Clinical care pathway appropriateness of the intoxicated paediatric patient: a retrospective evaluation with Poisoning Severity Score

Objectives: to assess the clinical care impact resulting from the lack of a regional reference Centre for Paediatric Poisoning in Liguria Region (Northern Italy) and to describe the demo-graphic and clinical characteristics of paediatric patients who accessed the Emergency Department of the 'Gaslini' Paediat-ric Hospital (Genoa, Liguria Region) for intoxication.Design: retrospective cohort study.Setting and participants: patients' cases of both sexes, <18 years old, who accessed the Emergency Department of the 'Gaslini' Paediatric Hospital between January 2017 and December 2019 for intoxication.Main outcome measures: the Poisoning Severity Score (PSS), a simple and reliable scoring system to describe pois-onings and define their severity, was used. The primary ob- jective was pursued by investigating the percentage of cases of intoxication which followed, in the study period, a clinical care pathway inconsistent with the degree of severity ascer-tained through the retrospective application of the PSS. Clin-ical-demographic data, triage tag color-coding, and causes of intoxication of cases were also collected. Descriptive stat-istics were used to summarize results.Results: a total of 172 cases were identified over the study period; 28 did not meet the inclusion criteria. The final ana- lysis involved 144 cases of intoxication, 70 were from fe-males and 74 from males, with a median age of 3 years-old; 60% of study cases followed a clinical care pathway consist-ent with the intoxication severity ascertained trough the PSS, in 40% of study cases the clinical care pathway was incon-sistent with PSS. The triage tag colour-code assigned was green in 16% of accesses, yellow in 82%, and red in only 2%. Out of the total of accesses, 40% of cases were attributed to drug intoxication in which the agents most involved were an-algesics and sedative-hypnotic drugs, 30% to carbon monox-ide and fumes poisoning, 23% to food/other substance intox-ication, and 7% to alcohol intoxication.Conclusions: implementing a referral Centre for Paediat-ric Poisoning could potentially affect 40% of access to the Emergency Department. Further analysis should be carried out to clarify whether an integrated Telemedicine Service could guide the correct management of intoxicated paediat-ric patients by referring them, through the Poisoning Sever-ity Score system, for home monitoring or immediate hospit-alization, if necessary.