P3.G124: Characteristics and Predictors of Severe Pediatric Intentional Ingestions Before and During the COVID-19 Pandemic Using a National Registry

Background: During the COVID-19 pandemic, there was a significant increase in pediatric emergency department visits and hospital admissions for suicidality and self-harm, with deliberate self-poisoning being a leading cause. Prior studies in this area report only limited epidemiologic and clinical data. This study aims to report and compare demographics, clinical characteristics, management, and outcome data of pediatric patients with severe intentional self-poisonings before and during the pandemic.

Methods: We retrospectively reviewed de-identified data from the Toxicology Investigators’ Consortium registry of patients ages 6-18 years presenting with intentional self-poisoning. The pre-pandemic (PreP) study period encompassed April 2017-February 2020, and the pandemic (PAND) period was March 2020-October 2022. Severe outcome was defined as those patients who received critical care admission or interventions, or who died. Critical care interventions included intubation, vasopressors, antiarrhythmics, hemodialysis/continuous renal replacement therapy, cardioversion, CPR, or ECMO. Chi-square analyses and Fisher’s exact test were performed to determine associations among variables between the PreP and PAND periods, with p value < 0.05 considered significant. SAS 9.4 (SAS Institute, Cary, NC) was used to perform statistical analyses. This study was deemed not human subject research by the IRB.

Results: 4,739 pediatric cases meeting severity criteria were identified during the study period: 2,406 PreP and 2,333 PAND with demographic and clinical characteristics shown in Table 1. There were no significant differences in age category. There was a statistically significant difference in the gender category with a higher percentage of patients in the PAND group identifying as transgender (3.94% vs 1.7%, p<.001). The ethnicity category showed few differences between PreP and PAND cohorts with the notable exception of Hispanic/Latino patients (15.13% PreP vs 10.93% PAND, p<.001). The PreP group had a higher frequency of anticholinergic toxidromes (16.33% vs 12%, p<.001), respiratory depression (6.73% vs 4.63%, p=0.002), coma/CNS depression (31.13% vs 24.99%, p<.001) and seizures (8.23% vs 6.43%, p=0.02). The PAND group required more treatment with N-acetylcysteine (14.4% vs 10.97%, p=0.003). The PreP group more frequently required intubation (12.68% vs 9.09%, p<.001). There were no significant differences in rates of hemodialysis, CPR, ECMO, or mortality.
Top medication categories reported as the primary agent ingested are listed in Table 2. Acetaminophen was significantly associated with more PAND ingestions.

Conclusion: While there were observable differences between the PreP and PAND cohorts, it is unclear whether this truly reflects the impact of the pandemic rather than coincidental trends over time. Clinical data suggest that acetaminophen ingestion and use of its antidote occurred more during the pandemic, possibly due to its widespread availability compared to prescription medications which may have been limited by pandemic-related restrictions in access to routine healthcare.