1]. One in four deaths among adolescents in the European Region is associated with alcohol [
2]. Poisoning in adolescents is not only a health problem, but also a socio-economic problem, since huge funds are spent on providing medical care and rehabilitation of adolescents with poisoning, and the outcome of poisoning can be disability, which reduces the quality of life of these children and requires enormous costs [
3].">
VI. RELEVANCE
Acute poisoning is one of the most pressing health problems of recent decades. Their etiology is different. In pediatric practice, the most common reasons for seeking medical help and hospitalization in intensive care units include poisoning with poisons and drugs [
1]. One in four deaths among adolescents in the European Region is associated with alcohol [
2]. Poisoning in adolescents is not only a health problem, but also a socio-economic problem, since huge funds are spent on providing medical care and rehabilitation of adolescents with poisoning, and the outcome of poisoning can be disability, which reduces the quality of life of these children and requires enormous costs [
3].
VII. PURPOSE
Determination of the structure, features and frequency of acute poisoning among the adolescent population of the Voronezh region.
VIII. MATERIALS AND METHODS
1. Research plan
The study was conducted at the Department of Clinical Pharmacology of the N. N. Burdenko VSMU of the Ministry of Health of the Russian Federation in 2020. The structure of all exogenous poisoning in children aged 11-17 years was studied, and data from medical histories were used. The study design is a retrospective analysis of medical histories.
2. Compliance criteria
The study included all patients who applied by self-referral, by emergency medical assistance, or were referred from other medical institutions. The criteria for exclusion from the study are the lack of clear data on the use of drugs. Poisoning with all drugs and other substances was taken into account.
3. Terms of the event
The study was conducted on the basis of the Voronezh Regional Children's Clinical Hospital No. 1. Children with poisoning of any severity from the city of Voronezh and children with severe poisoning from other districts of the Voronezh region are hospitalized in this hospital. Children with mild poisoning, living in remote areas of the Voronezh region, could receive treatment in district hospitals and not be included in the study. In addition, some patients with mild poisoning could refuse further transportation to the hospital and not enter the study when they were treated by ambulance.4. Duration of the study The study of the structure of drug poisoning was carried out retrospectively according to the analysis of medical records for three years (2016-2019).
5. Description of the medical intervention
The study took into account the gender, age, place of residence of patients, the year of hospitalization, the etiology of the toxic substance, the route of its intake, the type of poisoning, the severity of clinical manifestations, the drug therapy and the outcome of poisoning.
6. The main outcome of the study
Study of the etiological structure of acute poisoning in the adolescent population of the Voronezh Region in 2016-2019.
7. Secondary outcomes of the study
Secondary outcomes of the study have not been studied.
8. Group analysis
The analysis of the structure and clinical picture of poisoning was carried out in a general group of children hospitalized in VODKB No. 1 with poisoning in 2016-2019.
9.Methods for registering outcomes
Accounting and analysis of anamnesis, clinical, instrumental and laboratory data presented in the medical history of children with drug poisoning.
10. Statistical analysis
The sample size was not previously calculated. Statistical analysis was carried out using Microsoft Excel, Biostat (version 4.3). Qualitative nominal and ordinal data are indicated with the frequency of occurrence, represented as an absolute value and relative (%). For comparison of quality indicators used the χ2 criterion, in cases of small sample size (if the number of observations in one of the cells fourfold table <5) Fisher's exact test and the χ2 with Yates correction for 2x2 tables.
IX. RESULTS
Objects (participants) of the study: A total of 50 children with poisoning were admitted to the Voronezh Regional Children's Clinical Hospital No. 1 for 3 years, including 27 patients (54%) with drug poisoning.
The main results of the study: The group of children with poisoning included 26 boys (52%) and 24 girls (48%). The age of children ranged from 11 to 17 years, among them patients aged 13 to 15 years prevailed (58%). Drug poisoning was observed in 27 people (54%), 11 patients – with narcotic and psychotropic drugs that are not related to drugs, 4 people (8%) - were poisoned with alcohol and unspecified substances-the consequences of animal bites were observed in 3 people, carbon monoxide poisoning – in 1 child. Among the groups of drugs that caused poisoning, the most common were anxiolytics (mainly bromodihydrochlorophenylbenzodiazepine) - 18.5%, neuroleptics-18.5%, a combination of different groups of drugs was 25.9%, analgesics, antidepressants, antispasmodics, hypnotics accounted for 7.4%, and other groups – 3.7%. In most children, the route of ingestion of the toxic substance is oral – 42 people (84%), inhaled and percutaneous – 2 people (4%), in 3 adolescents (6%), the route of ingestion of toxic substances is unknown. The majority of adolescents – 38 people (76%) - are characterized by the deliberate nature of poisoning. According to the clinical picture of poisoning, it is classified according to the severity [
4]. Poisoning of moderate severity was diagnosed in 18 children (36%), severe – in 31 patients (62%), with mild poisoning 1 child was hospitalized (2%). It is possible that some children with mild poisoning received treatment on an outpatient basis. There were no patients with extremely severe poisoning. Positive dynamics of the condition against the background of the treatment was observed in 100% of cases. The clinical symptoms of acute poisoning depended on the nature of the toxic substance. The most serious abnormalities were found in the case of poisoning with anxiolytics (characterized by pallor of the skin, lethargy, depression of consciousness, possible visual and auditory hallucinations). In cases of moderate poisoning, the most common symptoms were: severe drowsiness (38%), tachycardia (38%), pallor of the skin (38%), gastrointestinal disorders (38%). Severe poisoning was accompanied by depression of consciousness (52%), pronounced pallor and coldness of the skin (48%), tachycardia (38%), lethargy (52%), and gastrointestinal disorders (23%).
5]. In the Volgograd region, in 20.7% of cases, the cause of poisoning of adolescents was the use of narcotic substances and psychodisleptics [
6]. The structure of intentional poisoning in the Voronezh Region was dominated by poisoning with anxiolytics (15.6%), alcohol substitutes (10.5%), and drug intoxication (spice) (13.2%).">
X. DISCUSSION
When analyzing poisoning among adolescents in the Voronezh region, we found the prevalence of intentional poisoning over accidental poisoning. Studying cases of acute poisoning in children in St. Petersburg and the Leningrad region in the period from 2016 to 2018, it can be noted that the structure of intentional poisoning was dominated by cases of poisoning with the purpose of alcohol (50.6%) and drug intoxication (35.9%); poisoning with a suicidal purpose was 10.3%. The above-mentioned cases were most common in the age group from 15 to 17 years [
5]. In the Volgograd region, in 20.7% of cases, the cause of poisoning of adolescents was the use of narcotic substances and psychodisleptics [
6]. The structure of intentional poisoning in the Voronezh Region was dominated by poisoning with anxiolytics (15.6%), alcohol substitutes (10.5%), and drug intoxication (spice) (13.2%).
Summary of the main result of the study: in the structure of acute poisoning in adolescents in the Voronezh region, a significant predominance of drug poisoning was found – 60%; with the purpose of drug and alcohol intoxication-10 and 8%, respectively.
XI. Conclusion
The structure of poisoning of adolescents in the Voronezh region in 2016-2019 is characterized by the predominance of drug poisoning-anxiolytics, neuroleptics, etc. Often, the poisoning was intentional. Most of the children were admitted with moderate to severe poisoning. In all cases, a favorable outcome of treatment was observed. In order to reduce cases of poisoning, it is necessary to increase individual control over adolescents, strengthen the quality of work of psychologists in educational organizations and sanitary and educational work in educational institutions.
