Characteristics and Trends in Intentional Acetaminophen Intoxication in Adolescents Over Two Decades
Notice bibliographique
Résumé
Abstract BACKGROUND: Acetaminophen is a common drug used for self-poisoning in adolescents, and an important cause of acute liver failure in the pediatric population. Data regarding intentional acetaminophen intoxication in Canadian youths is limited. OBJECTIVES: The purpose of the study was to describe the characteristics of intentional acetaminophen intoxications in Canadian adolescents and evaluate its evolution over two decades. DESIGN/METHODS: We performed a retrospective chart review of intentional acetaminophen ingestions in adolescents (11-18 years old) hospitalized at a Canadian pediatric tertiary care centre between 1989 and 2009. We recorded the patients’ sociodemographic data, as well as the characteristics, complications and treatments of the intoxications. Data was compared across approximately five year periods as a group, then in both sexes separately. RESULTS: A total of 383 cases were examined, 53 of which were in male patients and 330 in female patients. Given the small number of male patients, only female patients were included in this analysis. There were 200 cases within the time intervals 1 and 2 (1989-1993, 1994-1998) and 130 cases within the time intervals 3 and 4 (1999-2003, 2004-2009). Demographics were relatively constant across the time periods. Impulsive gestures were indicated as the motivation in almost 80% of cases, which remained stable over time (p=0.56). The ingestion of additional substances and the quantity of acetaminophen also remained constant over time (p=0.79 and p=0.46). Mean time to physician consultation significantly increased in time from 6h in interval 1 to 13.4h in interval 4 (p=0.0001). The proportion of ICU admissions, coagulopathy and multiple organ failures also increased across time intervals (p=0.01, 0.03 and 0.03 respectively). There was no definitive linear trend in cases of hepatitis, encephalopathy or acute kidney injury (p=0.26, 0.81 and 0.27 respectively). There were two deaths, and one liver transplant over the 21-year period. Treatment significantly changed over time with progressive increase in N-acetylcysteine use from 47.4% to 81.1% (p=<0.0001) and progressive decline in charcoal use from 70.2% to 17.6% (p<0.0001) in intervals 1 to 4. Poison centre consultations significantly increased in time from 14.4% in interval 1 to 67.7% in interval 4 (p<0.0001). CONCLUSION: We suggest that the apparent severity increase in adolescent acetaminophen intoxication is related to the progressive increase in time to physician consultation with associated delays in treatment. The changes in management observed over the 21-year period is likely reflective of the evolution and availability of treatment protocols. Furthermore, the increase in poison centre consultations may account for part of the decrease in treatment variability across patients.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,002 | 0,003 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».