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Disproportionate effect on child admissions of the change in MHRA guidance for management of paracetamol poisoning: an analysis of hospital admissions for paracetamol overdose in England and Scotland.

Lookup NU author(s): Professor Simon ThomasORCiD


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OBJECTIVE: To assess the effects of the changes in management of paracetamol overdose recommended by the UK Commission for Human Medicines on rates of hospital admission.METHODS: An interrupted time series analysis 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.MAIN OUTCOME MEASURES: Admissions to hospital with paracetamol poisoning (T39.1) as defined by 1st position coding in children and adults.RESULTS: The time series analysis (Jan 2010 to June 2014) shows that admission rates for paracetamol poisoning were steady from 2010 to the date of change (Sept 2012), with an estimated 269 (95%CI 252.5-285.5) child (0-14 y) and 3541 (3454-3628) adult admissions per month. In September 2013, 12 months after the change, there were an estimated additional 116 (37.3% [17.2-67.4]) child and 426 (12.5% [4.5-19.6]) adult admissions. Thus in the year before the change (Sept 2011-Aug 2012) there were 45,181 (3,500 child: 41,681 adult), and in the year after (Sept 2012-Aug 2013) there were 50,198 admissions (4,779 child: 45,419 adult). The overall proportion of child admissions was significantly greater after the change (Chi squared 32.486, p < 0.001), emphasising 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

Publication metadata

Author(s): Narayan H, Thomas SH, Eddleston M, Dear JW, Sandilands E, Bateman DN

Publication type: Article

Publication status: Published

Journal: British Journal of Clinical Pharmacology

Year: 2015

Volume: 80

Issue: 6

Pages: 1458-1463

Print publication date: 01/12/2015

Online publication date: 26/09/2015

Acceptance date: 31/08/2015

ISSN (print): 0306-5251

ISSN (electronic): 1365-2125

Publisher: Wiley-Blackwell Publishing Ltd.


DOI: 10.1111/bcp.12779

PubMed id: 26353969


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