375 - Clinical Evaluation of Exploratory Pediatric Cannabis Poisonings

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 375
Publication Number: 375.405

Kate Dorney, Boston Children's Hospital, Newton, MA, United States; Joel Hudgins, Boston Children's Hospital, Milton, MA, United States; Gabrielle D'Ambrosi, Boston Children's Hospital, Somerville, MA, United States; Michael Monuteaux, Boston Children's Hospital, Boston, MA, United States; Florence Bourgeois, Boston Children's Hospital, Boston, MA, United States; Niloufar Paydar-Darian, Boston Children's Hospital, Boston, MA, United States; Vidya R. Raghavan, Boston Children's Hospital, Boston, MA, United States; Michael S.. Toce, Boston Children's Hospital, Boston, MA, United States

Presenting Author(s)

Kate Dorney, MD, MSHPEd (she/her/hers)

Attending physician, associate program director
Boston Children's Hospital
Newton, Massachusetts, United States

Background: Exploratory cannabis poisonings in children reported to United States poison control centers are increasing. There are a paucity of data describing the clinical evaluations of these children.

Objective: To examine the clinical evaluations performed for children presenting with exploratory cannabis poisoning to emergency departments (EDs). We hypothesize that as poisonings increase and providers become more familiar with cannabis poisoning as a diagnosis, diagnostic testing and imaging will decrease.

Design/Methods: This is a retrospective cross-sectional study of the Pediatric Health Information Systems Database. We included ED encounters associated with cannabis poisoning (ICD-10 T40.7) for children aged 0-10 years between 1/2016 and 12/2021. We collected data on diagnostic testing, imaging, and procedures. We estimated trends in cannabis poisonings using a negative binomial regression model and estimated three logistic regression analyses with ancillary testing, imaging, and procedures as the outcomes and year as the predictor to assess temporal trends.

Results:

2,001 cannabis poisonings among 1,999 children were analyzed. Females comprised a larger proportion of exposures (1022; 51.1%). Cannabis poisonings per 100,000 ED visits increased on average by 68.7% (95% CI, 50.3 to 89.3) annually (Figure 1). Drug testing was the most common diagnostic test performed (80.4%) (Table 1). There was a median of 4 [IQR 2.0. 6.0] diagnostic tests performed per encounter. The youngest age group and Black patients were more likely to undergo ancillary testing (OR 1.51 [95% CI, 1.18, 1.93] and OR 1.48 [95% CI, 1.23, 1.80], respectively) or imaging (OR 2.52 [95% CI, 1.98, 3.22) and OR 1.60 [95% CI, 1.29, 1.98], respectively) (Table 2). We found no significant annual change in the odds of receiving ancillary testing (OR 1.05 [95% CI, 0.98, 1.14]), imaging (OR 0.98 [95% CI, 0.91, 1.07]), or procedures (OR 0.95 [95% CI, 0.82, 1.11]).

Conclusion(s): In this cross-sectional analysis of pediatric cannabis exposures, we found no decrease in the proportion of encounters receiving ancillary testing, imaging, or procedures, despite exploratory cannabis poisonings increasing over the study period, contrary to our hypothesis. With a median of four diagnostic tests per encounter, these results highlight the difficulty providers face when evaluating pediatric cannabis poisonings. Earlier use of urine drug screening is advised in healthy patients with acute onset of altered mental status and a history of cannabis in the home to limit potentially unnecessary testing.