Thitphalak Chounthirath

E-Cigarette and Liquid Nicotine Exposures Among Young Children

Monthly liquid nicotine exposures among US children <6 years old peaked in early 2015. Annual exposure rates decreased by ∼20% from 2015 to 2016. OBJECTIVES: To investigate exposures to liquid nicotine (including electronic cigarette devices and liquids) among children <6 years old in the United States and evaluate the impact of legislation requiring child-resistant packaging for liquid nicotine containers. METHODS: Liquid nicotine exposure data from the National Poison Data System for January 2012 through April 2017 were analyzed. RESULTS: There were 8269 liquid nicotine exposures among children <6 years old reported to US poison control centers during the study period. Most (92.5%) children were exposed through ingestion and 83.9% were children <3 years old. Among children exposed to liquid nicotine, 35.1% were treated and released from a health care facility, and 1.4% were admitted. The annual exposure rate per 100u2009000 children increased by 1398.2% from 0.7 in 2012 to 10.4 in 2015, and subsequently decreased by 19.8% from 2015 to 8.3 in 2016. Among states without a preexisting law requiring child-resistant packaging for liquid nicotine containers, there was a significant decrease in the mean number of exposures during the 9 months before compared with the 9 months after the federal child-resistant packaging law went into effect, averaging 4.4 (95% confidence interval: −7.1 to −1.7) fewer exposures per state after implementation of the law. CONCLUSIONS: Pediatric exposures to liquid nicotine have decreased since January 2015, which may, in part, be attributable to legislation requiring child-resistant packaging and greater public awareness of risks associated with electronic cigarette products. Liquid nicotine continues to pose a serious risk for young children. Additional regulation of these products is warranted.

Effectiveness of a Voice Smoke Alarm Using the Child's Name for Sleeping Children: A Randomized Trial

Objectives To test maternal voice alarm effectiveness under residential conditions and determine whether personalizing the maternal voice alarm message with the childs first name improves effectiveness. Study design Using a randomized, nonblinded, repeated measures design, we compared 3 maternal voice smoke alarms with respect to their ability to awaken 176 children 5‐12 years old from stage 4 slow‐wave sleep and prompt their performance of an escape procedure. A conventional residential high‐frequency tone smoke alarm was used as a comparative reference. Childrens sleep stage was monitored in a residence‐like research setting. Results Maternal voice alarms awakened 86%‐91% of children and prompted 84%‐86% to escape compared with 53% awakened and 51% escaped for the tone alarm. A sleeping child was 2.9‐3.4 times more likely to be awakened by each of the 3 voice alarms than the tone alarm. The median time to awaken was 156 seconds for the tone alarm and 2 seconds for each voice alarm. The proportions of children who awakened and escaped differed significantly between the tone alarm and each voice alarm, but no significant differences were found between each pair of the voice alarms, regardless of whether the childs first name was included in the alarm message. Conclusions The maternal voice alarms significantly outperformed the tone alarm under residential conditions. Personalizing the alarm message with the childs first name did not increase alarm effectiveness. These findings have important implications for development of an effective and practical smoke alarm for children. Trial registration ClinicalTrials.gov: NCT01169155.

Antidepressant and antipsychotic medication errors reported to United States poison control centers

To investigate unintentional therapeutic medication errors associated with antidepressant and antipsychotic medications in the United States and expand current knowledge on the types of errors commonly associated with these medications.

Pediatric ADHD Medication Exposures Reported to US Poison Control Centers

With this epidemiological study, we investigate the characteristics and trends of pediatric exposures to ADHD medications reported to PCCs in the United States. BrightcoveDefaultPlayer10.1542/6138655489001PEDS-VA_2017-3872 Video Abstract OBJECTIVES: To describe the characteristics and trends of exposures to attention-deficit/hyperactivity disorder (ADHD) medications among individuals 0 to 19 years old reported to US poison control centers. METHODS: National Poison Data System data from 2000 through 2014 were retrospectively analyzed to examine pediatric ADHD medication exposures. RESULTS: From 2000 through 2014, there were 156u2009365 exposures reported to US poison control centers related to ADHD medications. The overall rate of reported exposures increased 71.2% from 2000 to 2011, followed by a 6.2% decrease from 2011 to 2014. Three-fourths (76.0%) of exposures involved children ≤12 years old. Methylphenidate and amphetamine medications accounted for 46.2% and 44.5% of exposures, respectively. The most common reason for exposure was therapeutic error (41.6%). Intentional medication exposures (including suspected suicide and medication abuse and/or misuse) were reported most often among adolescents (13–19 years old), accounting for 50.2% of exposures in this age group. Overall, the majority of exposed individuals (60.4%) did not receive health care facility treatment; however, 6.2% were admitted to a hospital for medical treatment, and there were 3 deaths. The increasing number and rate of reported ADHD medication exposures during the study period is consistent with increasing trends in ADHD diagnosis and medication prescribing. Exposures associated with suspected suicide or medication abuse and/or misuse among adolescents are of particular concern. CONCLUSIONS: Unintentional and intentional pediatric exposures to ADHD medications are an increasing problem in the United States, affecting children of all ages.

Pediatric Injuries Related to Window Blinds, Shades, and Cords

In this study, we investigate the epidemiology of window blind–related injuries, and specifically window cord–related strangulations, among US children younger than 6 years of age. OBJECTIVES: To provide an epidemiologic description of fatal and nonfatal window blind–related injuries among US children younger than 6 years of age. METHODS: Data from the Consumer Product Safety Commission’s National Electronic Injury Surveillance System and In-Depth Investigation (IDI) databases were retrospectively analyzed. RESULTS: From 1990 to 2015, there were an estimated 16u2009827 (95% confidence interval: 13u2009732–19u2009922) window blind–related injuries among children younger than 6 years of age treated in emergency departments in the United States, corresponding to an injury rate of 2.7 per 100u2009000 children. The most common mechanism of injury was “struck by” (48.8%). Entanglement injuries accounted for 11.9% of all cases, and among this subgroup, 98.9% involved blind cords, and 80.7% were to the neck. Overall, most injuries (93.4%) were treated and released. In IDI reports for 1996 through 2012, we identified 231 window blind cord entanglement incidents among children <6 years of age, and 98.7% involved the child’s neck; entanglements with the window blind’s operating cords (76.4%) or inner cords (22.1%) were the most common. Two-thirds of entanglement incidents included in the IDI database resulted in death (67.1%). CONCLUSIONS: Despite existing voluntary safety standards for window blinds, these products continue to pose an injury risk to young children. Although many of the injuries in this study were nonfatal and resulted in minor injuries, cases involving window blind cord entanglements frequently resulted in hospitalization or death. A mandatory safety standard that eliminates accessible window blind cords should be adopted.

Infant Walker–Related Injuries in the United States

In this study, we demonstrate the decline in infant walker–related injuries over 25 years and investigate the effect of the 2010 federal safety standard on these injuries. OBJECTIVES: To investigate the epidemiologic characteristics of infant walker–related injuries among children <15 months old who were treated in US emergency departments and to evaluate the effect of the 2010 federal mandatory safety standard on these injuries. METHODS: National Electronic Injury Surveillance System data from 1990 to 2014 were analyzed. RESULTS: An estimated 230u2009676 children <15 months old were treated for infant walker–related injuries in US emergency departments from 1990 to 2014. Most of the children sustained head or neck injuries (90.6%) and 74.1% were injured by falling down the stairs in an infant walker. Among patients who were admitted to the hospital (4.5%), 37.8% had a skull fracture. From 1990 to 2003, overall infant walker–related injuries and injuries related to falling down the stairs decreased by 84.5% and 91.0%, respectively. The average annual number of injuries decreased by 22.7% (P = .019) during the 4-year period after the implementation of the federal mandatory safety standard compared with the 4-year period before the standard. CONCLUSIONS: Infant walker–related injuries decreased after the implementation of the federal mandatory safety standard in 2010. This decrease may, in part, be attributable to the standard as well as other factors, such as decreased infant walker use and fewer older infant walkers in homes. Despite the decline in injuries, infant walkers remain an important and preventable source of injury among young children, which supports the American Academy of Pediatrics’ call for a ban on their manufacture and sale in the United States.

Buprenorphine Exposures Among Children and Adolescents Reported to US Poison Control Centers

From 2007 to 2016, there were 11u2009275 pediatric exposures to buprenorphine reported to US poison centers. Most exposures were unintentional (86.8%) and among children <6 years old (86.1%). OBJECTIVE: To investigate buprenorphine exposures among children and adolescents ≤19 years old in the United States. METHODS: Data were analyzed from calls to US poison control centers for 2007–2016 from the National Poison Data System. RESULTS: From 2007 to 2016, there were 11u2009275 children and adolescents ≤19 years old exposed to buprenorphine reported to US poison control centers. Most exposures were among children <6 years old (86.1%), unintentional (89.2%), and to a single substance (97.3%). For single-substance exposures, children <6 years old had greater odds of hospital admission and of serious medical outcome than adolescents 13 to 19 years old. Adolescents accounted for 11.1% of exposures; 77.1% were intentional (including 12.0% suspected suicide), and 27.7% involved multiple substances. Among adolescents, the odds of hospital admission and a serious medical outcome were higher for multiple-substance exposures than single-substance exposures. CONCLUSIONS: Buprenorphine is important for the treatment of opioid use disorder, but pediatric exposure can result in serious adverse outcomes. Manufacturers should use unit-dose packaging for all buprenorphine products to help prevent unintentional exposure among young children. Health providers should inform caregivers of young children about the dangers of buprenorphine exposure and provide instructions on proper medication storage and disposal. Adolescents should receive information regarding the risks of substance abuse and misuse. Suspected suicide accounted for 12% of adolescent exposures, highlighting the need for access to mental health services for this age group.

Non-health care facility anticonvulsant medication errors in the United States:

Introduction: This study provides an epidemiological description of non-health care facility medication errors involving anticonvulsant drugs. Methods: A retrospective analysis of National Poison Data System data was conducted on non-health care facility medication errors involving anticonvulsant drugs reported to US Poison Control Centers from 2000 through 2012. Results: During the study period, 108,446 non-health care facility medication errors involving anticonvulsant pharmaceuticals were reported to US Poison Control Centers, averaging 8342 exposures annually. The annual frequency and rate of errors increased significantly over the study period, by 96.6 and 76.7%, respectively. The rate of exposures resulting in health care facility use increased by 83.3% and the rate of exposures resulting in serious medical outcomes increased by 62.3%. In 2012, newer anticonvulsants, including felbamate, gabapentin, lamotrigine, levetiracetam, other anticonvulsants (excluding barbiturates), other types of gamma aminobutyric acid, oxcarbazepine, topiramate, and zonisamide, accounted for 67.1% of all exposures. Conclusions: The rate of non-health care facility anticonvulsant medication errors reported to Poison Control Centers increased during 2000–2012, resulting in more frequent health care facility use and serious medical outcomes. Newer anticonvulsants, although often considered safer and more easily tolerated, were responsible for much of this trend and should still be administered with caution.

Analgesic-related medication errors reported to U.S. poison control centers

ObjectivenThis study investigates the characteristics and trends of medication errors involving analgesic medications.nnnDesign and MethodsnA retrospective analysis was conducted of analgesic-related medication errors reported to the National Poison Data System (NPDS) from 2000 through 2012.nnnResultsnFrom 2000 through 2012, the NPDS received 533,763 reports of analgesic-related medication errors, averaging 41,059 medication errors annually. Overall, the rate of analgesic-related medication errors reported to the NPDS increased significantly by 82.6% from 2000 to 2009, followed by a 5.7% nonsignificant decrease from 2009 to 2012. Among the analgesic categories, rates of both acetaminophen-related and opioid-related medication errors reported to the NPDS increased during 2000-2009, but the opioid error rate leveled off during 2009-2012, while the acetaminophen error rate decreased by 17.9%. Analgesic-related medication errors involved nonsteroidal anti-inflammatory drugs (37.0%), acetaminophen (35.5%), and opioids (23.2%). Children five years or younger accounted for 38.8% of analgesics-related medication errors. Most (90.2%) analgesic-related medication errors were managed on-site, rather than at a health care facility; 1.6% were admitted to a hospital, and 1.5% experienced serious medical outcomes, including 145 deaths. The most common type of medication error was inadvertently taking/given the medication twice (26.6%).nnnConclusionnAnalgesic-related medication errors are common, and although most do not result in clinical consequences, they can have serious adverse outcomes. Initiatives associated with the decrease in acetaminophen-related medication errors among young children merit additional research and potential replication as a model combining government policy and multisectoral collaboration.

Non-health Care Facility Medication Errors Associated with Hormones and Hormone Antagonists in the United States

IntroductionHormones and hormone antagonists are frequently associated with medication errors and may result in important adverse outcomes. The purpose of this study is to investigate non-health care facility (non-HCF) medication errors associated with hormones and hormone antagonists in the United States (US).MethodsA retrospective analysis of National Poison Data System data was conducted to identify characteristics and trends of unintentional non-HCF therapeutic errors involving hormones and hormone antagonists among individuals of all ages from 2000 to 2012.ResultsFrom 2000 to 2012, US poison control centers received 169,695 calls regarding unintentional non-HCF therapeutic errors associated with hormone therapies, averaging 13,053 medication error calls annually. The rate of reported errors increased significantly by 162.6% (pxa0<xa00.001), from 2.24 per 100,000 US residents in 2000 to 5.89 per 100,000 in 2012. Two thirds of the errors (65.2%) occurred among females. The medications most commonly associated with errors were thyroid preparations (23.2%), corticosteroids (21.9%), and insulin (20.0%). All nine deaths and 93.2% of major effects were attributed to hypoglycemic agents. Sulfonylureas alone accounted 43.9% of major effects. The number and rate of therapeutic errors increased significantly for all medication categories except estrogen and thiazolidinediones. Most errors were managed at the site of exposure (82.9%) and did not result in serious medical outcomes (95.6%).ConclusionsThis study provides an overview of non-HCF medication errors associated with hormones and hormone antagonists in the US. While most errors did not result in adverse outcomes, their increasing frequency places a greater burden on the health care system.