Evaluation of Forensic and Clinical Characteristics of Drug Intoxication Cases Admitted to the Pediatric Emergency Department

Öz

Aim: To evaluate pediatric drug intoxication cases presenting to a tertiary emergency department with respect to demographics, etiologies, ingested agents, interventions, and clinical outcomes, and to compare accidental and suicidal origins. Methods: The study cohort comprised 304 patients for whom a forensic report was issued due to drug ingestion. The recorded variables included demographics, origin of intoxication (accident/suicide), time of presentation, drug category, interventions, consultations, and outcomes. Group comparisons were performed using chi-square or Fisher’s exact tests (two-sided p<0.05). Results: The mean age was 12.46±6.00 years, and 70.4% were female. Drug intake was predominantly accidental in boys (67.7%) and suicidal in girls (80.4%) (p<0.001). Suicidal cases clustered in adolescents, while accidental ingestions were concentrated in ages 0–5 years. The most common agents were neuropsychiatric drugs, multiple-drug ingestion, and analgesic–antipyretics; the use of one’s own medication was significantly higher in suicide attempts (p<0.001). Child and adolescent psychiatry was consulted in 90.3% of the cases. No mortality occurred. Conclusion: Pediatric drug intoxication is largely preventable. For younger children, prevention should prioritize secure storage and child-resistant practices; for adolescents, emphasis should be placed on family communication, supervised dispensing of medications, and timely psychiatric referral.

Anahtar Kelimeler

• Child
• Adolescent
• Poisoning
• Drug Overdose
• Emergency Service
• Forensic Medicine

Destekleyen Kurum

N/A

Etik Beyan

It was reported by the Istanbul Medipol University Non-Interventional Clinical Research Ethics Committee that our study was ethically and scientifically appropriate, in the evaluation dated 10/10/2024, E-10840098-202.3.02-6366, decision number 963.

Pediatrik Acil Servise Başvuran İlaç Zehirlenmesi Vakalarının Adli ve Klinik Özelliklerinin Değerlendirilmesi

Öz

Amaç: Bu çalışmada, çocuk acil servisine ilaç intoksikasyonu nedeniyle başvuran adli olguların demografik özellikleri, başvuru nedenleri, maruz kalınan etken maddeler, yapılan müdahaleler ve klinik seyirleri değerlendirilmiş; kaza ve özkıyım amaçlı olgular karşılaştırılmıştır. Yöntemler: Çalışma grubunu, ilaç alımı nedeniyle adli rapor düzenlenen 304 hasta oluşturdu. Kaydedilen değişkenler arasında demografik özellikler, intoksikasyonun kökeni (kaza/özkıyım), başvuru zamanı, ilaç kategorisi, yapılan müdahaleler, konsültasyonlar ve klinik sonuçlar yer aldı. Gruplar arasındaki karşılaştırmalar ki-kare veya Fisher testi ile yapıldı (p<0.05). Bulgular: Ortalama yaş 12.46±6.00 yıl olup olguların %70.4’ü kızdı. İlaç alımı erkeklerde çoğunlukla kaza (%67.7), kızlarda ise özkıyım (%80.4) amaçlıydı (p<0.001). Özkıyım olguları adolesan yaş grubunda, kazaya bağlı alımlar ise 0–5 yaş aralığında yoğunlaşmıştı. En sık karşılaşılan ilaç grupları nöropsikiyatrik ilaçlar, çoklu ilaç alımı ve analjezik–antipiretiklerdi; özkıyım girişimlerinde kişinin kendi ilacını kullanma oranı anlamlı düzeyde yüksekti (p<0.001). Olguların %90.3’üne çocuk ve ergen psikiyatrisi konsültasyonu yapılmış olup mortalite saptanmamıştır. Sonuç: Çocukluk çağında ilaç intoksikasyonları önlenebilir bir sağlık sorunudur. Küçük yaş grubunda güvenli ilaç saklama önlemleri, adolesanlarda ise aile içi iletişim, ebeveyn kontrolünde ilaç kullanımı ve psikiyatrik destek, önleyici stratejiler arasında yer almalıdır.

Anahtar Kelimeler

• pediatri
• ilaç
• intoksikasyon
• çocuk acil
• adli tıp

Kaynakça

1. Bolat A. Evaluation of forensic cases admitted to the pediatric emergency department. J Health Sci Med. 2023;6(1):111–5. https://doi.org/10.32322/JHSM.1197015
2. Sever M, Saz EU, Koşargelir M. An evaluation of pediatric medico-legal admissions to a tertiary hospital emergency department. Ulus Travma Acil Cerrahi Derg. 2010;16(3):260–7.
3. Öztoprak Ü, Energin V. Evaluation of Cases Presenting to the Pediatric Emergency Department Due to Poisoning [in Turkish]. J Contemp Med. 2020;10(4):585–90. https://doi.org/10.16899/JCM.679961
4. TÜİK Kurumsal [Internet]. [cited 2025 Dec 7]. Available from: https://data.tuik.gov.tr/Bulten/Index?p=Istatistiklerle-Cocuk-2024-54197
5. Koppen A, Thoonen IMJ, Hunault CC, van Velzen AG, de Lange DW, Rietjens SJ. Significant increase in deliberate self-poisoning among adolescents during the second year of the COVID-19 pandemic. J Adolesc Health. 2023;73(2):319–24. https://doi.org/10.1016/j.jadohealth.2023.02.041
6. Predescu E, Calugar I, Bibu-Monus C, Sipos R. Trends and prevalence of hospital admissions related to deliberate self-poisoning in Romanian adolescents between 2016 and 2022. Children (Basel). 2023;10(5):790. https://doi.org/10.3390/children10050790
7. NCHS Data Query System. Suicide deaths [Internet]. Hyattsville (MD): National Center for Health Statistics; [cited 2025 Dec 7]. Available from: https://www.cdc.gov/nchs/dqs/index.html.
8. Dökmeci İ. Toksikoloji - Zehirlenmelerde Tanı ve Tedavi. 3rd ed. İstanbul: Nobel Tıp; 1991

9. Polat S, Terece C, Yaman A, Gurpinar K. Evaluation of forensic cases in pediatric intensive care unit. Sisli Etfal Hastan Tip Bul. 2021;55(1):122–8. https://doi.org/10.14744/SEMB.2019.73693
10. Arslan İ, Demir KI. Evaluation of forensic cases presented to pediatric emergency department. Turk J Emerg Med. 2022;22(3):137–42. https://doi.org/10.4103/2452-2473.348432
11. Singer CE, Văruț RM, Singer M, Cosoveanu S, Abdul Razzak J, Popescu ME, Gaman S, Petrescu IO, Popescu C. Epidemiological and Clinical Characteristics of Pediatric Acute Drug Intoxications: A Retrospective Analysis. Children (Basel). 2024;12(1):44. https://doi.org/10.3390/children12010044
12. Pac-Kożuchowska E, Krawiec P, Mroczkowska-Juchkiewicz A, Mełges B, Pawłowska-Kamieniak A, Kominek K, Gołyska D. Patterns of Poisoning in Urban and Rural Children: A Single-Center Study. Adv Clin Exp Med. 2016;25(2):335-40. https://doi.org/10.17219/acem/36142
13. Kadıoğlu E. Pediatric forensic cases: an emergency department experience. Turk J Forensic Med. 2018;32(1):1–9. https://doi.org/10.5505/ADLITIP.2018.43765
14. Duramaz BB, Yıldırım HM, Kıhtır HS, Yeşilbaş O, Şevketoğlu E. Evaluation of forensic cases admitted to pediatric intensive care unit. Turk Pediatri Ars. 2015;50(3):145–50. https://doi.org/10.5152/TurkPediatriArs.2015.2399
15. Kennedy SP, Baraff LJ, Suddath RL, Asarnow JR. Emergency department management of suicidal adolescents. Ann Emerg Med. 2004;43(4):452–60. https://doi.org/10.1016/j.annemergmed.2003.09.009
16. Arslan M, Akçan R, Hilal A, Batuk H, Çekin N. Suicide among children and adolescents: data from Cukurova, Turkey. Child Psychiatry Hum Dev. 2007;38(4):271–7. https://doi.org/10.1007/s10578-007-0060-y
17. Park J, Jeon W, Ko Y, Choi YJ, Yang H, Lee J. Comparison of the clinical characteristics of pediatric poisoning patients before and during the COVID-19 pandemic. J Korean Med Sci. 2022;37:e337. https://doi.org/10.3346/jkms.2022.37.e337
18. Yazar A, Akın F, Türe E, Odabaş D. Evaluation of Medico-Legal Cases Admitted to the Pediatric Emergency Department [in Turkish]. Dicle Med J. 2017;44(4):345–53. https://doi.org/10.5798/dicletip.362395
19. Kırcı GS, Öztürk DU, Bölükbaşı HS, Çakır H, Özer E. Evaluation of intoxication cases admitted to the pediatric emergency department between 2016–2021. Bull Leg Med. 2023;28(1):66–73. https://doi.org/10.17986/blm.1638
20. Ökçesiz AK, Kozacı N, Avcı M, Demirel B. Evaluation of pediatric forensic cases presented to emergency department. Disaster Emerg Med J. 2018;3(3):75–81. https://doi.org/10.5603/DEMJ.2018.0018
21. Larson EK, Johnson KP, Sheridan DC. Sources of medications used by children and adolescents for intentional ingestion: a retrospective chart review. Pediatr Emerg Care. 2022;38(4):e1213–6. https://doi.org/10.1097/PEC.0000000000002553
22. Sarıkayalar F, Uzel N, Karaböcüoğlu M, Üçsel R, Çıtak A. (2001). Poisonings in Children [in Turkish]. Katkı Pediatri Derg. 2001;22:377–95.
23. Czyz EK, King CA. Longitudinal trajectories of suicidal ideation and subsequent suicide attempts among adolescent inpatients. J Clin Child Adolesc Psychol. 2015;44(1):181–93. https://doi.org/10.1080/15374416.2013.836454
24. Kim HJ, Lee DH. Predictive factors for medical hospitalization in patients visiting the emergency department after suicide attempt. BMC Psychiatry. 2021;21:580. https://doi.org/10.1186/s12888-021-03089-2