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Scores for severity grading of childhood poisoning may be useful in comparing different causes of poisoning, in order to identify the main risks and their changes over time. The Multicentre Study of Poisoning in Children score is based on four levels of severity (1 -- mild, 2 -- moderate, 3 -- severe, 4 -- very severe) involving nine target groups: seven relating to organ systems (gastrointestinal, nervous, respiratory, circulatory, renal, hepatic, skin), one to metabolic abnormalities and one to injuries from corrosive substances. Each patient is classified by the highest level attributed to any one of the nine groups. The score has been prospectively tested in 644 symptomatic children, aged 0-13 years, admitted to six pediatric hospitals of Northern Italy from January 1, 1991 to December 31, 1993. Poisoning was categorized as mild (1) in 357 children (53.8%), moderate (2) in 285 (42.9%), severe (3) in 18 (2.7%) and very severe (4) in 4 (0.6%). No deaths occurred. Severity grading according to The Multicentre Study of Poisoning in Children score confirms the prevalence of mild and moderate poisonings in children; the score seems to be an objective method suitable for epidemiological studies in different countries. Its clinical usefulness deserves more investigation., (Key Words: child; poisoning; severity grading; multicentre study.) INTRODUCTION Established objective criteria for severity grading of childhood poisoning are still lacking in the published medical literature, although they could be [...]

The medical record for hospitalized patients has been modified in order to orient it towards two types of surveillance: adverse drug reactions (ADRs) and the quality of medical care. The modification consists of an adaptation of the progress notes; the transfer of the information to a special database is facilitated by the use of a simple system of codes that identify and correlate the items necessary for surveillance purposes. During the 6 months of observation of the 1103 pediatric patients included in the study, 35 clinically important suspected ADRs were noted by physicians. For the quality of medical care surveillance, all drug prescriptions were evaluated and areas in which to intervene in order to improve the appropriateness of prescriptions were identified. Quality surveillance was also extended to the monitoring of ‘unexplained’ adverse events for which no particular cause was attributable. We consider it advantageous to carry out these two types of surveillance simultaneously because they require many common items of information. The use of an oriented medical record as a source of data makes it possible to integrate surveillance with everyday ward activities. Copyright © 1999 John Wiley & Sons, Ltd.

Traditional medical records have been oriented toward drug monitoring by adding a section which lists the drugs and adverse events referred to in the progress notes while respecting their temporal sequence. Simple identification and correlation codes allow the indications for the use of drugs and the diagnostic attribution of all of the adverse events experienced by a patient since the beginning of hospital treatment to be deduced. A file created from drug monitoring-oriented medical records can be used to study prescribing habits and for drug safety monitoring. For drug surveillance purposes, it is possible to apply both the adverse drug reaction reporting system based on doctors' suspicions, as well as the event reporting system which records all adverse events regardless of doctors' suspicions as to their cause.

This is a critical review of the methodological and motivational aspects of two experiences of adverse event (AE) monitoring using a surveillance diary incorporated into the progress notes of medical records. Methodological aspects of the study were that (1) AE monitoring was to become an everyday activity of ward physicians; (2) the physicians were to express their opinions concerning the causality of each AE, which was to allow the systematic detection of adverse drug reactions and unexplained AEs; (3) the surveillance diary was to include all AEs and all prescriptions, thus allowing prescription-event monitoring; (4) the time trends of unexplained AEs were to be monitored using control cards. The experiences were discontinued because the necessary investments were attributed to other competing priorities.It follows that it is essential to develop an awareness that AE surveillance requires continuous involvement insofar as it is an essential element of quality ofcare.