Neurological features of acute poisoning in paediatric patients presenting to the emergency department: a retrospective study.

Introduction: Early recognition of paediatric poisoning is crucial for timely intervention in emergency settings. This study aims to assess the epidemiological and clinical profiles of paediatric patients presenting with neurological features due to acute poisoning.

Methods: Data from children less than 18 years of age admitted to the emergency department of a tertiary paediatric hospital in Rome between 2017 and 2023 were retrospectively reviewed. Clinical variables associated with admission were reported and analysed across the entire study sample and stratified by age group. Logistic regression models were built to assess the association between clinical and/or laboratory signs and hospitalization in the whole study sample and stratified by age.

Results: A total of 276 children developed neurological features and were included in the study. The median age was 15.6 years (IQR: 14.0-16.7 years), with most patients being female. Ethanol was the single most frequently ingested xenobiotic (39.5%). The most commonly observed neurological feature was altered consciousness (74.3%). Most patients (56.9%) were graded as minor neurologically on the International Programme on Chemical Safety/European Association of Poison Centres and Clinical Toxicologists Poisoning Severity Score. Patients more than 10 years of age were significantly ( = 0.017) more frequently females (62.6%) and were significantly ( = 0.001) more likely to have a psychiatric co-morbidity (41.0%) than patients less than 10 years of age (4.1%). In patients more than 10 years of age, 55% of patients ingested a xenobiotic for recreational reasons, whereas none did in those less than 10 years of age ( = 0.001). The main predictor of hospitalization in patients more than 10 years of age was suicidal intent (odds ratio: 10.17;  = 0.001).

Discussion: While no specific neurological feature predicted hospitalization, ingestion of lithium, antipsychotics, and benzodiazepines increased the likelihood of admission. Female adolescents had higher rates of intentional poisoning, often linked to suicidal intent.

Conclusions: Altered consciousness is the most common neurological feature in paediatric poisoning but is not directly linked to hospitalisation. While neurological symptoms are important in assessment, factors such as suicidal intent, mode of emergency access, and age are stronger predictors of hospitalization and should be prioritized in the initial evaluation.