RESUMEN
OBJECTIVES: To investigate the characteristics and trends of out-of-hospital attention-deficit/hyperactivity disorder (ADHD) medication-related therapeutic errors among youth <20 years old reported to US poison centers. METHODS: National Poison Data System data from 2000 through 2021 were analyzed. Population-based rates were calculated using US census data. RESULTS: There were 124 383 ADHD medication-related therapeutic errors reported to US poison centers from 2000 through 2021, with the annual frequency increasing by 299.0% during that period. Two-thirds (66.6%) of the 87 691 first-ranked exposures involved children 6 to 12 years old, three-fourths (76.4%) were among males, and half (50.5%) involved amphetamines and related compounds. Most (79.7%) therapeutic errors were single-substance exposures. Although most (82.7%) individuals did not receive treatment in a health care facility (HCF), 2.3% were admitted to a HCF and 4.2% had a serious medical outcome. Children <6 years old were more likely to experience a serious medical outcome (odds ratio = 2.1; 95% confidence interval: 1.9-2.3) or be admitted to a HCF (odds ratio = 3.4; 95% confidence interval: 3.0-3.7) than 6 to 19-year-olds. The most common scenarios were "inadvertently taken or given medication twice" (53.9%), followed by "inadvertently taken or given someone else's medication" (13.4%), and "wrong medication taken or given" (12.9%). CONCLUSIONS: The frequency of cases reported to poison centers of pediatric out-of-hospital therapeutic errors related to ADHD medications increased by almost 300% during the 22-year study period and is likely attributable to increased prescribing of these medications. Because therapeutic errors are preventable, more attention should be given to patient and caregiver education and development of improved child-resistant medication dispensing and tracking systems.
Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad , Venenos , Masculino , Adolescente , Niño , Humanos , Estados Unidos/epidemiología , Adulto Joven , Adulto , Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológico , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Centros de Control de Intoxicaciones , Bases de Datos Factuales , Estudios Retrospectivos , Errores de MedicaciónRESUMEN
Background: Neuroendocrine cell hyperplasia of infancy (NEHI) is a rare respiratory disorder. During infancy, it typically presents with hypoxemia, tachypnea, and respiratory distress, and is commonly misdiagnosed as common childhood illnesses such as pneumonia, reactive airway disease, or bronchiolitis. Lack of awareness about this relatively new and rare disorder in primary care and acute care settings lead to delayed diagnosis and unnecessary use of antibiotics. Case Presentation. We present a case of a 7-month-old girl, born prematurely at 32 weeks with tachypnea and respiratory distress who was initially diagnosed with viral pneumonia, then upper respiratory infection, and finally with community-acquired bacterial pneumonia, while the child never had any fever or upper respiratory symptoms. Failure of outpatient treatment with oral antibiotic and bronchodilator, with the persistence of respiratory symptoms such as retractions, bilateral crackles, and hypoxemia led to hospitalization for intravenous antibiotics. Given persistent symptoms, further evaluation was performed, and she was diagnosed with NEHI based on characteristic chest CT findings. Conclusions: Viral respiratory infections are the most frequent cause of respiratory illnesses in the first years of life. Primary care providers should be aware of less frequent causes of persistent respiratory symptoms in infancy like NEHI and other interstitial lung diseases in children. This may prevent unnecessary use of antibiotics and delayed diagnosis.
RESUMEN
PROBLEM CONSIDERED: K-12 schools have shown minimal spread of COVID-19 when mitigation measures are employed. This study sought to determine baseline asymptomatic COVID-19 rates in secondary schools as students returned to full-time in-person learning with universal masking in place and to evaluate the logistical obstacles of implementing surveillance testing. METHODS: An observational cohort study lasting 11 weeks during spring 2021 included 2,288 students and staff in Wood County, Wisconsin. SARS-CoV-2 nasal polymerase chain reaction testing was done on consenting students and staff to determine baseline disease burden. Teacher surveys collected data on student masking compliance and classroom distancing. Information about percent positivity, secondary transmission, quarantine and distancing policies, screening participation, costs, and volunteer hour requirements were obtained. Modified quarantine for fully masked in-classroom exposures was evaluated. RESULTS: Percent positivity averaged 3.0% (0%-16.2% weekly) among students and 1.72% (0%-6.9% weekly) among staff. Two cases of secondary transmission were suspected out of 163 individuals quarantined. An average of 15.6% of the school population consented to participate each week. Minimum classroom distance between students ranged from 2.7 to 5.5 feet. Student masking compliance was greater than 87%. The cost of the program was $106,400 and required approximately 300 volunteer hours. The modified quarantine policy, where students were allowed to continue to attend in-person school after exposure to a case of COVID-19 if the infected and exposed parties were masking, did not result in additional transmission. CONCLUSIONS: In the setting of relatively high student masking compliance and limited distance between students, weekly secondary school screening of students and staff in an area of high community disease spread was found to be low yield, costly, and burdensome for the school district. Surveillance participation was low. A modified quarantine policy was not associated with increased in-school transmission. School funding may be better spent on targeted testing or other school expenses, especially with increasing vaccination rates.