To Explore the Characteristics of Fatality in Children Poisoned by Paraquat – with Analysis of 146 Cases

Abstract

Purpose The incidence of paraquat (PQ) poisoning in China is increasing, so it is important to identify the characteristics of fatalities in children with acute PQ poisoning in order to prevent and treat future cases. Methods A prospective study that enrolled 146 children with PQ poisoning was performed. A novel evaluation system called the score of lethal factors for PQ poisoning (SLFPP) was established, including 1 contributing factor and 4 weakening factors. Comparisons with the Pediatric Logistic Organ Dysfunction (PELOD) score, the Poisoning Severity Score (PSS) in admission and the SLFPP were made to determine their values for prognosis. Results Younger patients (71/146, <10 years) had accidental exposure to PQ (64/71, 90.14%), whereas older patients (75/146, ≥10 years) had ingested PQ intentionally (46/75, 61.33%) (p<0.01); 21/146 (14.38%) died of PQ poisoning. Of these 21 children, 20 committed suicide with ages ≥10 years. Significant differences (p<0.01) were found between nonsurvivors and survivors with regard to the Pediatric Logistic Organ Dysfunction (PELOD) scores (19.76 ± 18.44 vs. 4.17 ± 5.98), PSS in admission (2.48 ± 0.60 vs. 1.43 ± 0.59), the SLFPP (10.40 ± 1.07 vs. 3.60 ± 1.89). In PELOD score and PSS in admission, there were relative large overlaps in scores between nonsurvivors and survivors. But for SLFPP, there were smaller overlaps. Conclusions Deliberate ingestion of PQ to commit suicide occurred mainly in older children (≥10 years), while accidental exposure to PQ occurred mainly in younger children (<10 years). Owing to small overlaps, the SLFPP may exceed PELOD and PSS in predicting the prognosis of PQ poisoning, but the SLFPP scores still require further clinical validation.