Emergency department use after pediatric pharmaceutical ingestion: comparison of two national databases

Abstract

Background. As no “gold standard” measure exists for the number of children evaluated in emergency departments (EDs) for medication-related injuries, the public health impact is based on estimates. In January 2006 the Morbidity and Mortality Weekly Report published a National Electronic Injury Surveillance System–All Injury Program (NEISS–AIP) estimate on unintentional pediatric medication exposure to children ≤4 years of age that resulted in an ED visit: 53,517 per year for the period 2001–2003. We sought to generate a parallel estimate using American Association of Poison Control Centers' (AAPCC) National Poison Data System (NPDS) to see how these estimates compare. Methods. To match data reported from the NEISS–AIP, NPDS was searched for the electronic medical records of children ≤4 years of age whose call type was an unintentional exposure to a pharmaceutical that involved presenting to a health care facility (HCF) in 2001–2003. Results. 178,513 met all of the criteria: 57,100 in 2001; 60,098 in 2002; and 61,315 in 2003. Comparing NEISS–AIP to NPDS: 10% versus 13% were hospitalized; 72% versus 68% were either 1 or 2 years of age; and the substance distribution was acetaminophen (8.1%, 6.8%), cough/cold (7.5%, 9.6%), cardiovascular (7.8%, 11.0%), anticonvulsant (3.6%, 3.2%), and vitamins (4.5%, 3.4%). Conclusion. These results are close suggesting that the actual number is near these numbers. The NPDS number is greater than NEISS–AIP point estimate but within the 95% confidence interval. As NPDS is an actual count and NEISS–AIP is an extrapolation from a sample, to the extent that every child presenting to an ED following a medication exposure is not reported to a poison center, both databases may underestimate the problem. The NEISS–AIP extrapolation tool may need to be reassessed.