Home Use of Syrup of Ipecac Is Associated With a Reduction in Pediatric Emergency Department Visits☆,☆☆
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.
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Cited by (22)
Paediatric poisoning
2013, Oh's Intensive Care Manual, Seventh EditionThe role of activated charcoal and gastric emptying in gastrointestinal decontamination: A state-of-the-art review
2002, Annals of Emergency MedicineCitation Excerpt :No child who received decontamination required N-acetylcysteine therapy, but 2 children who were not decontaminated did. In a third study, using referral to hospital as an outcome measure for children ingesting medication at home, 7 poison centers were compared.17 A significant, linear association between the use of syrup of ipecac at home and a reduced rate of referral to a health care facility was found.
Gastrointestinal decontamination [3]
1999, American Journal of Emergency MedicinePosition paper update: Ipecac syrup for gastrointestinal decontamination
2013, Clinical ToxicologyGuideline on the use of ipecac syrup in the out-of-hospital management of ingested poisons
2005, Clinical ToxicologyPosition paper: Ipecac syrup
2004, Journal of Toxicology - Clinical Toxicology
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From the Division of Emergency Medicine, University of Virginia, Charlottesville, Virginia.
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Reprint no. 47/1/62589