ArticleFrontiers in pediatrics2026
Independent risk factors for clinically significant acute poisoning in children presenting to the emergency department: a 4-year cohort study of 2,345 cases.
Article in Frontiers in pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Acute poisoning is a major pediatric emergency department (ED) presentation, yet evidence-based tools for early risk stratification at triage remain limited. This study aimed to characterize epidemiological trends and identify independent risk factors for clinically significant poisoning (Poisoning Severity Score [PSS] ≥ 2) in children. Methods: We conducted a retrospective cohort study of 2,345 children (<18 years) with acute poisoning (2021-2024). Patients were stratified into mild (PSS 0-1) and clinically significant (moderate-to-severe) groups. Multiple imputation handled missing data. Multivariable logistic regression identified independent risk factors. Model discrimination and calibration were assessed using the Area Under the Receiver Operating Characteristic curve (AUC-ROC) and Hosmer-Lemeshow test. Patient-centered outcomes (acute organ dysfunctions) were systematically analyzed. Results: Over 4 years, the poisoning spectrum shifted from agricultural chemicals toward psychotropic drugs (18.5%-31.2%). Clinically significant poisoning occurred in 422 patients (18.0%). Independent risk factors for moderate-to-severe outcomes were: age >12 years (aOR 2.34), intentional self-harm (aOR 3.12), pre-hospital delay >6 h (aOR 2.78), multiple-agent exposure (aOR 2.15), exposure to agricultural herbicides (aOR 5.45), and psychotropic drugs (aOR 3.86). The model achieved an outstanding AUC-ROC of 0.892 (95% CI: 0.864-0.920). Clinically significant poisoning (PSS ≥ 2) was strongly associated with patient-centered organ injury, including acute respiratory failure (26.5% vs. 0.1%, Conclusion: Readily identifiable risk factors-age >12 years, self-harm, delay >6 h, multiple-agent exposure, and exposure to herbicides or psychotropics-independently predict clinically significant pediatric poisoning. The PSS ≥ 2 classification correlates tightly with acute organ dysfunction and Multiple Organ Dysfunction Syndrome (MODS).
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