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Adverse Events Related to Accidental Unintentional Ingestions From Cough and Cold Medications in Children.
Pediatr Emerg Care. 2020 Jun 22 [Online ahead of print]PE

Abstract

OBJECTIVES

Previous research has demonstrated that accidental unsupervised ingestions (AUIs) were responsible for the majority of cough and cold medication (CCM) ingestions leading to significant adverse events (AEs) in children. The objective of this analysis was to characterize the role of AUIs in the morbidity associated with CCM exposure in children.

METHODS

This surveillance study collected data from 5 United States data sources from 2009 to 2016, in children younger than 6 years with an AE from an AUI involving at least 1 CCM over-the-counter pharmaceutical ingredient. An expert panel reviewed each case to determine causality.

RESULTS

From 4756 total cases reviewed, 3134 (65.9%) had an AE from an AUI determined to be at least potentially related to a CCM ingredient. The majority (61.3%) of cases occurred in children aged 2 to younger than 4 years. Most exposures occurred in the child's own residence (94.9%), and 43.8% were admitted to a health care facility (22.0% to a critical care unit). Dextromethorphan and diphenhydramine, when packaged alone or in combination products, contributed to 96.0% of AUIs. The most common specific products involved were single-ingredient pediatric liquid diphenhydramine (30.1%) and single-ingredient pediatric liquid dextromethorphan (21.4%). There were 3 deaths from solid diphenhydramine formulations.

CONCLUSIONS

There continues to be opportunities for the implementation of interventions to prevent AUIs of CCM in children. Additional emphasis on engineering controls, such as flow restrictors for liquid formulations targeting diphenhydramine and dextromethorphan products, represent additional opportunities to further reduce AEs from AUIs of CCM.

Authors+Show Affiliations

From the Department of Pediatrics Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO. Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, CO.Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, CO.Oklahoma Center for Poison and Drug Information, Oklahoma University College of Pharmacy, Oklahoma City, OK.Faculté de Médecine, Hope Africa University, Bujumbura, Burundi.Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO.Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, CO.Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey, PA.Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, CO.Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, CO. Inflexxion, an IBH Company, Costa Mesa, CA.Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, CO.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32576790

Citation

Wang, George Sam, et al. "Adverse Events Related to Accidental Unintentional Ingestions From Cough and Cold Medications in Children." Pediatric Emergency Care, 2020.
Wang GS, Reynolds KM, Banner W, et al. Adverse Events Related to Accidental Unintentional Ingestions From Cough and Cold Medications in Children. Pediatr Emerg Care. 2020.
Wang, G. S., Reynolds, K. M., Banner, W., Bond, G. R., Kauffman, R. E., Palmer, R. B., Paul, I. M., Rapp-Olsson, M., Green, J. L., & Dart, R. C. (2020). Adverse Events Related to Accidental Unintentional Ingestions From Cough and Cold Medications in Children. Pediatric Emergency Care. https://doi.org/10.1097/PEC.0000000000002166
Wang GS, et al. Adverse Events Related to Accidental Unintentional Ingestions From Cough and Cold Medications in Children. Pediatr Emerg Care. 2020 Jun 22; PubMed PMID: 32576790.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Adverse Events Related to Accidental Unintentional Ingestions From Cough and Cold Medications in Children. AU - Wang,George Sam, AU - Reynolds,Kate M, AU - Banner,William, AU - Bond,G Randall, AU - Kauffman,Ralph E, AU - Palmer,Robert B, AU - Paul,Ian M, AU - Rapp-Olsson,Malin, AU - Green,Jody L, AU - Dart,Richard C, Y1 - 2020/06/22/ PY - 2020/6/25/entrez JF - Pediatric emergency care JO - Pediatr Emerg Care N2 - OBJECTIVES: Previous research has demonstrated that accidental unsupervised ingestions (AUIs) were responsible for the majority of cough and cold medication (CCM) ingestions leading to significant adverse events (AEs) in children. The objective of this analysis was to characterize the role of AUIs in the morbidity associated with CCM exposure in children. METHODS: This surveillance study collected data from 5 United States data sources from 2009 to 2016, in children younger than 6 years with an AE from an AUI involving at least 1 CCM over-the-counter pharmaceutical ingredient. An expert panel reviewed each case to determine causality. RESULTS: From 4756 total cases reviewed, 3134 (65.9%) had an AE from an AUI determined to be at least potentially related to a CCM ingredient. The majority (61.3%) of cases occurred in children aged 2 to younger than 4 years. Most exposures occurred in the child's own residence (94.9%), and 43.8% were admitted to a health care facility (22.0% to a critical care unit). Dextromethorphan and diphenhydramine, when packaged alone or in combination products, contributed to 96.0% of AUIs. The most common specific products involved were single-ingredient pediatric liquid diphenhydramine (30.1%) and single-ingredient pediatric liquid dextromethorphan (21.4%). There were 3 deaths from solid diphenhydramine formulations. CONCLUSIONS: There continues to be opportunities for the implementation of interventions to prevent AUIs of CCM in children. Additional emphasis on engineering controls, such as flow restrictors for liquid formulations targeting diphenhydramine and dextromethorphan products, represent additional opportunities to further reduce AEs from AUIs of CCM. SN - 1535-1815 UR - https://www.unboundmedicine.com/medline/citation/32576790/Adverse_Events_Related_to_Accidental_Unintentional_Ingestions_From_Cough_and_Cold_Medications_in_Children L2 - https://doi.org/10.1097/PEC.0000000000002166 DB - PRIME DP - Unbound Medicine ER -