Home Use of Syrup of Ipecac Is Associated With a Reduction in Pediatric Emergency Department Visits,☆☆

Presented at the annual meeting of the Ambulatory Pediatric Association, May 1994, Seattle, Washington.
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Abstract

Study objective: To determine whether home use of syrup of ipecac is safe and effective in reducing pediatric emergency department visits.

Design: Retrospective, multicenter comparison based on secondary use of a large database. Participants: Children younger than 6 years after acute, accidental ingestion of a pharmaceutical product. Interventions: 1990 Data corresponding to the study patients from seven regional poison centers were obtained from the American Association of Poison Control Centers. Poison center management choices (particularly use of syrup of ipecac for home decontamination) and characteristics (distribution of pharmaceutical ingestions managed, work volume per staff, staff experience, and training of decision-making director) were analyzed for their impact on the decision to refer a patient to a health care facility or to manage the patient at home. Statistical techniques included weighted least-squares regression analysis using logistic transformation of dependent variables and the forward selection procedure. Adverse patient outcome was defined as moderate effect, major effect, or death (American Association of Poison Control Centers coding criteria). Results: In all, 55,436 children were included in the analysis (range, 3,839 to 12,691 per poison center). The distribution of medications ingested was similar among centers. Increased home use of syrup of ipecac, decreased frequency of ingestion of "high-risk" drugs, and increased staff experience were associated with decreased referral to a health care facility (P<.0001 for each variable). The forward selection procedure determined that syrup of ipecac use explained 45% of the variation in the poison center referral rates. The percentage of drugs defined as high-risk accounted for an additional 31%, and staff experience accounted for another 10% of the variation. Outcome of patients was excellent. No child died. Two home-managed patients had a major effect, and 26 had a moderate effect. Conclusion: Centers that recommended home use of syrup of ipecac more frequently were able to manage childhood poisoning more cost-effectively, without a decrease in safety. Although increased home management was strongly associated with syrup of ipecac use, the reason for this relationship cannot be determined from the data. Management by experienced professionals also contributed to cost-effectiveness. [Bond GR: Home use of syrup of ipecac is associated with a reduction in pediatric emergency department visits. Ann Emerg Med March 1995;25:338-343.]

Section snippets

INTRODUCTION

At one time, syrup of ipecac was used commonly in the management of pediatric ingestions in all settings. In recent years, however, the usefulness of syrup of ipecac after these ingestions has been questioned.1, 2, 3, 4, 5 Between 1986 and 1992, the use of syrup of ipecac in emergency departments fell by 71% as activated charcoal replaced it as the decontamination method of choice in that setting.6, 7 Concurrently, the use of syrup of ipecac at home after ingestion by children less than 6 years

MATERIALS AND METHODS

Centers participating in the data collection system of the AAPCC were canvassed for the number of human exposures managed annually, the size of the population served, the degree of urbanization of the population served, and the center's tendency to use syrup of ipecac to manage children at home. The study required that each center serve a primarily urban population so that the median time from a victim's home to a health care facility would not influence the reliance on syrup of ipecac or the

RESULTS

Six poison centers meeting the criteria of the AAPCC for a certified regional poison center and one large uncertified regional poison center contributing data to the AAPCC were recruited for this study. These seven centers are geographically dispersed throughout the United States. The population base served by each center ranged from 2.2 million to 10 million.

A total of 55,436 children less than 6 years old who ingested a pharmaceutical substance at home were managed by the seven poison control

DISCUSSION

The use of syrup of ipecac in the home is strongly associated with a lower cost of pediatric pharmaceutical ingestion management. Starting with the same patient population and achieving the same uniformly excellent results, poison centers that relied more heavily on the use of syrup of ipecac in the home referred fewer patients to health care facilities for evaluation. These centers have demonstrated that it is possible to safely manage at least 91% of pediatric pharmaceutical ingestions at

CONCLUSION

The hypothesis of this study was that home management of pediatric pharmaceutical ingestion without syrup of ipecac would be as safe and effective as home management with syrup of ipecac. The results of the study demonstrate that centers that recommended home use of syrup of ipecac more frequently were able to manage childhood poisoning more cost-effectively, without a decrease in safety. However, the reason for this relationship could not be determined from the data. It may represent a real

Acknowledgements

The author thanks Rick McFarland and Theodore Chang, PhD, for their invaluable assistance in the statistical analysis of this project.

No reprints available from the author.

References (16)

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From the Division of Emergency Medicine, University of Virginia, Charlottesville, Virginia.

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Reprint no. 47/1/62589

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