Evaluation and medical management of poisoning is often aided by laboratory tests. These range from basic analyses used widely in general clinical care to highly specific and sophisticated toxicology assays. For most poisonings, routine investigations such as measurement of blood glucose and electrolytes provide adequate information needed for management. Specific laboratory tests, such as quantitative assays for paracetamol, ethanol or other toxins, may be necessary. In some cases quantitative serum assays provide the primary information on which clinical management is based.Quantitative testing confirms the concentration of a toxin present and may help predict the anticipated clinical effects and guide management decisions such as the use of antidotes or haemodialysis. Qualitative testing to confirm the presence or absence of a toxin is less frequently helpful in clinical management of poisoning. Drug of abuse (DOA) testing is sometimes included in laboratory evaluation of poisoned patients. Though reported qualitatively as negative or positive, DOA testing is highly complex and easily misinterpreted.This review will discuss laboratory investigations for care of poisoned patients, including available tests and their indications, proper interpretation of results and testing limitations.

In this article, we identify and summarise articles describing 10 current, impactful topics related to paediatric healthcare overuse for articles published between 2023 and 2024. Articles were identified using a manual table of contents review of high-impact journals and a PubMed search strategy and then scored using an established three-score rubric based on strength of methods, magnitude of potential harm and number of patients harmed. Afterwards, the most impactful articles were selected by author consensus and summarised in this review. We identified 212 articles related to paediatric healthcare overuse between the manual and PubMed search strategies. Twelve articles describing 10 topics were selected by author consensus in the following areas: harms of proton pump inhibitors, constraints of lipid screening, early discharge for patients with febrile neutropenia, oral antibiotics for bone and joint infections, ultrasound evaluation of fractures, opioid stewardship for neonatal opioid withdrawal syndrome and reduced treatment duration, imaging and prophylaxis for urinary tract infections. Our review identifies and highlights impactful articles that build on a previous body of literature and introduces more recent areas of paediatric healthcare overuse.

To describe the epidemiology of a large, national outbreak of pertussis in England in 2023-2024, and key control measures implemented. Analysis of data for 2023-24 from multiple public health surveillance systems. England -national surveillance. All age groups but focusing on children and young people up to age 14 years. Laboratory-confirmed cases in the community, deaths and pertussis-related hospital admissions. National control measures implemented as part of outbreak response. 15 750 laboratory confirmed cases were reported in 2023-24, including 989 infants. Of 481 infants under 3 months, 12 died, of whom nine (75%) were born to mothers who were not vaccinated within the recommended timeframe in pregnancy. Incidence rates were highest among infants aged under 3 months. Most hospitalised pertussis cases were infants, but proportionately more hospitalisations in 2024 occurred in older age groups than expected based on earlier years. Whole genome sequencing indicated multiple lineages drove the increase. One isolate from 2023 and one from 2024 possessed 23s ribosomal RNA genotypes associated with macrolide resistance and this was confirmed phenotypically. Multiple control measures were implemented, including revisions to public health guidance and mobilisation work to promote childhood and prenatal vaccination uptake. Following a period of very low incidence during the COVID-19 pandemic, there was a large and rapid rise in pertussis cases across all age groups and geographies in England in 2023-24. Continued, high-quality surveillance and characterisation of circulating pertussis strains will be crucial to understanding evolving disease epidemiology postpandemic.