Reducing Childhood Admissions to the PICU for Poisoning (ReCAP2) by Predicting Unnecessary PICU Admissions After Acute Intoxication

Objective: To derive and validate clinical prediction models to identify children at low risk of clinically significant intoxications for whom intensive care admission is unnecessary. Design: Retrospective review of data in the National Poison Data Systems from 2011 to 2014 and Georgia Poison Center cases from July to December 2016. Setting: United States PICUs and poison centers participating in the American Association of Poison Control Centers from 2011 to 2016. Patients: Children 18 years and younger admitted to a United States PICU following an acute intoxication. Interventions: None. Measurements and Main Results: The primary study outcome was the occurrence of clinically significant intoxications defined a priori as organ system–based clinical effects that require intensive care monitoring and interventions. We analyzed 70,364 cases. Derivation (n = 42,240; 60%) and validation cohorts (n = 28,124; 40%) were randomly selected from the eligible population and had similar distributions of clinical effects and PICU interventions. PICU interventions were performed in 1,835 children (14.1%) younger than 6 years, in 374 children (15.4%) 6–12 years, and in 4,446 children (16.5%) 13 years and older. We developed highly predictive models with an area under the receiver operating characteristic curve of 0.834 (

from Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/2ygqMJF