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International audience; INTRODUCTION: In recent years, the number of patients managed by poison control centres (PCCs) has increased without a proportional increase in the number of physicians. To improve efficiency without neglecting patient follow-up, some PCCs have begun using text messages. We evaluated the difference in response rates between text messaging and traditional telephone follow-up. MATERIALS AND METHODS: This retrospective, monocentric, non-randomised cohort study was conducted using data from calls made by the New Aquitaine PCC between February 27, 2019, and March 31, 2019. Patients were contacted up to three times by a phone call or short message service (SMS). RESULTS: For the analysis, 823 patients were included. At the end of follow-up, the response rates were similar in the phone call and SMS group (94 vs. 94%; p = 0.76) with median [interquartile range] response times of 0 min [0; 27 min] and 29 min [6; 120 min], respectively. The response rates did not differ in subgroups stratified according to sex, self-poisoning vs. relative response, age class, and solicitation during working hours vs. outside of working hours (all p > 0.5). Moreover, health practitioners required 2.4-fold more time to call than to send text messages (p

In this study, we aimed to identify the factors related to esophageal impaction following button battery (BB) ingestion in children. PilBouTox, a prospective multicentric observational cohort study, was conducted from French Poison Control Centers between June 1, 2016 and May 31, 2018. Children (0-12 years old) with BB ingestion were included. After ingestion, patients were monitored for 21 days or more if they remained symptomatic (maximum 1 year). Causes of ingestion, clinical manifestations, medical management, and the outcomes were recorded. In total, 415 patients were included; among them, 35 had esophageal impaction and 14 had severe complications or died. Seven symptoms were closely related (relative risk (RR) 30) to esophageal impaction: anorexia, drooling, dyspnea, fever, hemodynamic instability, pallor, and pain. Furthermore, BBs 15 mm were related to esophageal impaction (RR = 19, CI

Resume Objectif Cette etude vise a decrire avec precision le contexte de survenue des erreurs medicamenteuses liees au methotrexate, d’en detailler les consequences cliniques et les approches therapeutiques, et de determiner le taux de mortalite lie a ces erreurs. Methodes Les donnees sur les erreurs de medicamenteuses liees au methotrexate ont ete obtenues aupres du reseau francais des centres antipoison et de pharmacovigilance qui recueillent et documentent les effets indesirables ou toxiques des medicaments leur ayant ete notifies. Ont ete inclus les cas ou la dose recue etait plus de deux fois superieure a la dose hebdomadaire prevue ou avec une dose hebdomadaire cumulee ≥ 30 mg et comportant un suivi d’au moins 4 jours apres la derniere dose administree. Les caracteristiques demographiques, l’indication therapeutique, la dose prescrite, les interactions medicamenteuses, les complications cliniques et l’evolution ont ete analysees. Resultats Soixante-quatorze patients ont ete inclus. Les causes d’erreurs etaient dues a une erreur lors du renouvellement de l’ordonnance (23,3 %) ou a la non-observance du schema d’administration hebdomadaire par les patients ou un aidant (56,2 %), ou par un professionnel de sante (20,5 %). Sur les 70 patients ayant pris du methotrexate tous les jours, la dose quotidienne moyenne recue pendant la duree de l’erreur etait de 9,6 ± 4,1 mg (extremes : 2,5 a 22,5) avec une duree moyenne de l’erreur de 11,7 ± 12,2 jours (extremes 2 a 90). Treize (18 %) patients sont restes asymptomatiques et 61 (82 %) ont presente des complications, dont 46 (62,2 %) etaient severes. Neuf patients (14,8 %) sont decedes dans les 11 a 45 jours suivant la premiere erreur de dose. Par rapport aux patients asymptomatiques ou presentant des symptomes mineurs, ceux qui presentaient des symptomes severes etaient plus âges (75,6 ± 10,8 ans vs 69,5 ± 12,9 ans) et avaient ete exposes a une dose cumulee plus elevee (94,8 ± 46,2 mg contre 68,0 ± 45,7 mg). Conclusions Cette etude confirme que les erreurs de posologie du methotrexate peuvent etre fatales et persistent malgre plusieurs mises en garde des agences nationales du medicament. De nouvelles mesures sont attendues de l’Agence europeenne des medicaments.

Objectifs Le paracetamol est l’antalgique et antipyretique le plus frequemment utilise en France. Il n’existe pas a ce jour de consensus national sur la prise en charge des intoxications aigues par paracetamol (IAP), dont la toxicite est majeure. Les principes de diagnostic et de traitement reposent sur les recommandations d’experts francais [1] actualisees en 2020 et sur les donnees de la litterature. Cependant, les sollicitations regulieres du Centre Antipoison (CAP-TV) de Lyon semblent indiquer une variabilite des pratiques cliniques dans la prise en charge de cette intoxication. Notre objectif etait d’evaluer les modalites de prise en charge des IAP par une enquete de pratique aupres des services d’urgences de la region Auvergne Rhone Alpes (AURA), en collaboration avec l’ARS. Methode Auto-questionnaire en ligne adresse par courrier electronique aux chefs de service des unites d’urgence (adultes, pediatriques, polyvalentes) de la region AURA. Cette enquete comprenait 7 questions et une vignette clinique d’IAP (VC) interrogeant sur differents aspects de la prise en charge medicale. Resultats Parmi les 82 etablissements de sante sollicites 69 praticiens de 37 etablissements differents ont repondu : 44 % urgences adultes [30 praticiens de 15 services differents/24 sollicites], 36 % urgences polyvalentes [25 praticiens de 20 services differents/56 sollicites], 20 % urgences pediatriques [14 praticiens de 9 services differents/22 sollicites]. Trente-six pour cent des repondants sont le chef de service/adjoint et 64 % des praticiens autres ; 85 % des cliniciens estiment prendre en charge moins d’une IAP par semaine dans leur service. Interroges sur l’existence d’un referentiel interne de traitement des IAP, 39 % declarent ne pas avoir de document precis, pres de 35 % se referent a un ouvrage de toxicologie/urgences/reanimation ou un article de la litterature medico-scientifique, 26 % disposent d’un protocole interne au service. Les praticiens (n = 53/69) requierent une conduite a tenir aupres d’un CAP-TV (48 %) et/ou d’un service de medecine specialisee (reanimation, gastro-enterologie ; 48 %). En reponse a la VC presentant une intoxication aigue par 13 g de paracetamol avec un delai d’admission Conclusion Les resultats confirment une disparite des pratiques professionnelles dans le traitement des IAP entre etablissements de sante, (notamment en raison d’une frequence de sollicitation variable et de contraintes techniques potentielles). Ces pratiques ne sont pas toujours en accord avec les recommandations d’expert, ni avec la litterature. La sensibilisation des praticiens de l’urgence aux recommandations de bonnes pratiques pourrait etre proposee par la Societe de Toxicologie Clinique.

The aim was to assess the impact of the COVID-19 pandemic on French Poison Control Centre (PCC) call characteristics. Reported cases of xenobiotic exposures from 1 March to 30 April in 2018, 2019, and 2020 were extracted from the French National Database of Poisonings. The collected data included call, patient, and exposure characteristics for both general calls and for calls involving sentinel xenobiotic categories related to the COVID-19 pandemic. The 2020 exposures were compared to 2018–2019 exposures by using simple logistic models in order to provide effect size with odds ratios. From March to April 2020, 32,182 exposures were reported to French PCCs with an overall increase of 5.6% compared to exposures in the same time frame in 2018–2019. A similar increase in calls was observed in non-epidemic and epidemic COVID-19 areas with an increase in calls from the public (+13.6%) while calls from health-professionals decreased (−7.5%). Despite the increase in exposures, the incidence of symptomatic exposures remained stable (−0.4%) with a decrease in severity (moderate/severe −17.2%). A significant increase in exposures to home cleaning products containing biocides, essential oils, and alcohol-based hand sanitizers (odds ratio >1.3, p The COVID-19 pandemic altered calls to French PCCs with a small increase in calls during the study period and changes in the pattern of exposure. These changes possibly reflected the indirect consequences of the COVID-19 pandemic i.e., limited access to primary care, fear of contracting COVID-19 and anxiety related to home isolation.

Objective The objectives of this study are to carefully describe the context of methotrexate medication errors, to details medical consequences and management approaches, and to determine the rate of fatal outcome. Methods Data on methotrexate medication errors were obtained from the French network of poison control and pharmacovigilance centres, which collected and documented reported drug-induced adverse effects. Cases were included if the intake was more than 2-fold the intended weekly dose or a weekly cumulative dose ≥ 30 mg and a follow-up of at least 4 days after the last dose. Data were analysed for demographics, treatment indication, prescribed dose, drug interactions, clinical complications and medical outcomes. Results Seventy four patients were included. The causes of methotrexate errors resulted from an erroneous prescription renewal (23.3%), incomprehensiveness of the weekly schedule by patients or at-home caregivers (56.2%) and administration of a wrong dose by a health care professional (20.5%). Of the 70 patients who took methotrexate daily, the mean daily dose received over the whole duration of the error was 9.6 ± 4.1 mg (range 2.5–22.5) with a mean duration of the error of 11.7 ± 12.2 days (range 2 to 90). Thirteen (18%) patients remained asymptomatic and 61 (82%) developed complications of which 46 (62.2%) were severe. Nine (14.8%) patients died within 11 to 45 days after the first dosing error. Compared to patients with no or mild symptoms, those with severe symptoms were more likely to be older (75.6 ± 10.8 vs. 69.5 ± 12.9 years) and to be exposed to a higher cumulative dose (94.8 ± 46.2 vs. 68.0 ± 45.7 mg). Conclusions This study confirms that dosing errors with methotrexate can be lethal and persisted despite several warnings from drug agencies. Further measures are awaited from the European Medicine Agency.

In the world, the impact of environmental conditions on the number of scorpion events was evaluated in North Africa,Middle East, and the Amazonian region but not in Europe. In mainland France, scorpion species described are Buthus occitanus (Amoreux, 1789), Belisarius xambeui (Simon, 1879) and 4 Euscorpiidae: Euscorpius concinnus (Koch, 1837), Euscorpius italicus (Herbst, 1800), Euscorpius tergestinus (Koch, 1837), and Tetratrichobothrius flavicaudis (De Geer, 1778). We aimed to describe the impact of environmental conduction on the number of scorpion events. For this, a retrospective multi-center study was conducted with data from the French poison control centers files about scorpion events between 1 January 2011 and 31 December 2020. During the study period, 975 incoming calls for scorpion events were recorded and 574 were related to scorpions native to mainland France and Corsica: B. occitanus (n = 86), Euscorpiidae species (n = 222), B. xambeui (n = 1), and undetermined species (n = 265). Cases were mostly reported along the Mediterranean coast, along rivers, and in cities with a trading port. The number of scorpion events was linked to the rivers' water level, rivers' flow, temperature, sunshine, and pluviometry (P < 0.05 for all variables). B. occitanus need warmest and driest environment than Euscorpiidae spp. A link between the severity of the envenoming and climatic condition or seasonality was not demonstrated.