Severe outcomes following pediatric cannabis intoxication: a prospective cohort study of an international toxicology surveillance registry
Creators: name: Cohen, Neta
name: Mathew, Mathew
name: Brent, Jeffrey
name: Wax, Paul
name: Davis, Adrienne L.
name: Obilom, Cherie
name: Burns, Michele M.
name: Canning, Joshua
name: Baumgartner, Kevin
name: Koons, Andrew L.
name: Wiegand, Timothy J.
name: Judge, Bryan
name: Hoyte, Christopher
name: Chenoweth, James A.
name: Froberg, Blake
name: Farrar, Henry
name: Carey, Jennifer L.
name: Hendrickson, Robert G.
name: Hodgman, Michael
name: Caravati, E. Martin
name: Christian, Michael R.
name: Wolk, Brian J.
name: Seifert, Steven A.
name: Bentur, Yedidia
name: Levine, Michael
name: Farrugia, Lynn A.
name: Vearrier, David
name: Minns, Alicia B.
name: Kennedy, Joseph M.
name: Kirschner, Ron I.
name: Aldy, Kim
name: Schuh, Suzanne
name: Campleman, Sharan
name: Li, Shao
name: Myran, Daniel T.
name: Feng, Lisa
name: Freedman, Stephen B.
name: Finkelstein, Yaron
Publisher: name: Taylor & Francis
Year: 2023
Subjects: subject: Medicine
subject: Microbiology
subject: FOS: Biological sciences
subject: Cell Biology
subject: Neuroscience
subject: Pharmacology
subject: Biotechnology
subject: Science Policy
subject: Mental Health
subject: Infectious Diseases
subject: FOS: Health sciences
subject: Virology
subject: Computational Biology

description: An increasing number of jurisdictions have legalized recreational cannabis for adult use. The subsequent availability and marketing of recreational cannabis has led to a parallel increase in rates and severity of pediatric cannabis intoxications. We explored predictors of severe outcomes in pediatric patients who presented to the emergency department with cannabis intoxication. In this prospective cohort study, we collected data on all pediatric patients (&lt;18 years) who presented with cannabis intoxication from August 2017 through June 2020 to participating sites in the Toxicology Investigators Consortium. In cases that involved polysubstance exposure, patients were included if cannabis was a significant contributing agent. The primary outcome was a composite severe outcome endpoint, defined as an intensive care unit admission or in-hospital death. Covariates included relevant sociodemographic and exposure characteristics. One hundred and thirty-eight pediatric patients (54% males, median age 14.0 years, interquartile range 3.7–16.0) presented to a participating emergency department with cannabis intoxication. Fifty-two patients (38%) were admitted to an intensive care unit, including one patient who died. In the multivariable logistic regression analysis, polysubstance ingestion (adjusted odds ratio = 16.3; 95% confidence interval: 4.6–58.3; <i>P</i> &lt; 0.001)) and cannabis edibles ingestion (adjusted odds ratio = 5.5; 95% confidence interval: 1.9–15.9; <i>P</i> = 0.001) were strong independent predictors of severe outcome. In an age-stratified regression analysis, in children older than &gt;10 years, only polysubstance abuse remained an independent predictor for the severe outcome (adjusted odds ratio 37.1; 95% confidence interval: 6.2–221.2; <i>P</i> &lt; 0.001). As all children 10 years and younger ingested edibles, a dedicated multivariable analysis could not be performed (unadjusted odds ratio 3.3; 95% confidence interval: 1.6–6.7). Severe outcomes occurred for different reasons and were largely associated with the patient’s age. Young children, all of whom were exposed to edibles, were at higher risk of severe outcomes. Teenagers with severe outcomes were frequently involved in polysubstance exposure, while psychosocial factors may have played a role.