Disproportionate effect on child admissions of the change in Medicines and Healthcare Products Regulatory Agency guidance for management of paracetamol poisoning: an analysis of hospital admissions for paracetamol overdose in England and Scotland
Objective The aim of the present study was to assess the effects of the changes in the management of paracetamol overdose recommended by the UK Commission for Human Medicines on rates of hospital admission. Methods An interrupted time series analysis was carried out on data for hospital admissions f...
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| Veröffentlicht in: | British journal of clinical pharmacology Jg. 80; H. 6; S. 1458 - 1463 |
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| Sprache: | Englisch |
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John Wiley and Sons Inc
01.12.2015
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| Abstract | Objective
The aim of the present study was to assess the effects of the changes in the management of paracetamol overdose recommended by the UK Commission for Human Medicines on rates of hospital admission.
Methods
An interrupted time series analysis was carried out on data for hospital admissions for paracetamol poisoning for England between January 2010 and June 2014, and for Scotland between January 2010 and Sept. 2014. The main outcome measure was admissions to hospital with paracetamol poisoning (T39.1), as defined by first position coding in children and adults.
Results
The time series analysis (Jan 2010 to June 2014) showed that admission rates for paracetamol poisoning were steady from 2010 to the date of change (September 2012), with an estimated 269 [95% confidence interval (CI) 252.5, 285.5] child (0–14 years) and 3541 (95% CI 3454, 3628) adult admissions per month. In September 2013, 12 months after the change, there were an estimated additional 116 [37.3% (95% CI 17.2–67.4)] child and 426 [12.5 % (95% CI 4.5–19.6)] adult admissions. Thus, in the year before the change (September 2011 to August 2012) there were 45,181 (3500 child and 41,681 adult) admissions, and in the year after (September 2012 to August 2013) there were 50,198 (4779 child and 45,419 adult) admissions. The overall proportion of child admissions was significantly greater after the change (Chi‐square 32.486, P < 0.001), emphasizing the disproportionate effect in children.
Conclusions
Changes to the management guidelines for paracetamol poisoning in September 2012 were rapidly implemented but have particularly increased paediatric hospital admissions for paracetamol poisoning. This impact in children, who are at low risk of mortality from paracetamol toxicity, appears excessive. |
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| AbstractList | The aim of the present study was to assess the effects of the changes in the management of paracetamol overdose recommended by the UK Commission for Human Medicines on rates of hospital admission.OBJECTIVEThe aim of the present study was to assess the effects of the changes in the management of paracetamol overdose recommended by the UK Commission for Human Medicines on rates of hospital admission.An interrupted time series analysis was carried out on data for hospital admissions for paracetamol poisoning for England between January 2010 and June 2014, and for Scotland between January 2010 and Sept. 2014. The main outcome measure was admissions to hospital with paracetamol poisoning (T39.1), as defined by first position coding in children and adults.METHODSAn interrupted time series analysis was carried out on data for hospital admissions for paracetamol poisoning for England between January 2010 and June 2014, and for Scotland between January 2010 and Sept. 2014. The main outcome measure was admissions to hospital with paracetamol poisoning (T39.1), as defined by first position coding in children and adults.The time series analysis (Jan 2010 to June 2014) showed that admission rates for paracetamol poisoning were steady from 2010 to the date of change (September 2012), with an estimated 269 [95% confidence interval (CI) 252.5, 285.5] child (0-14 years) and 3541 (95% CI 3454, 3628) adult admissions per month. In September 2013, 12 months after the change, there were an estimated additional 116 [37.3% (95% CI 17.2-67.4)] child and 426 [12.5% (95% CI 4.5-19.6)] adult admissions. Thus, in the year before the change (September 2011 to August 2012) there were 45,181 (3500 child and 41,681 adult) admissions, and in the year after (September 2012 to August 2013) there were 50,198 (4779 child and 45,419 adult) admissions. The overall proportion of child admissions was significantly greater after the change (Chi-square 32.486, P < 0.001), emphasizing the disproportionate effect in children.RESULTSThe time series analysis (Jan 2010 to June 2014) showed that admission rates for paracetamol poisoning were steady from 2010 to the date of change (September 2012), with an estimated 269 [95% confidence interval (CI) 252.5, 285.5] child (0-14 years) and 3541 (95% CI 3454, 3628) adult admissions per month. In September 2013, 12 months after the change, there were an estimated additional 116 [37.3% (95% CI 17.2-67.4)] child and 426 [12.5% (95% CI 4.5-19.6)] adult admissions. Thus, in the year before the change (September 2011 to August 2012) there were 45,181 (3500 child and 41,681 adult) admissions, and in the year after (September 2012 to August 2013) there were 50,198 (4779 child and 45,419 adult) admissions. The overall proportion of child admissions was significantly greater after the change (Chi-square 32.486, P < 0.001), emphasizing the disproportionate effect in children.Changes to the management guidelines for paracetamol poisoning in September 2012 were rapidly implemented but have particularly increased paediatric hospital admissions for paracetamol poisoning. This impact in children, who are at low risk of mortality from paracetamol toxicity, appears excessive.CONCLUSIONSChanges to the management guidelines for paracetamol poisoning in September 2012 were rapidly implemented but have particularly increased paediatric hospital admissions for paracetamol poisoning. This impact in children, who are at low risk of mortality from paracetamol toxicity, appears excessive. The aim of the present study was to assess the effects of the changes in the management of paracetamol overdose recommended by the UK Commission for Human Medicines on rates of hospital admission. An interrupted time series analysis was carried out on data for hospital admissions for paracetamol poisoning for England between January 2010 and June 2014, and for Scotland between January 2010 and Sept. 2014. The main outcome measure was admissions to hospital with paracetamol poisoning (T39.1), as defined by first position coding in children and adults. The time series analysis (Jan 2010 to June 2014) showed that admission rates for paracetamol poisoning were steady from 2010 to the date of change (September 2012), with an estimated 269 [95% confidence interval (CI) 252.5, 285.5] child (0-14 years) and 3541 (95% CI 3454, 3628) adult admissions per month. In September 2013, 12 months after the change, there were an estimated additional 116 [37.3% (95% CI 17.2-67.4)] child and 426 [12.5% (95% CI 4.5-19.6)] adult admissions. Thus, in the year before the change (September 2011 to August 2012) there were 45,181 (3500 child and 41,681 adult) admissions, and in the year after (September 2012 to August 2013) there were 50,198 (4779 child and 45,419 adult) admissions. The overall proportion of child admissions was significantly greater after the change (Chi-square 32.486, P < 0.001), emphasizing the disproportionate effect in children. Changes to the management guidelines for paracetamol poisoning in September 2012 were rapidly implemented but have particularly increased paediatric hospital admissions for paracetamol poisoning. This impact in children, who are at low risk of mortality from paracetamol toxicity, appears excessive. Objective The aim of the present study was to assess the effects of the changes in the management of paracetamol overdose recommended by the UK Commission for Human Medicines on rates of hospital admission. Methods An interrupted time series analysis was carried out on data for hospital admissions for paracetamol poisoning for England between January 2010 and June 2014, and for Scotland between January 2010 and Sept. 2014. The main outcome measure was admissions to hospital with paracetamol poisoning (T39.1), as defined by first position coding in children and adults. Results The time series analysis (Jan 2010 to June 2014) showed that admission rates for paracetamol poisoning were steady from 2010 to the date of change (September 2012), with an estimated 269 [95% confidence interval (CI) 252.5, 285.5] child (0–14 years) and 3541 (95% CI 3454, 3628) adult admissions per month. In September 2013, 12 months after the change, there were an estimated additional 116 [37.3% (95% CI 17.2–67.4)] child and 426 [12.5 % (95% CI 4.5–19.6)] adult admissions. Thus, in the year before the change (September 2011 to August 2012) there were 45,181 (3500 child and 41,681 adult) admissions, and in the year after (September 2012 to August 2013) there were 50,198 (4779 child and 45,419 adult) admissions. The overall proportion of child admissions was significantly greater after the change (Chi‐square 32.486, P < 0.001), emphasizing the disproportionate effect in children. Conclusions Changes to the management guidelines for paracetamol poisoning in September 2012 were rapidly implemented but have particularly increased paediatric hospital admissions for paracetamol poisoning. This impact in children, who are at low risk of mortality from paracetamol toxicity, appears excessive. |
| Author | Eddleston, Michael Thomas, Simon HL Narayan, Hafid Sandilands, Euan Nicholas Bateman, D. Dear, James W. |
| AuthorAffiliation | 1 Pharmacology, Toxicology and Therapeutics University/BHF Centre for Cardiovascular Science, University of Edinburgh Edinburgh UK 3 NPIS Edinburgh Royal Infirmary of Edinburgh Edinburgh UK 2 Institute of Cellular Medicine Newcastle University and NPIS Newcastle, Newcastle Hospitals NHS Foundation Trust Newcastle upon Tyne UK |
| AuthorAffiliation_xml | – name: 1 Pharmacology, Toxicology and Therapeutics University/BHF Centre for Cardiovascular Science, University of Edinburgh Edinburgh UK – name: 2 Institute of Cellular Medicine Newcastle University and NPIS Newcastle, Newcastle Hospitals NHS Foundation Trust Newcastle upon Tyne UK – name: 3 NPIS Edinburgh Royal Infirmary of Edinburgh Edinburgh UK |
| Author_xml | – sequence: 1 givenname: Hafid surname: Narayan fullname: Narayan, Hafid organization: University/BHF Centre for Cardiovascular Science, University of Edinburgh – sequence: 2 givenname: Simon HL surname: Thomas fullname: Thomas, Simon HL organization: Newcastle University and NPIS Newcastle, Newcastle Hospitals NHS Foundation Trust – sequence: 3 givenname: Michael surname: Eddleston fullname: Eddleston, Michael organization: Royal Infirmary of Edinburgh – sequence: 4 givenname: James W. surname: Dear fullname: Dear, James W. organization: Royal Infirmary of Edinburgh – sequence: 5 givenname: Euan surname: Sandilands fullname: Sandilands, Euan organization: Royal Infirmary of Edinburgh – sequence: 6 givenname: D. surname: Nicholas Bateman fullname: Nicholas Bateman, D. organization: University/BHF Centre for Cardiovascular Science, University of Edinburgh |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/26353969$$D View this record in MEDLINE/PubMed |
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| References_xml | – volume: 54 start-page: 1696 year: 2010 end-page: 706 article-title: Testing, monitoring, and dating structural changes in exchange rate regimes publication-title: Comput Stat Data Anal – volume: 7 start-page: 1 year: 2002 end-page: 38 article-title: strucchange: an R package for testing for structural change in linear regression models publication-title: J Stat Software – volume: 27 start-page: 299 year: 2002 end-page: 309 article-title: Segmented regression analysis of interrupted time series studies in medication use research publication-title: J Clin Pharm Ther – volume: 99 start-page: 37 year: 2014 end-page: 40 article-title: MHRA recommendations on the use of intravenous acetylcysteine in paracetamol overdose publication-title: Arch Dis Child – volume: 51 start-page: 130 year: 2013 end-page: 3 article-title: Treating acetaminophen overdose: thresholds, costs and uncertainties publication-title: Clin Toxicol – volume: 78 start-page: 610 year: 2014 end-page: 8 article-title: Effect of the ’s revised paracetamol poisoning management guidelines on admissions, adverse reactions, and costs of treatment publication-title: Br J Clin Pharmacol – volume: 62 start-page: 143 year: 2013 end-page: 8 article-title: Methods for estimating confidence intervals in interrupted time series analyses of health interventions publication-title: J Clin Epidemiol – volume: 28 start-page: 387 year: 2011 end-page: 9 article-title: ICD‐10 coding: poor identification of recreational drug presentations to a large emergency department publication-title: Emerg Med J – year: 2013 – ident: e_1_2_8_2_1 – ident: e_1_2_8_3_1 doi: 10.3109/15563650.2013.775292 – ident: e_1_2_8_8_1 doi: 10.1016/j.csda.2009.12.005 – ident: e_1_2_8_5_1 doi: 10.1046/j.1365-2710.2002.00430.x – ident: e_1_2_8_11_1 – ident: e_1_2_8_4_1 doi: 10.1111/bcp.12362 – ident: e_1_2_8_10_1 doi: 10.1136/emj.2009.088344 – ident: e_1_2_8_7_1 doi: 10.18637/jss.v007.i02 – volume: 99 start-page: 37 year: 2014 ident: e_1_2_8_9_1 article-title: MHRA recommendations on the use of intravenous acetylcysteine in paracetamol overdose publication-title: Arch Dis Child – ident: e_1_2_8_6_1 doi: 10.1016/j.jclinepi.2008.08.007 |
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| SubjectTerms | Acetaminophen - poisoning Adolescent Child Child, Preschool children Drug Overdose - therapy epidemiology hospital admissions Hospitalization - statistics & numerical data Humans Infant Infant, Newborn paracetamol Patient Admission - statistics & numerical data Pharmacoepidemiology poisoning Practice Guidelines as Topic |
| Title | Disproportionate effect on child admissions of the change in Medicines and Healthcare Products Regulatory Agency guidance for management of paracetamol poisoning: an analysis of hospital admissions for paracetamol overdose in England and Scotland |
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