Group (reference: 18/CAG/0006); and the Scottish Public Benefit and Privacy Panel (1718-0299).

Support group

Child Accident Prevention Trust