Use of a tablet-based application for clinical handover and data collection

Downes, Michael A.; Page, Colin B.; Berling, Ingrid; Whyte, Ian M

doi:10.1080/15563650.2019.1674322

Cited by 5 publications

(9 citation statements)

References 18 publications

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“…The consultation database was set up for quality assurance purposes and has long‐term and ongoing approval from the local ethics committee. The design and use of the database has been described in detail elsewhere 8 …”

Section: Methodsmentioning

confidence: 99%

Paediatric poisoning presentations reported to a regional toxicology service in Australia

Downes

Lovett

2021

J Paediatrics Child Health

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Aim The aim of this study is to describe the epidemiology and health‐care utilisation of paediatric emergency department (ED) presentations due to poisoning. Methods A retrospective review of all ED presentations of paediatric poisoning cases (<18 years) reported to a tertiary toxicology service from 2015 to 2016 was conducted. Cases were classified into three age groups: pre‐school (0–6 years), primary school (7–11 years) and adolescent (12–17 years). Outcomes included patient transfer, length of ED stay (LOS) and proportion admitted to a medical ward, mental health unit or intensive care unit (ICU). Results From 764 consultations over a 2‐year period, 87 were excluded as non‐ED presentations. From these, there were 194 (29%; 47% female) pre‐school aged, 34 (5%; 41% female) primary school aged and 449 (66%; 77% female) adolescent presentations. Deliberate self‐poisoning was most common in 394 of 449 (88%) adolescents. Accidental exposures accounted for 159 (82%) of pre‐school presentations and natural toxins occurred in all three age groups. Paracetamol, selective serotonin reuptake inhibitors, antipsychotics and ibuprofen were the most common toxins. Discharge from ED occurred in 147 of 194 (76%) pre‐school, 24 of 34 (71%) primary school and 223 of 449 (50%) adolescent presentations. Of the 449 adolescents, 137 (31%) were admitted medically (median LOS 19.9 h), 19 were admitted to ICU (median LOS 71 h) and 70 (16%) admitted to mental health (median LOS 122 h). Five pre‐school aged children were admitted to ICU. Conclusions Adolescent deliberate self‐poisoning has a significant impact on hospital resources, with mental health problems requiring extended length of stay. There were fewer pre‐school accidental poisoning consultations, which were mainly discharged from ED.

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Section: Methodsmentioning

confidence: 99%

Paediatric poisoning presentations reported to a regional toxicology service in Australia

Downes

Lovett

2021

J Paediatrics Child Health

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“…Admission data are collected on either a preformatted admission sheet or tabletbased application. 7,16 Data include demographics, clinical effects, investigations, complications and treatments. The data are…”

Section: Study Design and Settingsmentioning

confidence: 99%

Pregabalin poisoning and rising recreational use: a retrospective observational series

Isoardi

Polkinghorne

Harris

et al. 2020

Brit J Clinical Pharma

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With rising use worldwide, pregabalin is increasingly implicated in poisoning deaths. We aimed to investigate the clinical effects and complications of pregabalin poisoning. Methods: This is a retrospective review of patients presenting with pregabalin poisoning to two tertiary toxicology units from 1 July 2014 to 30 June 2019. Patients were identified from prospective databases maintained by both units and data were extracted from these in addition to medical records. Results: There were 488 presentations in 413 patients (237 [57%] male) over the five-year period. The median age was 41 years (IQR 31-50 years). Deliberate selfpoisonings accounted for 342 (70%) presentations, with 121 (25%) recreational exposures. Recreational exposures increased over the period from 2 (4%) in the first year to 54 (39%) presentations in the final year. The median dose of pregabalin was 1200 mg (IQR 600-3000 mg, range 75-16 800 mg). Co-ingestions occurred in 427 (88%) presentations, with sedating agents being co-ingested in 387 (79%)-most commonly opioids and benzodiazepines in 201 (41%) and 174 (36%) presentations respectively. Coma (GCS < 9) occurred in 89 (18%) cases, with 52 (11%) patients being intubated. Only one (0.2%) of these patients had not co-ingested a sedating agent. Hypotension occurred in 26 (5%) cases, all with co-ingestants. Seizures occurred in 11 (2%) cases, 3/59 (5%) in pregabalin-only overdoses. The median length of stay was 16.5 hours (IQR 10-25 hours). Conclusions: Pregabalin overdose does not cause severe toxicity, but rather mild sedation and, uncommonly, seizures. Coma is common in the presence of sedating co-ingestants. Recreational use is increasing. K E Y W O R D S drug abuse, overdose and poisoning, toxicology 1 | INTRODUCTION Pregabalin is a gamma-aminobutyric acid analogue that binds to voltage-gated calcium channels to inhibit the release of excitatory neurotransmitters, which accounts for its antinociceptive, anticonvulsant and anxiolytic properties. 1,2 Over the last decade, pregabalin has been increasingly prescribed for neuropathic pain, as well as a number of off-label indications including anxiety, mood instability and withdrawal syndromes. 1-4 With the broadening of both approved and off-label indications, pregabalin use has increased worldwide over the last The authors confirm that the PI for this paper is Katherine Isoardi and that she had direct clinical responsibility for patients.

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“…All telephone consultations to the clinical toxicology service are logged into a tablet-based database. 12 The design of the database has been reported in detail previously and was developed for quality assurance purposes. 12 The toxicology inpatient service is based at an adult facility where there is generally limited data on paediatric poisonings, except direct emergency department presentations that then need to be transferred for paediatric in patient admission.…”

Section: Design and Settingmentioning

confidence: 99%

“…12 The design of the database has been reported in detail previously and was developed for quality assurance purposes. 12 The toxicology inpatient service is based at an adult facility where there is generally limited data on paediatric poisonings, except direct emergency department presentations that then need to be transferred for paediatric in patient admission. The tabletbased application allows collection of information on all toxicology consultations within the region, 12 including all paediatric poisonings, irrespective of the location of presentation.…”

Section: Design and Settingmentioning

confidence: 99%

“…12 The toxicology inpatient service is based at an adult facility where there is generally limited data on paediatric poisonings, except direct emergency department presentations that then need to be transferred for paediatric in patient admission. The tabletbased application allows collection of information on all toxicology consultations within the region, 12 including all paediatric poisonings, irrespective of the location of presentation. 10 Clinical data, including demographics, information on the poisoning (toxin, dose and time of ingestion), treatments and outcomes are entered at the time of the consultation into the database by the clinical toxicologist.…”

Section: Design and Settingmentioning

confidence: 99%

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Reality of clonidine poisoning in children and adolescents

Duong

Lovett

Downes

2023

J Paediatrics Child Health

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Aim We aimed to describe the severity of clonidine poisonings in a paediatric population referred to a tertiary toxicology service. Methods We undertook a retrospective review of all presentations of clonidine poisoning in children or adolescents reported to a tertiary toxicology service from March 2014 to February 2020. Cases were divided into young children (0–6 years), older children (7–11 years) and adolescents (12–17 years). We report clinical effects: bradycardia, hypotension and abnormal Glasgow coma score (GCS), based on standard paediatric observation charts, interventions, length of emergency department stay, proportion admitted to a medical ward or paediatric intensive care unit. Results We identified 111 clonidine poisonings, 41 young children, 9 older children and 61 adolescents. There were more females in the adolescent group and slightly more males in the younger age groups. The median dose ingested was 13 mcg/kg (interquartile range: 7–38 mcg/kg), which varied across ages. Clonidine alone was ingested in 78 cases (70%) and co‐ingestion was more common in adolescents (24/61; 39%). Thirty‐seven patients (33%) were admitted and 23 (21%) were admitted to paediatric intensive care unit. Median length of emergency department stay was 16.4 h, longer for adolescents. At least one abnormal observation occurred in 101 of 111 (91%) cases: 76 of 106 (72%) bradycardia, 76 of 110 (69%) hypotension and 4 of 99 (4%) GCS < 9. Thirteen (12%) had severe bradycardia, more common in young children and 23 (21%) had severe hypotension, more common in adolescents. For 27 children (0–11 years) ingesting 5–10 mcg/kg, 3 (11%) had severe bradycardia or severe hypotension and 1 received naloxone (4%). No cases ingesting <5 mcg/kg developed moderate/severe bradycardia or hypotension. Four cases received naloxone with no significant change, two patients got atropine with a transient response. One patient was intubated to facilitate safe inter‐hospital transfer. Conclusion Paediatric clonidine poisoning commonly results in bradycardia, hypotension and decreased GCS, but rarely severe or requiring major interventions. Children ingesting <5 mcg/kg do not require admission.

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Use of a tablet-based application for clinical handover and data collection

Cited by 5 publications

References 18 publications

Paediatric poisoning presentations reported to a regional toxicology service in Australia

Paediatric poisoning presentations reported to a regional toxicology service in Australia

Pregabalin poisoning and rising recreational use: a retrospective observational series

Reality of clonidine poisoning in children and adolescents

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