Poisoning-related Pediatric Emergency Department Visits During the COVID-19 Pandemic at Three Mid-atlantic Hospitals

Background: The COVID-19 pandemic restructured daily life for children and adolescents in the United States and may have altered injury risk patterns. Studies exploring a possible increase in pediatric poisoning events are equivocal, with some indicating increased calls to poison control centers but no increased pediatric emergency visits for poisoning. This study aimed to i) compare the proportion of Emergency Department (ED) visits related to poisoning for pediatric patients before and during the COVID-19 pandemic, and ii) describe the acuity and patient characteristics associated with these visits.

Methods: This is a repeated cross-sectional study of ED health records for patients 0 to 18 years of age at three hospitals in the mid-Atlantic region from 2018 through 2020. Poisoning-related visits were identified through International Classification of Disease (ICD-10) code or chief complaint. Relevant ICD-10 codes included T36-50 “Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances,” T51-65 “Toxic effect of substances chiefly nonmedical as to source,” and F10-19 “Mental and behavioral disorders due to psychoactive substance use.” Poisoning-related keywords in the chief complaint included “Poison / Poisoning,” “Ingestion,” “Overdose” and “Toxin.” These identifiers do not distinguish between intentional and unintentional poisonings. Patient demographic characteristics (age, sex, race, ethnicity), illness acuity, and disposition were reported. Data were analyzed using descriptive statistics and logistic regression on the odds of poisoning-related ED visits compared to ED visits for other reasons.

Results: Of 147,736 total ED visits over the three-year study period, 2,478 (1.68%) were related to poisoning. There was a higher proportion of poisoning-related ED visits in 2020 (2.07% [721/34,835], 95%CI 1.92%-2.22%) compared to 2019 (1.49% [845/56,814], 95%CI 1.39%-1.59%) or 2018 (1.63% [912/56,087], 95% CI 1.52%-1.73%). The most common substances referenced in poisoning-related codes included cannabis (12.2%), non-opioid analgesics (7.7%), and alcohol (6.9%). The odds of poisoning-related ED visits increased for each increase in acuity along a 5-point scale (adjusted OR 2.18, 95%CI 1.90 – 2.50). The odds of poisoning-related ED visits increased in 2020 compared to 2018 (OR 1.28, 95%CI 1.16 – 1.41) and to 2019 (OR 1.40, 95%CI 2.53 – 2.79), but results did not persist when adjusted for acuity and demographic characteristics. Teenagers and females displayed higher odds of poisoning-related ED visits (Table 1). Median acuity differed by year according to the Kruskal-Wallis test (X2(2) = 35, p<0.001). Post-hoc Dunn testing revealed median acuity differed in 2020 compared to 2018 (p < 0.0001) or 2019 (p < 0.0001), which suggests increased acuity of poison-related visits over time (Figure 1).

Conclusion: Poisoning-related ED visits represented a higher proportion of total ED visits in 2020 compared to prior years; this was likely driven by the higher acuity of poisoning-related visits. Public health interventions should be targeted to decrease the frequency and acuity of pediatric poisoning events.