Published online August 1, 2008
PEDIATRICS Vol. 122 No. 2 August 2008, pp. e359-e362 (doi:10.1542/peds.2007-3729)
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ARTICLE

Accidental and Nonaccidental Poisonings as a Cause of Apparent Life-Threatening Events in Infants

Raymond D. Pitetti, MD, MPHa, Emily Whitman, BAb and Abigail Zaylor, BAb

a Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
b Department of Arts and Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania

BACKGROUND. Apparent life-threatening events are a relatively common event in children for which there may be a number of causes. Previous reports have suggested that poisonings, either accidental or intentional, may be causes of some events. However, this theory has not been systematically studied.

METHODS. We conducted a prospective, descriptive study of infants aged <2 years presenting to a pediatric emergency department of a large, urban tertiary care children's hospital with signs and symptoms of an apparent life-threatening event. All of the children presenting with an apparent life-threatening event were to undergo a standardized evaluation, which included obtaining a comprehensive urine toxicology screen. A positive toxicology screen result was defined as follows: a clinically insignificant screen result (identification of a medication that would not cause an apparent life-threatening event) or a clinically significant screen result (identification of a medication that could cause apnea or other event consistent with an apparent life-threatening event, even if it was a medication that the child was known to be taking).

RESULTS. During the study period, 596 children presented to the emergency department with an apparent life-threatening event, and 274 (46.0%) had a toxicology screen performed. Of 274 toxicology screen results, 50 were considered truly positive (18.2%), and 23 positive screen results were considered clinically significant (23 of 274 [8.4%]). Thirteen toxicology screen results were positive for an over-the-counter cold preparation (13 of 274 [4.7%]). No parent admitted to having given his or her child an over-the-counter cold preparation.

CONCLUSIONS. A substantial number of children presenting to the emergency department with an apparent life-threatening event had a positive toxicology screen result. In particular, a number of children were found to have been given an over-the-counter cold preparation. We would recommend that toxicology screens be included as part of the routine evaluation of children who present with an apparent life-threatening event.

Key Words: apparent life-threatening events • toxicology • over-the-counter medications • poisoning

Abbreviations: ALTE—apparent life-threatening event • ED—emergency department • OTC—over-the-counter

Accepted Mar 11, 2008.


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