Resource utilization among children presenting with cannabis poisonings in the emergency department

Michael S Toce; Kate Dorney; Gabrielle D'Ambrosi; Michael C Monuteaux; Niloufar Paydar-Darian; Vidya R Raghavan; Florence T Bourgeois; Joel Hudgins

doi:10.1016/j.ajem.2023.09.002

Resource utilization among children presenting with cannabis poisonings in the emergency department

Am J Emerg Med. 2023 Nov:73:171-175. doi: 10.1016/j.ajem.2023.09.002. Epub 2023 Sep 9.

Authors

Michael S Toce¹, Kate Dorney², Gabrielle D'Ambrosi², Michael C Monuteaux², Niloufar Paydar-Darian², Vidya R Raghavan², Florence T Bourgeois³, Joel Hudgins²

Affiliations

¹ Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States of America; Harvard Medical Toxicology Program, Boston Children's Hospital, Boston, MA, United States of America; Department of Pediatrics, Harvard Medical School, Boston, MA, United States of America. Electronic address: Michael.toce@childrens.harvard.edu.
² Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States of America; Department of Pediatrics, Harvard Medical School, Boston, MA, United States of America.
³ Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States of America; Department of Pediatrics, Harvard Medical School, Boston, MA, United States of America; Computational Health Informatics Program (CHIP), Boston Children's Hospital, Boston, MA, United States of America.

PMID: 37696075
DOI: 10.1016/j.ajem.2023.09.002

Abstract

Background: Exploratory pediatric cannabis poisonings are increasing. The aim of this study is to provide a national assessment of the frequency and trends of diagnostic testing and procedures in the evaluation of pediatric exploratory cannabis poisonings.

Methods: This is a retrospective cross-sectional study of the Pediatric Health Information Systems database involving all cases of cannabis poisoning for children age 0-10 years between 1/2016 and 12/2021. Cannabis poisoning trends were assessed using a negative binomial regression model. A new variable named "ancillary testing" was created to isolate testing that would not confirm the diagnosis of cannabis poisoning or be used to exclude co-ingestion of acetaminophen or aspirin. Ancillary testing was assessed with regression analyses, with ancillary testing as the outcomes and year as the predictor, to assess trends over time.

Results: A total of 2001 cannabis exposures among 1999 children were included. Cannabis exposures per 100,000 ED visits increased 68.7% (95% CI, 50.3, 89.3) annually. There was a median of 4 (IQR 2.0, 6.0) diagnostic tests performed per encounter. 64.5% of encounters received blood tests, 28.8% received a CT scan, and 2.4% received a lumbar puncture. Compared to White individuals, Black individuals were more likely to receive ancillary testing (OR 1.52 [95% CI, 1.23, 1.89]). Compared to those 2-6 years, those <2 years were more likely to receive ancillary testing (OR 1.55 [95% CI, 1.19, 2.02). We found no significant annual change in the odds of receiving ancillary testing (OR 1.04 [95% CI, 0.97, 1.12]).

Conclusions: We found no change in the proportion of encounters associated with ancillary testing, despite increases in exploratory cannabis poisonings over the study period. Given the increasing rate of pediatric cannabis poisonings, emergency providers should consider this diagnosis early in the evaluation of a pediatric patient with acute change in mental status. While earlier use of urine drug screening may reduce ancillary testing and invasive procedures, even a positive urine drug screen does not rule out alternative pathologies and should not replace a thoughtful evaluation.

Keywords: Cannabis; Diagnostic testing; Pediatrics; Poisoning.