Jon B Cole, Anne M Kouri, Joshua D King, Travis D Olives, Nathaniel L Scott, Carrie L Oakland
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This study compared outcomes in children receiving extracorporeal treatments for poisoning at centers with and without a pediatric nephrologist.</p><p><strong>Methods: </strong>This was a retrospective cohort study of all patients aged ≤17 years reported to an American poison center covering three upper midwestern states during 2000-2024.</p><p><strong>Results: </strong>We identified 72 patients: 54 received extracorporeal treatments at a hospital with pediatric nephrologists, and 18 patients aged 14-17 years (minimum weight, 35 kg) received extracorporeal treatments at hospitals staffed solely by adult nephrologists. The most common responsible poisons were toxic alcohols (10/18, 55%) and salicylates (4/18, 22%). Children receiving extracorporeal treatments from adult nephrologists more commonly (<i>P</i> <0.001) received intermittent hemodialysis (18/18, 100%) compared to pediatric nephrologists (31/54, 57%). Conversely, children treated by pediatric nephrologists more commonly (<i>P</i> <0.05) received continuous kidney replacement therapy (28/54, 52%) compared to adult nephrologists (0/18). 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引用次数: 0
摘要
背景：儿童肾病专家在美国很少见；许多需要体外治疗的中毒儿童可能无法及时获得护理。这项研究比较了在有和没有儿科肾病专家的中心接受体外治疗的儿童中毒的结果。方法：这是一项回顾性队列研究，研究对象是2000-2024年间向美国中西部三个州的中毒中心报告的年龄≤17岁的所有患者。结果：我们确定了72例患者：54例在儿科肾病专家的医院接受了体外治疗，18例年龄在14-17岁（最低体重为35公斤）的患者在仅由成人肾病专家组成的医院接受了体外治疗。最常见的中毒是毒性酒精（10/18,55%）和水杨酸盐（4/18,22%）。与接受成人肾病专家体外治疗的儿童（0/18）相比，接受成人肾病专家体外治疗的儿童死亡率更高（P P P = 0.1）（9/ 54,17 %）。讨论：十几岁的儿童通常接受血液透析从成人肾病专家中毒，并有类似的结果由儿童肾病专家治疗。结论：这些数据表明，成人肾病专家可以成功地对青少年中毒进行体外治疗。
Comparison of children receiving extracorporeal treatments for poisoning at United States centers with and without a pediatric nephrologist.
Background: Pediatric nephrologists are rare in the United States; many children with poisoning needing extracorporeal treatments may not have timely access to care. This study compared outcomes in children receiving extracorporeal treatments for poisoning at centers with and without a pediatric nephrologist.
Methods: This was a retrospective cohort study of all patients aged ≤17 years reported to an American poison center covering three upper midwestern states during 2000-2024.
Results: We identified 72 patients: 54 received extracorporeal treatments at a hospital with pediatric nephrologists, and 18 patients aged 14-17 years (minimum weight, 35 kg) received extracorporeal treatments at hospitals staffed solely by adult nephrologists. The most common responsible poisons were toxic alcohols (10/18, 55%) and salicylates (4/18, 22%). Children receiving extracorporeal treatments from adult nephrologists more commonly (P <0.001) received intermittent hemodialysis (18/18, 100%) compared to pediatric nephrologists (31/54, 57%). Conversely, children treated by pediatric nephrologists more commonly (P <0.05) received continuous kidney replacement therapy (28/54, 52%) compared to adult nephrologists (0/18). We found no difference (P = 0.1) in mortality between the children treated by pediatric nephrologists (9/54, 17%) compared to those treated by adult nephrologists (0/18).
Discussion: Teenage children commonly received hemodialysis from adult nephrologists for poisoning and had similar outcomes to those treated by pediatric nephrologists.
Conclusions: These data suggest adult nephrologists can successfully perform extracorporeal treatments for poisoning in teenage children.
期刊介绍：
clinical Toxicology publishes peer-reviewed scientific research and clinical advances in clinical toxicology. The journal reflects the professional concerns and best scientific judgment of its sponsors, the American Academy of Clinical Toxicology, the European Association of Poisons Centres and Clinical Toxicologists, the American Association of Poison Control Centers and the Asia Pacific Association of Medical Toxicology and, as such, is the leading international journal in the specialty.
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