Abstract：
An increasing number of jurisdictions have legalized recreational cannabis for adult use. The subsequent availability and marketing of recreational cannabis has led to a parallel increase in rates and severity of pediatric cannabis intoxications. We explored predictors of severe outcomes in pediatric patients who presented to the emergency department with cannabis intoxication.
In this prospective cohort study, we collected data on all pediatric patients (<18 years) who presented with cannabis intoxication from August 2017 through June 2020 to participating sites in the Toxicology Investigators Consortium. In cases that involved polysubstance exposure, patients were included if cannabis was a significant contributing agent. The primary outcome was a composite severe outcome endpoint, defined as an intensive care unit admission or in-hospital death. Covariates included relevant sociodemographic and exposure characteristics.
One hundred and thirty-eight pediatric patients (54% males, median age 14.0 years, interquartile range 3.7-16.0) presented to a participating emergency department with cannabis intoxication. Fifty-two patients (38%) were admitted to an intensive care unit, including one patient who died. In the multivariable logistic regression analysis, polysubstance ingestion (adjusted odds ratio = 16.3; 95% confidence interval: 4.6-58.3; P < 0.001)) and cannabis edibles ingestion (adjusted odds ratio = 5.5; 95% confidence interval: 1.9-15.9; P = 0.001) were strong independent predictors of severe outcome. In an age-stratified regression analysis, in children older than >10 years, only polysubstance abuse remained an independent predictor for the severe outcome (adjusted odds ratio 37.1; 95% confidence interval: 6.2-221.2; P < 0.001). As all children 10 years and younger ingested edibles, a dedicated multivariable analysis could not be performed (unadjusted odds ratio 3.3; 95% confidence interval: 1.6-6.7).
Severe outcomes occurred for different reasons and were largely associated with the patient\'s age. Young children, all of whom were exposed to edibles, were at higher risk of severe outcomes. Teenagers with severe outcomes were frequently involved in polysubstance exposure, while psychosocial factors may have played a role.
In this prospective cohort study, we collected data on all pediatric patients (<18 years) who presented with cannabis intoxication from August 2017 through June 2020 to participating sites in the Toxicology Investigators Consortium. In cases that involved polysubstance exposure, patients were included if cannabis was a significant contributing agent. The primary outcome was a composite severe outcome endpoint, defined as an intensive care unit admission or in-hospital death. Covariates included relevant sociodemographic and exposure characteristics.
One hundred and thirty-eight pediatric patients (54% males, median age 14.0 years, interquartile range 3.7-16.0) presented to a participating emergency department with cannabis intoxication. Fifty-two patients (38%) were admitted to an intensive care unit, including one patient who died. In the multivariable logistic regression analysis, polysubstance ingestion (adjusted odds ratio = 16.3; 95% confidence interval: 4.6-58.3; P < 0.001)) and cannabis edibles ingestion (adjusted odds ratio = 5.5; 95% confidence interval: 1.9-15.9; P = 0.001) were strong independent predictors of severe outcome. In an age-stratified regression analysis, in children older than >10 years, only polysubstance abuse remained an independent predictor for the severe outcome (adjusted odds ratio 37.1; 95% confidence interval: 6.2-221.2; P < 0.001). As all children 10 years and younger ingested edibles, a dedicated multivariable analysis could not be performed (unadjusted odds ratio 3.3; 95% confidence interval: 1.6-6.7).
Severe outcomes occurred for different reasons and were largely associated with the patient\'s age. Young children, all of whom were exposed to edibles, were at higher risk of severe outcomes. Teenagers with severe outcomes were frequently involved in polysubstance exposure, while psychosocial factors may have played a role.
摘要：
■越来越多的司法管辖区将成人使用的休闲大麻合法化。娱乐性大麻的后续供应和销售导致小儿大麻中毒的发生率和严重程度同时增加。我们探讨了因大麻中毒到急诊科就诊的儿科患者的严重结局的预测因素。
■在这项前瞻性队列研究中，我们收集了2017年8月至2020年6月期间向毒理学研究者联盟参与研究点提交大麻中毒的所有儿科患者(<18岁)的数据.在涉及多物质暴露的情况下，如果大麻是重要的贡献剂,则包括患者.主要结局是复合严重结局终点，定义为重症监护病房入院或住院死亡。协变量包括相关的社会人口统计学和暴露特征。
■138名儿科患者（54%为男性，中位年龄14.0岁，四分位数范围3.7-16.0）提交给参与的急诊科，患有大麻中毒。52名病人(38%)被送进重症监护室,包括一名死亡的病人.在多变量逻辑回归分析中，多物质摄入(校正比值比=16.3;95%置信区间:4.6-58.3;P<0.001)和大麻食品摄入(校正比值比=5.5;95%置信区间:1.9-15.9;P=0.001)是严重结局的强独立预测因子.在年龄分层回归分析中，在>10岁以上的儿童中，仅多物质滥用仍然是严重结局的独立预测因子(校正比值比37.1;95%置信区间:6.2-221.2;P<0.001).因为所有10岁及以下的孩子都在摄取食物，无法进行专门的多变量分析(未校正比值比3.3;95%置信区间:1.6~6.7).
■由于不同的原因发生了严重的转归，并且在很大程度上与患者的年龄有关。年幼的孩子,所有这些人都接触过食物，严重结局的风险较高。结果严重的青少年经常参与多物质暴露，而心理社会因素可能起了作用。
■在这项前瞻性队列研究中，我们收集了2017年8月至2020年6月期间向毒理学研究者联盟参与研究点提交大麻中毒的所有儿科患者(<18岁)的数据.在涉及多物质暴露的情况下，如果大麻是重要的贡献剂,则包括患者.主要结局是复合严重结局终点，定义为重症监护病房入院或住院死亡。协变量包括相关的社会人口统计学和暴露特征。
■138名儿科患者（54%为男性，中位年龄14.0岁，四分位数范围3.7-16.0）提交给参与的急诊科，患有大麻中毒。52名病人(38%)被送进重症监护室,包括一名死亡的病人.在多变量逻辑回归分析中，多物质摄入(校正比值比=16.3;95%置信区间:4.6-58.3;P<0.001)和大麻食品摄入(校正比值比=5.5;95%置信区间:1.9-15.9;P=0.001)是严重结局的强独立预测因子.在年龄分层回归分析中，在>10岁以上的儿童中，仅多物质滥用仍然是严重结局的独立预测因子(校正比值比37.1;95%置信区间:6.2-221.2;P<0.001).因为所有10岁及以下的孩子都在摄取食物，无法进行专门的多变量分析(未校正比值比3.3;95%置信区间:1.6~6.7).
■由于不同的原因发生了严重的转归，并且在很大程度上与患者的年龄有关。年幼的孩子,所有这些人都接触过食物，严重结局的风险较高。结果严重的青少年经常参与多物质暴露，而心理社会因素可能起了作用。
