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G89(P) Accidental ingestion of potentially harmful substances: analysing paediatric emergency department presentations to guide health promotion advice and triage
  1. KM Knight,
  2. V Merrick
  1. Paediatric Emergency Department, Royal London Hospital, London, UK

Abstract

Aims Accidental ingestion of a potentially harmful substance is a common complaint in paediatric A&E – in 2002, 31,500 children <15 years old attended hospital with suspected poisoning. Large UK based studies focus on fatal poisonings. However, most children do not require any treatment, and the literature currently lacks detail regarding the minor end of the spectrum.

Gathering data from a large inner city paediatric A&E, we studied every attendance with accidental ingestion – not only cases requiring intervention – to look for emerging trends to guide health promotion advice, and improve the pathway for these children from triage through to discharge.

Method Two years of electronic records were analysed. Search criteria included any presenting complaint or discharge diagnosis containing the term ‘accidental ingestion’ or ‘accidental overdose’. Demographic data was established, along with details of the substance ingested, any treatment or admission required and any follow up arranged.

Results There were 169 presentations during 2012–2013. 12–23 month old children accounted for 29% of cases. There was no seasonal variation, and the gender divide was equal. In 90% of cases, the child was unsupervised when the ingestion occurred. Substances were divided by category – parent/carers medication (33% of cases); bathroom/kitchen product (21%); paracetamol containing products (11%); rodent/insect poison (8%), and own medication (5%). Most children (57%) were sent home with reassurance. 21% had 4 h of A&E observation, while only 8% were admitted. 3% returned for repeat tests. Sixteen cases (9%) had a documented health visitor referral. Social services were notified about three cases.

Conclusion Although most events happened while the child was unsupervised, there were few health visitor referrals – a key strategy in preventing further incidents. Most substances ingested were medications or cleaning products. Children can sometimes still open ‘child resistant’ containers, so health promotion advice should focus on safer storage. All children waited to see a doctor, however the majority needed no treatment or observation. There may be scope for certain children to be discharged from nurse triage, streamlining their A&E pathway.

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