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Global Pediatric Emergency Poisoning Surveillance System

Global Pediatric Emergency Poisoning Surveillance System. Research in European Paediatric Emergency Medicine ( REPEM). Background. Poisoning remains a major public health care problem, particularly in children.

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Global Pediatric Emergency Poisoning Surveillance System

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  1. Global Pediatric Emergency Poisoning Surveillance System Research in European Paediatric Emergency Medicine (REPEM)

  2. Background • Poisoning remains a major public health care problem, particularly in children. • Few data about the impact of poisonings in the Pediatric Emergency Departments (PED) are available. • Great variability has been described in the management of poisoned children and teenagers admitted in PEDs

  3. Objectives • To study key epidemiological features of pediatric poisonings admitted in Pediatric Emergency Departments • To evaluate the management of children and teenagers’ poisonings admitted in the Pediatric Emergency Departments

  4. 5 questions from PERN • Why the proposed topic should be investigated internationally through PERN? • Importance of the topic/issue • Scientific methodology • Sample size • Logistical methodology (how study will be administered, data management, funding, etc)

  5. 1.- Why the proposed topic should be investigated internationally through PERN? • Best network to fulfill the objectives: • International epidemiological differences • International variability

  6. 2.- Importance of the topic/issue • Variability • Morbimortality • Financial resources: • Pre-hospital care • Tests and treatments in the ED • High admission rate

  7. 3.- Scientific methodology • Prospective • Registry • Specific electronic questionnaire fulfilled • All the patients admitted with a presumed poisoning the 14th of every month • Data sent to SM, responsible for the integrity of the data and the accuracy of the data analysis.

  8. 3.- Scientific methodology

  9. 4.- Sample size • Spain: Drugs, 56% of poisonings admitted to PEDs • If the rate in different countries all over the worldis 30-60%, we need 25 episodes/country or region to find differences (80% power; alpha = 0.05) • Industrialized regions: if this rate is  45 - 60%, we need 90 episodes/country or region to find differences (85% power; alpha = 0.05). • Not industrialized regions: if this rate is  30 - 40%, we need 350 episodes/country or region to find differences (80% power; alpha = 0.05).

  10. 4.- Sample size • We will need around 100 episodes/country or region • Probably: during two years • Registry 1 day/month • Registry 3 days/month

  11. 5.- Logistical methodology Contact with toxic Informed consent Internet Cruces University Hospital Electronic questionnaire Database Analysis Diffusion

  12. Diffusion of the results and conclusions • Meetings of Pediatric and Emergency Societies • The main data of the G-PEPS should be annually reported and SM takes the responsibility to draft the manuscript.

  13. Our question: Is it possible to be done? • In August 2008, an electronic Toxic Surveillance System was established in different Spanish PEDs by the Clinical Toxicologic Working Group of the Spanish Society of Pediatric Emergency Medicine (SEUP)

  14. the 13th of every month each hospital sends a specific electronic questionnaire fulfilled ideally through the SEUP’s website to Cruces University Hospital Is it possible to be done?SPAIN. SEUP

  15. Is it possible to be done?SPAIN. SEUP • Feasibility of such a Surveillance System. • Azkunaga B, Mintegi S, Bizkarra I, Fernández J; Intoxications Working Group of the Spanish Society of Pediatric Emergencies. Toxicology surveillance system of the Spanish Society of Paediatric Emergencies: first-year analysis. Eur J Emerg Med. 2011 Oct;18(5):285-7 • Azkunaga B, Mintegi S, del Arco L, Bizkarra I; Intoxications Working Group of the Spanish Society of Pediatric Emergencies. Epidemiological changes in poisonings admitted in Spanish Pediatric Emergency Departments in the last decade: Increase in ethanol poisoning. Emergencias 2012 (in press)

  16. IRELAND (1) U.K. (1) FRANCE (2) BELGIUM (2) NETHERLANDS (1) SWEDEN (4) SWITZERLAND (1) HUNGARY (1) TURKEY (1) ISRAEL (1) Adhesions (12-Jun) 46 PEDs from 15 countries SAUDI ARABIA (1) URUGUAY (1) PORTUGAL (3) SPAIN (22) ITALY (3)

  17. Adhesions (12-Jun) 3/6 WHO regions

  18. Research team. Cruces University Hospital. Bilbao. Basque Country. • Pediatric Emergency Physicians: • Santiago Mintegi, PhD. Quality Manager of the Pediatric Emergency Department. Member of REPEM • Javier Benito, PhD. Director of the Pediatric Emergency Department. Member of REPEM • Beatriz Azkunaga, MD • Pediatric Fellows: • Yordana Acedo, MD • Nerea Salmon, MD • Clinical Epidemiology Unit: • Lorea Martinez • Eunate Arana, MD

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