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. 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

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

5 questions from PERN 1. Why the proposed topic should be investigated internationally through PERN? 2. Importance of the topic/issue 3. Scientific methodology 4. Sample size 5. Logistical methodology (how study will be administered, data management, funding, etc)

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

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

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. 3.- Scientific methodology

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

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

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

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.

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)

Is it possible to be done? SPAIN. SEUP 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 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 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)

URUGUAY (1) SWEDEN (4) ISRAEL (1) TURKEY (1) HUNGARY (1) U.K. (1)IRELAND (1) SPAIN (22) PORTUGAL (3) FRANCE (2) ITALY (3) BELGIUM (2)NETHERLANDS (1) SWITZERLAND (1) SAUDI ARABIA (1)

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