Title

Clinical predictors of adverse cardiovascular events for acute pediatric drug exposures

UMMS Affiliation

Department of Emergency Medicine, Division of Medical Toxicology; Department of Quantitative Health Sciences

Publication Date

2019-07-03

Document Type

Article

Disciplines

Cardiovascular Diseases | Emergency Medicine | Health Services Administration | Health Services Research | Medical Toxicology | Pediatrics | Translational Medical Research

Abstract

Context: Risk factors for adverse cardiovascular events (ACVE) from drug exposures have been well-characterized in adults but not studied in children. The objective of the present study is to describe the incidence, characteristics, and risk factors for in-hospital ACVEs among pediatric emergency department (ED) patients with acute drug exposures.

Methods: This is a prospective cohort design evaluating patients in the Toxicology Investigators Consortium (ToxIC) Registry. Pediatric patients (age < 18 years) who were evaluated at the bedside by a medical toxicologist for a suspected acute drug exposure were included. The primary outcome was in-hospital ACVE (myocardial injury, shock, ventricular dysrhythmia, or cardiac arrest). The secondary outcome was in-hospital death. Multiple logistic regression analyses were performed to examine novel clinical risk factors and extrapolate adult risk factors (bicarbonate < 20 mEq/L; QTc > /=500 ms), for the primary/secondary outcomes.

Results: Among the 13,097 patients (58.5% female), there were 278 in-hospital ACVEs (2.1%) and 39 in-hospital deaths (0.3%). Age and drug class of exposure (specifically opioids and cardiovascular drugs) were independently associated with ACVE. Compared with adolescents, children under 2 years old (OR: 0.41, 95% CI: 0.21-0.80), ages 2-6 (OR: 0.37, 95% CI: 0.21-0.80), and ages 7-12 (OR: 0.51, 95% CI: 0.27-0.95) were significantly less likely to experience an ACVE. Serum bicarbonate concentration < 20 mEq/L (OR: 2.31, 95% CI: 1.48-3.60) and QTc > /= 500 ms (OR: 2.83, 95% CI: 1.67-4.79) were independently associated with ACVE.

Conclusion: Previously derived clinical predictors of ACVE from an adult drug overdose population were successfully extrapolated to this pediatric population. Novel associations with ACVE and death included adolescent age and opioid drug exposures. In the midst of the opioid crisis, these findings urgently warrant further investigation to combat adolescent opioid overdose morbidity and mortality.

Keywords

Pediatrics, adverse events, cardiovascular, opioid, poisoning, UMCCTS funding

DOI of Published Version

10.1080/15563650.2019.1634272

Source

Clin Toxicol (Phila). 2019 Jul 3:1-7. doi: 10.1080/15563650.2019.1634272. [Epub ahead of print] Link to article on publisher's site

Journal/Book/Conference Title

Clinical toxicology (Philadelphia, Pa.)

Related Resources

Link to Article in PubMed

PubMed ID

31267804

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