Cross-sectional Comparative Acute Poisoning in Children and Adolescents During and After COVID-19 Pandemic (2020-2023)

Cross-sectional Comparative Acute Poisoning in Children and Adolescents During and After COVID-19 Pandemic (2020-2023) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Cross-sectional Comparative Acute Poisoning in Children and Adolescents During and After COVID-19 Pandemic (2020-2023) leila Barati, Mohammadali Vakili, Omid Mehrpour, Mehrdad Teimoorian This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7152014/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: The causes and demographic factors affecting children's poisoning change over time and is always a challenge for emergency department physicians. Evaluation the changes of pediatrics poisoning due to Covid19 pandemic was the purpose of this study. Methods: In this cross-sectional study, the documents of all patients referred to the Taleghani Hospital in Gorgan during (April 2020–2022) and after Covid19 pandemic (April 2022–2023) due to poisoning were investigated. Demographic information, causes of poisoning was statistically analyzed. Results: In this study, 598 patients were registered in the hospital due to poisoning. The IQR age of the patients during and after pandemic were 3 ( 2 – 6 ) and 4 ( 2 – 14 ) years respectively. Multiple logistic regression analysis showed that after Covid19 pandemic, females were 1.4; [AOR = 1.43 (95% CI 1.01–2.02)], intentional poisoning were 2.09; [AOR = 2.09 (95% CI 1.35–3.25)], admission in the Emergency ward were 2.82; [AOR = 2.82 (95% CI 1.85–4.29)] and children upper 10 years old were 2.35, [AOR = 2.35 (95% CI 1.58–3.47)] more than during pandemic admitted for poisoning. During pandemic intentional intoxication in pharmacologic and illicit drugs were 17.3% and 14.4%, but after pandemic were 42% and 30.9% respectively. Conclusion: After Covid19 pandemic, the number of referral cases of children due to poisoning had increased and a significant difference was reported between intentional poisoning, the upper 10 years old age and the gender of girls and hospitalization in the emergency department. It showed that the pandemic has severely affected adolescent mental health, especially among girls. Adolescent Child Covid19 Pandemic Intoxication Poisoning Pediatric Figures Figure 1 Figure 2 Figure 3 Background Poisoning is one of the main causes of children's emergencies and is one of the preventable causes of pediatrics mortality and morbidity ( 1 ). In the last 20 years, the global incidence of acute poisoning in children has been 1.8 per 100,000 ( 2 ), and has been reported from 0.3–7.6% ( 3 ). During Covid19 pandemic, rate of poisoning increased from 3.4 to 5.5% in Aydin`s study ( 4 ) The Covid19 pandemic had a various impact on emergency visits ( 5 ). Emergency ward admission was decreased, but all kind of poisoning accidental and intentional related poisoning increased 127.8% and 104.2% respectively compare to other causes of admission in a research in Canada ( 6 ). The proportion of adolescent’s calls and hospital admissions and suicidal attempt were higher compare with other pediatric age groups according to US poison center (PCs) and there were more sever outcomes and death during Covid19 ( 7 ). According to national center for health statics there was increased illicit drugs ingestion in young children and adolescents during pandemic ( 7 – 8 ).The most immediate increase is reported in Cannabis, Opioids and ethanol ingestion ( 9 ). It was reported that adolescents and children`s poisoning and drug overdose was the third leading cause of death in this age group during pandemic ( 10 ). In cases of poisoning more than half of them were under 5 years old ( 1 ) and according to poison statics more than 99% were unintentional among children under 6 years old ( 11 ). The risk of poisoning due to sanitizers, disinfectants and caustic-corrosive substances significantly increased specially in preschool child in research in Saudi Arabia and Sahar`s study ( 1 , 12 – 13 ). On the other hand in Devlin`s study it was reported that the frequency of poisoning in children under 5 years old remained stable during pandemic regardless of shelter-in-place policies( 14 ). Since patterns of intoxication may differ according to variables such as causes and demographic factors, in addition children's poisoning may change over time even in a geographical area, which is always a challenge for emergency department doctors ( 15 , 16 ); in this study we investigated the feature of pediatrics and adolescents poisoning during and after Covid19 pandemic in our region. To our assessment although there were some studies about the poisoning before and during Covid19, ( 1 , 4 – 14 , 17 ) there were limited data about post pandemic period. For this reason, in this study, the medical documents of children referred to the Taleghani Hospital in Gorgan due to poisoning during and after Covid19 pandemic were assessed. Methods Study Design and Setting : In a Cross-sectional Comparative study the documents of all patients under 18 years old who referred to the emergency department of therapeutic and educational pediatric hospital in Gorgan that is the only third level pediatrics hospital under the Golestan University of Medical Sciences supervision in Golestan province due to poisoning during April 2020–2023 (during and after Covid19 pandemic) were studied. This hospital covers urban and rural referral patients and all socioeconomic and demographic characteristics. Population and Sample : Inclusion criteria were records of all patients referred to the Taleghani Hospital in Gorgan because of all kind of poisoning (ingestion, inhalation) and less than 18 years old and exclusion criteria were cases with incomplete data by more than 10% missing data in demographic information and unclear poisoning cause. Diagnosis of intoxication was based on physician evaluation, guardian`s reports, clinical manifestation and toxicology`s results. The patients divided in to two groups during Covid19 (April 2020–2022) and after Covid19 (April 2022–2023). In term of causes of poisoning, they categorized in “Intentional”) The poisoning was done with the intent of self-harm or suicide.), “Accidental” (‌ The poisoning occurred accidentally and without intent), and “Neglected” (The poisoning occurred accidentally and by the guardian`s) that was based on self-reported and physician`s assessments. Data Collection : Their information was collected by studying the documents of patients. For ensuring the consistency and accuracy of data, it was collected by pediatrician who was the author of the survey. All of the data were coded and entered in to SPSS version 24 software. Variables and Definitions : Demographic information, Age (under 6 months, 6–11 months, 1–4 Years, 5–9 years, 10–17 Years old.), Gender ( Male, Female), Residential area ( Urban, Rural), kind of admission (Emergency ward, under observation, refused to admission), Causes of poisoning (Intentional, Accidental, Neglected), Season and Month and Year of admission, kind of poisoning substances (Illicit Drugs and alcohol, pharmacologic drugs (Antidepressant and Antipsychotic, Antipyretics, Antihypertensive, Vitamins, Anti- histamine, Anti Helmets, Antibiotics, Gastrointestinal, OCP, Anti-lipid, Anti-epileptics Diabetics, Anti-emetic), Detergents, Hydrocarbon, Pesticides and Repellents, Gases, Plants and Others. Statistical Analysis: The data was statistically analyzed with SPSS software version 24. Mean, frequency and percentage were used to describe the data. Chi-square was used to compare the analysis of categorical groups. The Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) of the risk factors associated with the incidence of poisoning were calculated using a Binary multiple logistic regression model. In the logistic regression analysis, the outcome variable was hospital admission at two different time points (During and after Covid19 pandemic), and the predictor (independent) variables include gender, age, kind of admission, cause of poisoning and season. In order to eliminate the effect of confounding factors, variables with a significance level of p-value < 0.1 in the univariate logistic regression model were introduced into a multivariate logistic regression model. Also, a P value less than 0.05 was considered statistically significant. Ethical Considerations : This study was the result of a research project approved by the Research Council and the Regional Ethics Committee of Golestan University of Medical Sciences (GOUMS) with the code of ethics IR.GOUMS.REC.1404.140. Based on GOUMS`s regulations, all patients after admission in the hospital asked for participation in an academic research and if they agreed, informed consent for review of their records were obtained. In this retrospective study all methods were carried out based on relevant guidelines and regulations and data were extracted from patients` records with their informed consents and all ethical standards for research involving human subjects were considered. Results General Demographics : In this study, 598 patients were registered in the hospital because of poisoning during April 2020–2023. There were 308 cases (51.5%) during the pandemic (April 2020–2022) and 290 cases (48.5%) admitted after Covid19 pandemic (April 2022–2023)‌. The average age of the patients was 63.66 ± 63.45 months and IQR of age of the patients was 3 ( 2 – 11 ) years, during pandemic 3 ( 2 – 6 ) years and after pandemic 4 ( 2 – 14 ) years. The youngest age was 16 days and the oldest age was 17 years. The largest age group of patients was 1–4 years old with 328 cases (54.9%) and 10–17 years old with 141 cases (23.6%). During pandemic 16.3% of patients were 10–17 years old and after pandemic it was 31.4% which was almost double the previous years (Table 1 ). Table 1 Demographic characteristics data of patients according during and after Covid19 Pandemic N (%) Covid19 Pandemic During pandemic (2020–2021) After pandemic (2022) Total P-Value Gender Female 136(44.2) 162(55.8) 298(49.8) 0.004 Male 172(55.8) 128(44.3) 300(50.2) Age < 6Months 8(2.6) 8(2.8) 16(2.7) < 0.001 6–11 Months 32(10.4) 18(6.2) 50(8.4) 1–4 Years 182(59.3) 146(50.3) 328(54.9) 5–9 Years 35(11.4) 27(9.3) 62(10.4) 10–17 Years 50(16.3) 92(31.4) 142(23.6) Admission Emergency ward 88(28.6) 126(43.4) 214(35.8) < 0.001 under observation 81(26.3) 88(30.3) 169(28.2) Refusal to admission in the hospital 139(45.1) 76(26.2) 215(36) Causes Intentional 45(14.6) 83(28.6) 128(21.4) < 0.001 Accidental 263(85.4) 207(71.4) 470(78.6) Season Spring 140(45.5) 77(26.6) 217(36.3) < 0.001 Summer 82(26.6) 101(34.8) 183(30.6) Autumn 59(19.2) 67(23.1) 126(21.1) Winter 27(8.8) 45(15.5) 72( 12 ) Total 308(51.5) 290(48.5) 598(100) Figure1demonstrated the distribution of age groups during (2020–2021)‌ and after (2023) Covid19 pandemic. There was a significant statistical difference between age and groups of during and after the Covid19 pandemic. (Chi-square = 20.358, df = 4, p = 0.0001). Multivariate logistic regression analysis showed children 10 years old and more were 2.35 more than during pandemic admitted for poisoning [AOR = 2.35 (95% CI 1.58–3.47)] (Table 2 ). Table 2 Multiple logistic regression analysis of demographic factors of poisoning during and after Covid19 pandemic Variables Multiple AOR(95% CI) P-value Gender Male 1.00(reference) 0.04 Female 1.43(1.01–2.02) Age < 10 years 1.00(reference) < 0.001 ≥ 10 years 2.35(1.58–3.47) Admission Emergency ward 2.81(1.85–4.29) < 0.001 Under observation 1.68(1.09–2.6) 0.019 Refusal to admission in the hospital 1.00(reference) Causes Intentional 2.09(1.35–1.14) 0.001 Accidental 1.00(reference) Season Spring 0.24(0.13–0.44) < 0.001 Summer 0.61(0.34–1.11) 0.106 Autumn 0.61(0.32–1.14) 0.124 Winter 1.00(reference) OR, odds ratio; CI, confidence interval. Gender Differences : Table 1 showed that there were 297 cases (49.8%) females and 300 cases (50.2%) were males. During pandemic 172 cases (55.8%) were males, but after pandemic female were 162 cases (55.8%); that showed in Fig. 2. There was a significant statistical difference between gender and groups of during and after the Covid19 pandemic. (Chi-square = 8.18, df = 1, p = 0.004) (Table 1 ) There was a statistically significant difference between gender and the cause of poisoning. Eighty three girls (28.4%) were intentionally poisoned compared to 45 boys (15.4%) (Chi-square = 14.63, df = 2, p = 0.001). In multiple logistic regression analysis, females were 1.4 more than males admitted for poisoning after Covid19 pandemic.[AOR = 1.43 (95% CI 1.01–2.02)] (Table 2 ). Admission Details : Table 1 showed that in Emergency department 214 cases (35.8%) were admitted and 168 cases (28.2%) were under observation, which were discharged within 2 hours, and 215 cases (36%) did not agree to be hospitalized and refused to admission in the hospital. Out of the hospitalized cases, 87 cases (40.7%) were discharged within 24 hours because of good condition and no sign and symptom of intoxication, of which 25 cases (28.7%) were less than 6 hours. The average hospitalization time was 0.9 ± 2.1 days, during pandemic 0.84 ± 1.31 and after pandemic 0.94 ± 2.39. Death cases were reported due to methadone poisoning (one case in 2020, and two cases in 2022) and opium poisoning (two cases in 2021). Table 1 showed there was a statistically significant difference between the hospitalization status and the year of hospitalization (Chi-square = 24.97, df = 2, p < 0.0001). In 2022, the rate of hospitalization in the emergency department was 43.4% compared to during pandemic, which was reported as 28.6%. During pandemic 139(45.1%) refused to admission in the hospital. Multiple logistic regression of analysis of the factors showed that admission in Emergency department and under observation after Covid19 pandemic were 2.81 and 1.68 more than during pandemic [AOR = 2.81 (95% CI 1.85–4.29)] and [AOR = 1.68 (95% CI 1.09–2.6) ] respectively(Table 2 ). Causes of Poisoning : The causes of poisoning include 397 cases (67.9%) accidental poisoning, 128 cases (21.9%) intentional poisoning, and 60 cases (10.2%) caregivers' negligence. Table 1 showed that during and after pandemic; intentional poisoning was 14.6% and 28.6% respectively and there was a statistically differences between two groups (Chi-square = 17.42, df = 1, P-value < 0.0001). In multiple logistic regression analysis, after Covid19 pandemic intentional poisoning were 2.09 more than during pandemic period [AOR = 2.09 (95% CI 1.35–1.14)] (Table 2 ). The most common causes of poisoning among referred children were poisoning with pharmacologic drugs; 198 cases (33.1%), illegal drugs and alcohol in 171 cases (28.6%), detergents in 84 cases (14%), and hydrocarbons in 65 cases (10.9%). Table 3 showed that there were statistically differences in pharmacologic and illicit drugs regards cause of substances intoxication between two groups (Chi-square = 14.38, df = 1, p = 0.0001) (Chi-square = 6.65, df = 1, p = 0.01) respectively. During pandemic intentional intoxication in pharmacologic and illicit drugs were 17.3% and 14.4%, but after pandemic were 42% and 30.9% respectively. Table 3 kind of poisoning substances based on causes of intoxication between two groups (During and after Covid19 Pandemic) N (%) Substances During(2020−2021) After(2022) Total P−Value Pharmacologic Drugs Intentional 17(17.3) 42(42) 59(29.8) 0.0001 Accidental 81(82.7) 58(58) 139(70.2) Total 98(100) 100(100) 198(100) Illicit Drugs and Alcohol Intentional 13(14.4) 25(30.9) 38(22.2) 0.01 Accidental 77(85.6) 56(69.1) 133(77.8) Total 90(100) 81(100) 171(100) Detergents Intentional 2(3.9) 2(6.1) 4(4.8) 0.65 Accidental 49(96.1) 31(93.9) 80(95.2) Total 51(100) 33(100) 84(100) Hydrocarbons Intentional 0 0 0 − Accidental 34(100) 31(100) 65(100) Total 34(100) 31(100) 65(100) Others Intentional 13(37.1) 14(31.1) 27(33.8) 0.57 Accidental 22(62.9) 31(68.9) 53(66.3) Total 35(100) 45(100) 80(100) Total Intentional 45(14.6) 83(28.6) 128(21.4) 0.0001 Accidental 263(85.4) 207(71.4) 470(78.6) Total 308(100) 290(100) 598(100) Table 3 demonstrated that there was not any intentional intoxication with hydrocarbons. There were not any statistical difference between intoxication with detergents and other substances between two groups (p = 0.65) and (p = 0.57) respectively. The methods of poisoning were the consumption of tablets (45.8%), liquids and syrups (43.5%), inhalation and smoke (9.4%). Seasonal Variation : Figure 1 showed that the highest poisoning was reported in the month May (90 cases, 15.1%) and the lowest in the month February (15 cases, 2.5%). During pandemic May (19.2%) and after pandemic July (15.9%) were the highest month with intoxication. Spring and summer seasons were the highest intoxication admission during and after pandemic retrospectively. There were a statistically differences between two groups regarding month and season admission. (Chi-square = 62.24, df = 11, p < 0.0001) (Chi-square = 24.75, df = 3, p < 0.0001). In multiple logistic regression analysis after covid19 pandemic, season of admission in Spring was 0.24 [AOR = 0.24 (95% CI 0.13–0.44)], Summer was 0.61 [AOR = 0.61 (95% CI 0.34–1.11)] and Autumn was 0.61 [AOR = 0.61 (95% CI 0.32–1.14)] respectively (Table 3 ). Discussion Covid19 pandemics had many impactions on pediatrics health especially visiting Emergency department. There were some articles about the comparison the changes in poisoning in pediatrics population before and during covid19 pandemics, but according to our knowledge there is not any survey about the impact of covid19 on poisoning after pandemics. In this study, After Covid19 pandemic the number of referral cases of poisoned children had increased and a significant difference was reported between intentional poisoning, the upper 10 years old age and the gender of girls and hospitalization in the emergency department compared to Covid19 period. Gender Distribution Although Park`s study ( 17 ) found no significant changes in admission of girls before and during Covid19 period, the gender distribution of poisoning cases in this study showed a significant trend over the study years, with a notable increase in female cases, especially post-COVID-19. This trend aligns with findings from Beauchamp et al. ( 18 ), who reported a higher prevalence of intentional pharmaceutical poisonings among female adolescents. Similarly, Lee et al. ( 16 ) and Salman ( 1 ) found that while younger children were predominantly male, female adolescents had higher rates of intentional poisonings. This increase in female poisoning cases, particularly in the post-pandemic period, may be due to increased psychological stressors faced by adolescent girls. These findings underscore the need for targeted mental health interventions for this demographic. Age Distribution The study found that the majority of poisoning cases were accidental and in the 1–4 years age group, with a significant increase in cases among the 10–17 years age group post-pandemic. This aligns with Beauchamp et al. ( 18 ) and Lee et al. ( 16 ), and Salman ( 1 ) who reported higher rates of accidental intoxication in less than 6 years old and intentional poisonings among adolescents. In Raffa j `s ( 9 ) study it was highlighted that intentional poisoning among youth and unintentional poisoning among less than 6 years old during pandemic increased, and in Park`s survey ( 17 ) the average of age of patients during pandemic was significant higher than before pandemic and showed that the middle adolescent age were more than before pandemics. Although the mentioned studies described the during pandemic situation that showed the increased in intentional poisoning among adolescent group, in the current study the increase in older children presenting with poisoning, particularly intentional poisoning after pandemic in compare with during pandemic, highlights the critical need for mental health support and preventive measures specifically targeted at adolescents in stressful condition. Hospitalization and Admission Patterns During pandemic about 45% of poisoning patients refuse the admission in the hospital that was because of fear of Covid19 virus, but there was a significant increase in the percentage of pediatric patients admitted to the emergency ward post-pandemic. In Delvin`s study ( 14 ) despite dramatic decreases in hospital admission during pandemic, the number of poisoning did not change and Wang`s survey ( 19 ) reported that in adolescents; drug overdose, suicidal attempt and death compare with before pandemic were increased. This finding is supported by Sinanoglu ( 20 ), who reported high rates of intensive care admissions for pediatric poisoning cases during pandemics. In Park`s survey ( 17 ) the admission rate and length of stay in the hospital were significantly higher in Covid19 period. In comparison with mentioned studies this current survey showed that the length of stay and admission in the hospital after Covid19 was higher than during pandemics; which may be due to increased severity or complications in poisoning cases and the high rate of intentional poisoning among adolescents. Causes of poisoning This study found a significant increase in intentional poisonings, particularly among females and older children after pandemic. This trend is consistent with Tay et al. ( 21 ) and González-Urdiales et al. ( 22 ), who found that intentional self-poisoning cases were predominantly among adolescents and more common in females. The review showed that pharmaceuticals, illicit drugs, and hydrocarbons were the most common causes of poisoning, with an increase in opioid poisonings over the years. In Park`s study ( 17 ) pharmacologic drugs was the main cause of poisoning, in Salman`s survey ( 1 ) non- pharmacologic agents were the main cause in accidental poisoning and in intentional poisoning pharmacologic drugs were the most. In Raffa`s survey( 9 ) during pandemic 13% of adults initiating substance use to cope with stress and caregivers reported worsening mental health following pandemic, this increased used of illicit drugs by caregivers may lead to exposure to illicit drugs by adolescents and children that cause rise in poisoning in this groups. Although after pandemic school reopened and travel has resumed, the situation and the mental health of people were not return to pre-pandemic norms.( 9 ) The rise in intentional poisonings underscores the urgent need for mental health interventions and preventive strategies to address psychological distress among adolescents. Seasonal Variations In this study Spring and Summer seasons were the highest intoxication admission during and after pandemic retrospectively. There were a statistically differences between two groups regarding month and season admission. This finding is similar to Tiwari et al. ( 23 ) and Kutluturk & Aslan ( 24 ), and Salman ( 1 ) who reported higher incidences of poisoning during summer and spring suggesting seasonal trends linked to school vacations and less supervision because of gardening and agricultural work and cleaning the house. These discrepancies highlight the importance of context-specific analyses and suggest that preventive measures should consider regional and seasonal factors. The systematic review also noted higher poisoning rates in summer, likely due to increased outdoor activities and reduced parental supervision during this period. During pandemic poisoning with detergents were higher than after pandemic, that was may be due to increased use of detergents during isolation and lockdown periods. Additional Discussion Points Psychological Impact Post-COVID-19 The significant increase in intentional poisonings, particularly among adolescents, suggests a heightened need for mental health resources ( 19 , 25 ). Screening tools for depression, anxiety, and other psychiatric disorders in schools could help identify at-risk individuals early and provide necessary interventions specifically during stressful situation in community that may lead to behavioral and psychological health crisis Accidental Poisoning and Parental Supervision The study underscores the importance of safe storage of toxic substances and better parental supervision to prevent accidental poisonings, particularly in younger children. Educational campaigns should address these issues to reduce the incidence of accidental poisonings. Care givers specifically drug abusers should be informed about the storage of substances in places inaccessible to children and adolescents and avoiding use of these drugs for calming in younger children. Additionally, relevant authorities should strengthen their supervision over how these individuals care for children. Registry and Follow-Up Establishing a child poisoning registry and ensuring follow-up for cases discharged against medical advice are critical steps to monitor and manage poisoning cases effectively. This can help in identifying patterns, assessing intervention efficacy, and reducing mortality and morbidity rates. Adolescents hospitalized due to drug poisoning should be evaluated by a child and adolescent psychologist. Furthermore, their mental health and family circumstances should be monitored through follow-up evaluations to support their emotional well-being. Implications The significant increase in pediatric poisoning cases post-COVID-19, particularly intentional poisonings among adolescent girls, underscores the need for comprehensive mental health support. Public health interventions should include regular psychological screenings in schools, enhanced public awareness campaigns about the dangers of toxic substances, and improved safe storage practices for household chemicals and medications. The establishment of a comprehensive pediatric poisoning registry would also be beneficial for monitoring trends and evaluating the effectiveness of interventions. Limitation: There are some limitation that was related to a retrospective analysis of documents, some of data was missed and omitted from analysis. Conclusion Findings of this study contribute to the growing body of literature on pediatric poisoning, highlighting significant shifts in demographic patterns and causes of poisoning post-pandemic. By comparing these findings with existing studies, it becomes clear that targeted interventions are necessary to address the unique risks faced by different age groups and genders. Implementing these recommendations can significantly reduce the incidence of pediatric poisonings and improve outcomes for affected children. Abbreviations IQR Interquartile Range AOR Adjusted Odds Ratio CI Confidence Interval Declarations Ethics approval and consent to participate: This study was the result of a research project approved by the Research Council and the Regional Ethics Committee of Golestan University of Medical Sciences (GOUMS) with the code of ethics IR.GOUMS.REC.1404.140. All patients’ parents or legal guardians after admitted their children in the hospital asked for participation in an academic research and if they agreed, informed consent for review of their records were obtained. In this retrospective study all ethical standards for research involving human subjects were considered. Consent for publication: Informed consent could not be obtained for our retrospective study. Data were anonymized. This was also declared to the ethics committee. Availability of data and materials: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request Competing Interests: The authors declare no competing interests Funding: This study was not supported by any grant. Authors' contributions Leila Barati (L.B) contributed to the conceptualization, methodology, data curation, investigation, project administration, supervision, and writing and editing of the manuscript. Omid Mehrpour (O.M) contributed to the conceptualization, methodology, investigation, and writing and editing of the manuscript. Mohammadali Vakili (M.V) contributed to data analysis, supervision, and writing and editing of the manuscript. Mehrdad Teimoorian (M.T) contributed to conceptualization, methodology, data curation, investigation, project administration, supervision, and writing and editing of the manuscript. 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Sex differences in pediatric poisonings by age group: a toxicology investigators’ consortium (ToxIC) analysis (2010–2016). J Med Toxicol. 2020;16:423–43. -Wang GS, Leonard J, Cornell A, Hoyte C. Adolescent US poison center exposure calls during the COVID-19 pandemic. J Adolesc Health. 2022;71(6):764–7. - Sinanoğlu MS, Berk E. Clinical Spectrum of Acute Poisoning Cases Admitted to the Pediatric Emergency Department. HAYDARPAŞA NUMUNE Med J. 2023;63(3):316–21. -Tay EY, Tan GF, Yeo AW, Tham EH. Intentional poisoning in pediatric patients: examining the risk factors. Pediatr Emerg Care. 2021;37(12):e1510–4. Gonzalez-Urdiales P, Kuppermann N, Dalziel SR, Prego J, Benito J, Mintegi S. Pediatric intentional self-poisoning evaluated in the emergency department: an international study. Pediatr Emerg Care. 2021;37(12):e1631–6. -Tiwari A, Trivedi P, Mishra S, Sachdev M, Panda S, Malini G. Clinical Profile and Outcome of Poisoning in Children Admitted to a Tertiary Care Hospital. Asian J Pediatr. 2020;6(3):240–6. -Kutluturk K, Aslan M. Evaluation of drug poisoning cases in pediatric emergency department. -Czeisler MÉ. Mental health, substance use, and suicidal ideation during the COVID-19 pandemic—United States, June 24–30, 2020. MMWR. Morbidity and mortality weekly report. 2020;69. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7152014","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":504846849,"identity":"7ad35264-aa2f-4e94-b122-4b30b32aec18","order_by":0,"name":"leila Barati","email":"","orcid":"","institution":"Golestan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"leila","middleName":"","lastName":"Barati","suffix":""},{"id":504846850,"identity":"55c05246-6209-442c-b0d7-02ff762bb2c6","order_by":1,"name":"Mohammadali Vakili","email":"","orcid":"","institution":"Golestan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mohammadali","middleName":"","lastName":"Vakili","suffix":""},{"id":504846851,"identity":"ecd1c966-bc39-4967-8f31-de240b979f1d","order_by":2,"name":"Omid Mehrpour","email":"","orcid":"","institution":"Wayne State University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Omid","middleName":"","lastName":"Mehrpour","suffix":""},{"id":504846852,"identity":"8f1bbfcf-8be4-4d3c-ad8e-3fb3d73ceb6a","order_by":3,"name":"Mehrdad Teimoorian","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3UlEQVRIiWNgGAWjYBACgwM8DAw8DMwMDOwNIK4FYS2WUC0SDDwHQFokCGuxh2uRSADxidBidrz32Ic3NdZ1ujOfX93wo0CCgb+9OwG/ljPnkmfOOZYuYXY7p+xmD9BhEmfObsCv5UaOMTMP22GQlrQbPEAtBhK5+LUY3H8D1PIPqOXmmbSbf4jScoPHmJm3DajlBvux28TZcibHmHFuX7rktjM5bLdlDCR4CPrF4PgZY4Y336z5zY4ff3bzzR8bOf72XvxakACPAZgkVjkIsD8gRfUoGAWjYBSMIAAA71hKILqzPwoAAAAASUVORK5CYII=","orcid":"","institution":"Golestan University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Mehrdad","middleName":"","lastName":"Teimoorian","suffix":""}],"badges":[],"createdAt":"2025-07-17 20:08:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7152014/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7152014/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89983074,"identity":"554577d8-313d-46eb-af5c-c4d36e965076","added_by":"auto","created_at":"2025-08-27 06:31:10","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":54843,"visible":true,"origin":"","legend":"\u003cp\u003eMonth of admission during and after pandemic Covid19\u003c/p\u003e","description":"","filename":"11.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7152014/v1/4284782f9b57e8d110561ee4.jpg"},{"id":89983075,"identity":"4f2afd0d-1fbc-45ba-959d-60908ffc3576","added_by":"auto","created_at":"2025-08-27 06:31:10","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":21103,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7152014/v1/35a459cccc2577411529bfd6.png"},{"id":89983077,"identity":"54a6861e-cf09-4ac2-a3e8-5cbbebce9ee1","added_by":"auto","created_at":"2025-08-27 06:31:10","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":39203,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7152014/v1/6adc18848a849d29883c11d7.jpg"},{"id":90916265,"identity":"14dbf39b-885c-4b50-9e0b-bde78d049857","added_by":"auto","created_at":"2025-09-09 14:16:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1002540,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7152014/v1/7db1fcf4-8bbb-4474-9e6f-960bb20e2bc7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Cross-sectional Comparative Acute Poisoning in Children and Adolescents During and After COVID-19 Pandemic (2020-2023)","fulltext":[{"header":"Background","content":"\u003cp\u003ePoisoning is one of the main causes of children's emergencies and is one of the preventable causes of pediatrics mortality and morbidity (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In the last 20 years, the global incidence of acute poisoning in children has been 1.8 per 100,000 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), and has been reported from 0.3\u0026ndash;7.6% (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). During Covid19 pandemic, rate of poisoning increased from 3.4 to 5.5% in Aydin`s study (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eThe Covid19 pandemic had a various impact on emergency visits (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Emergency ward admission was decreased, but all kind of poisoning accidental and intentional related poisoning increased 127.8% and 104.2% respectively compare to other causes of admission in a research in Canada (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The proportion of adolescent\u0026rsquo;s calls and hospital admissions and suicidal attempt were higher compare with other pediatric age groups according to US poison center (PCs) and there were more sever outcomes and death during Covid19 (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). According to national center for health statics there was increased illicit drugs ingestion in young children and adolescents during pandemic (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).The most immediate increase is reported in Cannabis, Opioids and ethanol ingestion (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIt was reported that adolescents and children`s poisoning and drug overdose was the third leading cause of death in this age group during pandemic (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn cases of poisoning more than half of them were under 5 years old (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) and according to poison statics more than 99% were unintentional among children under 6 years old (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The risk of poisoning due to sanitizers, disinfectants and caustic-corrosive substances significantly increased specially in preschool child in research in Saudi Arabia and Sahar`s study (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). On the other hand in Devlin`s study it was reported that the frequency of poisoning in children under 5 years old remained stable during pandemic regardless of shelter-in-place policies(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSince patterns of intoxication may differ according to variables such as causes and demographic factors, in addition children's poisoning may change over time even in a geographical area, which is always a challenge for emergency department doctors (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e); in this study we investigated the feature of pediatrics and adolescents poisoning during and after Covid19 pandemic in our region. To our assessment although there were some studies about the poisoning before and during Covid19, (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan additionalcitationids=\"CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) there were limited data about post pandemic period. For this reason, in this study, the medical documents of children referred to the Taleghani Hospital in Gorgan due to poisoning during and after Covid19 pandemic were assessed.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cb\u003eStudy Design and Setting\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eIn a Cross-sectional Comparative study the documents of all patients under 18 years old who referred to the emergency department of therapeutic and educational pediatric hospital in Gorgan that is the only third level pediatrics hospital under the Golestan University of Medical Sciences supervision in Golestan province due to poisoning during April 2020\u0026ndash;2023 (during and after Covid19 pandemic) were studied. This hospital covers urban and rural referral patients and all socioeconomic and demographic characteristics.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePopulation and Sample\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eInclusion criteria were records of all patients referred to the Taleghani Hospital in Gorgan because of all kind of poisoning (ingestion, inhalation) and less than 18 years old and exclusion criteria were cases with incomplete data by more than 10% missing data in demographic information and unclear poisoning cause. Diagnosis of intoxication was based on physician evaluation, guardian`s reports, clinical manifestation and toxicology`s results.\u003c/p\u003e\u003cp\u003eThe patients divided in to two groups during Covid19 (April 2020\u0026ndash;2022) and after Covid19 (April 2022\u0026ndash;2023). In term of causes of poisoning, they categorized in \u0026ldquo;Intentional\u0026rdquo;) The poisoning was done with the intent of self-harm or suicide.), \u0026ldquo;Accidental\u0026rdquo; (\u0026zwnj; The poisoning occurred accidentally and without intent), and \u0026ldquo;Neglected\u0026rdquo; (The poisoning occurred accidentally and by the guardian`s) that was based on self-reported and physician`s assessments.\u003c/p\u003e\u003cp\u003e\u003cb\u003eData Collection\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eTheir information was collected by studying the documents of patients. For ensuring the consistency and accuracy of data, it was collected by pediatrician who was the author of the survey. All of the data were coded and entered in to SPSS version 24 software.\u003c/p\u003e\u003cp\u003e\u003cb\u003eVariables and Definitions\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eDemographic information, Age (under 6 months, 6\u0026ndash;11 months, 1\u0026ndash;4 Years, 5\u0026ndash;9 years, 10\u0026ndash;17 Years old.), Gender ( Male, Female), Residential area ( Urban, Rural), kind of admission (Emergency ward, under observation, refused to admission), Causes of poisoning (Intentional, Accidental, Neglected), Season and Month and Year of admission, kind of poisoning substances (Illicit Drugs and alcohol, pharmacologic drugs (Antidepressant and Antipsychotic, Antipyretics, Antihypertensive, Vitamins, Anti- histamine, Anti Helmets, Antibiotics, Gastrointestinal, OCP, Anti-lipid, Anti-epileptics Diabetics, Anti-emetic), Detergents, Hydrocarbon, Pesticides and Repellents, Gases, Plants and Others.\u003c/p\u003e\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis:\u003c/h2\u003e\u003cp\u003eThe data was statistically analyzed with SPSS software version 24. Mean, frequency and percentage were used to describe the data. Chi-square was used to compare the analysis of categorical groups. The Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) of the risk factors associated with the incidence of poisoning were calculated using a Binary multiple logistic regression model. In the logistic regression analysis, the outcome variable was hospital admission at two different time points (During and after Covid19 pandemic), and the predictor (independent) variables include gender, age, kind of admission, cause of poisoning and season. In order to eliminate the effect of confounding factors, variables with a significance level of p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.1 in the univariate logistic regression model were introduced into a multivariate logistic regression model. Also, a P value less than 0.05 was considered statistically significant.\u003c/p\u003e\u003cp\u003e\u003cb\u003eEthical Considerations\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e This study was the result of a research project approved by the Research Council and the Regional Ethics Committee of Golestan University of Medical Sciences (GOUMS) with the code of ethics IR.GOUMS.REC.1404.140. Based on GOUMS`s regulations, all patients after admission in the hospital asked for participation in an academic research and if they agreed, informed consent for review of their records were obtained. In this retrospective study all methods were carried out based on relevant guidelines and regulations and data were extracted from patients` records with their informed consents and all ethical standards for research involving human subjects were considered.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eGeneral Demographics\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eIn this study, 598 patients were registered in the hospital because of poisoning during April 2020\u0026ndash;2023. There were 308 cases (51.5%) during the pandemic (April 2020\u0026ndash;2022) and 290 cases (48.5%) admitted after Covid19 pandemic (April 2022\u0026ndash;2023)\u0026zwnj;.\u003c/p\u003e\u003cp\u003eThe average age of the patients was 63.66\u0026thinsp;\u0026plusmn;\u0026thinsp;63.45 months and IQR of age of the patients was 3 (\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6 CR7 CR8 CR9 CR10\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) years, during pandemic 3 (\u003cspan additionalcitationids=\"CR3 CR4 CR5\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) years and after pandemic 4 (\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) years. The youngest age was 16 days and the oldest age was 17 years. The largest age group of patients was 1\u0026ndash;4 years old with 328 cases (54.9%) and 10\u0026ndash;17 years old with 141 cases (23.6%). During pandemic 16.3% of patients were 10\u0026ndash;17 years old and after pandemic it was 31.4% which was almost double the previous years (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic characteristics data of patients according during and after Covid19 Pandemic N (%)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eCovid19 Pandemic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDuring pandemic\u003c/p\u003e\u003cp\u003e(2020\u0026ndash;2021)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAfter pandemic\u003c/p\u003e\u003cp\u003e(2022)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP-Value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e136(44.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e162(55.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e298(49.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e172(55.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e128(44.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e300(50.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;6Months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8(2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8(2.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16(2.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u0026ndash;11 Months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32(10.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18(6.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e50(8.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u0026ndash;4 Years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e182(59.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e146(50.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e328(54.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u0026ndash;9 Years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35(11.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e27(9.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e62(10.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u0026ndash;17 Years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e50(16.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e92(31.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e142(23.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAdmission\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmergency ward\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e88(28.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e126(43.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e214(35.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eunder observation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e81(26.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e88(30.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e169(28.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRefusal to admission in the hospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e139(45.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e76(26.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e215(36)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCauses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntentional\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e45(14.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e83(28.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e128(21.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAccidental\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e263(85.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e207(71.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e470(78.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eSeason\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSpring\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e140(45.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e77(26.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e217(36.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSummer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e82(26.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e101(34.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e183(30.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAutumn\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e59(19.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e67(23.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e126(21.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWinter\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27(8.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e45(15.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e72(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e308(51.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e290(48.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e598(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFigure1demonstrated the distribution of age groups during (2020\u0026ndash;2021)\u0026zwnj; and after (2023) Covid19 pandemic.\u003c/p\u003e\u003cp\u003eThere was a significant statistical difference between age and groups of during and after the Covid19 pandemic. (Chi-square\u0026thinsp;=\u0026thinsp;20.358, df\u0026thinsp;=\u0026thinsp;4, p\u0026thinsp;=\u0026thinsp;0.0001). Multivariate logistic regression analysis showed children 10 years old and more were 2.35 more than during pandemic admitted for poisoning [AOR\u0026thinsp;=\u0026thinsp;2.35 (95% CI 1.58\u0026ndash;3.47)] (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultiple logistic regression analysis of demographic factors of poisoning during and after Covid19 pandemic\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eMultiple\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAOR(95% CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.00(reference)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.43(1.01\u0026ndash;2.02)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.00(reference)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.35(1.58\u0026ndash;3.47)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAdmission\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmergency ward\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.81(1.85\u0026ndash;4.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnder observation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.68(1.09\u0026ndash;2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.019\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRefusal to admission in the hospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.00(reference)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCauses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntentional\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.09(1.35\u0026ndash;1.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAccidental\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.00(reference)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eSeason\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSpring\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.24(0.13\u0026ndash;0.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSummer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.61(0.34\u0026ndash;1.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.106\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAutumn\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.61(0.32\u0026ndash;1.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.124\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWinter\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.00(reference)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eOR, odds ratio; CI, confidence interval.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eGender Differences\u003c/b\u003e:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e showed that there were 297 cases (49.8%) females and 300 cases (50.2%) were males. During pandemic 172 cases (55.8%) were males, but after pandemic female were 162 cases (55.8%); that showed in Fig.\u0026nbsp;2. There was a significant statistical difference between gender and groups of during and after the Covid19 pandemic. (Chi-square\u0026thinsp;=\u0026thinsp;8.18, df\u0026thinsp;=\u0026thinsp;1, p\u0026thinsp;=\u0026thinsp;0.004) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eThere was a statistically significant difference between gender and the cause of poisoning. Eighty three girls (28.4%) were intentionally poisoned compared to 45 boys (15.4%) (Chi-square\u0026thinsp;=\u0026thinsp;14.63, df\u0026thinsp;=\u0026thinsp;2, p\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003eIn multiple logistic regression analysis, females were 1.4 more than males admitted for poisoning after Covid19 pandemic.[AOR\u0026thinsp;=\u0026thinsp;1.43 (95% CI 1.01\u0026ndash;2.02)] (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eAdmission Details\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e showed that in Emergency department 214 cases (35.8%) were admitted and 168 cases (28.2%) were under observation, which were discharged within 2 hours, and 215 cases (36%) did not agree to be hospitalized and refused to admission in the hospital.\u003c/p\u003e\u003cp\u003eOut of the hospitalized cases, 87 cases (40.7%) were discharged within 24 hours because of good condition and no sign and symptom of intoxication, of which 25 cases (28.7%) were less than 6 hours.\u003c/p\u003e\u003cp\u003eThe average hospitalization time was 0.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1 days, during pandemic 0.84\u0026thinsp;\u0026plusmn;\u0026thinsp;1.31 and after pandemic 0.94\u0026thinsp;\u0026plusmn;\u0026thinsp;2.39. Death cases were reported due to methadone poisoning (one case in 2020, and two cases in 2022) and opium poisoning (two cases in 2021).\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e showed there was a statistically significant difference between the hospitalization status and the year of hospitalization (Chi-square\u0026thinsp;=\u0026thinsp;24.97, df\u0026thinsp;=\u0026thinsp;2, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). In 2022, the rate of hospitalization in the emergency department was 43.4% compared to during pandemic, which was reported as 28.6%. During pandemic 139(45.1%) refused to admission in the hospital.\u003c/p\u003e\u003cp\u003eMultiple logistic regression of analysis of the factors showed that admission in Emergency department and under observation after Covid19 pandemic were 2.81 and 1.68 more than during pandemic [AOR\u0026thinsp;=\u0026thinsp;2.81 (95% CI 1.85\u0026ndash;4.29)] and [AOR\u0026thinsp;=\u0026thinsp;1.68 (95% CI 1.09\u0026ndash;2.6) ] respectively(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eCauses of Poisoning\u003c/b\u003e:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe causes of poisoning include 397 cases (67.9%) accidental poisoning, 128 cases (21.9%) intentional poisoning, and 60 cases (10.2%) caregivers' negligence.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e showed that during and after pandemic; intentional poisoning was 14.6% and 28.6% respectively and there was a statistically differences between two groups (Chi-square\u0026thinsp;=\u0026thinsp;17.42, df\u0026thinsp;=\u0026thinsp;1, P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). In multiple logistic regression analysis, after Covid19 pandemic intentional poisoning were 2.09 more than during pandemic period [AOR\u0026thinsp;=\u0026thinsp;2.09 (95% CI 1.35\u0026ndash;1.14)] (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe most common causes of poisoning among referred children were poisoning with pharmacologic drugs; 198 cases (33.1%), illegal drugs and alcohol in 171 cases (28.6%), detergents in 84 cases (14%), and hydrocarbons in 65 cases (10.9%).\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e showed that there were statistically differences in pharmacologic and illicit drugs regards cause of substances intoxication between two groups (Chi-square\u0026thinsp;=\u0026thinsp;14.38, df\u0026thinsp;=\u0026thinsp;1, p\u0026thinsp;=\u0026thinsp;0.0001) (Chi-square\u0026thinsp;=\u0026thinsp;6.65, df\u0026thinsp;=\u0026thinsp;1, p\u0026thinsp;=\u0026thinsp;0.01) respectively. During pandemic intentional intoxication in pharmacologic and illicit drugs were 17.3% and 14.4%, but after pandemic were 42% and 30.9% respectively.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ekind of poisoning substances based on causes of intoxication between two groups (During and after Covid19 Pandemic) N (%)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003csub\u003eSubstances\u003c/sub\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003csub\u003eDuring(2020\u0026minus;2021)\u003c/sub\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003csub\u003eAfter(2022)\u003c/sub\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003csub\u003eTotal\u003c/sub\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003csub\u003eP\u0026minus;Value\u003c/sub\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003csub\u003ePharmacologic Drugs\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003csub\u003eIntentional\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003csub\u003e17(17.3)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003csub\u003e42(42)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003csub\u003e59(29.8)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003csub\u003e0.0001\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003csub\u003eAccidental\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003csub\u003e81(82.7)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003csub\u003e58(58)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003csub\u003e139(70.2)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003csub\u003eTotal\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003csub\u003e98(100)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003csub\u003e100(100)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003csub\u003e198(100)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003csub\u003eIllicit Drugs and Alcohol\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003csub\u003eIntentional\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003csub\u003e13(14.4)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003csub\u003e25(30.9)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003csub\u003e38(22.2)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003csub\u003e0.01\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003csub\u003eAccidental\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003csub\u003e77(85.6)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003csub\u003e56(69.1)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003csub\u003e133(77.8)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003csub\u003eTotal\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003csub\u003e90(100)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003csub\u003e81(100)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003csub\u003e171(100)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003csub\u003eDetergents\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003csub\u003eIntentional\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003csub\u003e2(3.9)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003csub\u003e2(6.1)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003csub\u003e4(4.8)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003csub\u003e0.65\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003csub\u003eAccidental\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003csub\u003e49(96.1)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003csub\u003e31(93.9)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003csub\u003e80(95.2)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003csub\u003eTotal\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003csub\u003e51(100)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003csub\u003e33(100)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003csub\u003e84(100)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003csub\u003eHydrocarbons\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003csub\u003eIntentional\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003csub\u003e0\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003csub\u003e0\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003csub\u003e0\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003csub\u003e\u0026minus;\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003csub\u003eAccidental\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003csub\u003e34(100)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003csub\u003e31(100)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003csub\u003e65(100)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003csub\u003eTotal\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003csub\u003e34(100)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003csub\u003e31(100)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003csub\u003e65(100)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003csub\u003eOthers\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003csub\u003eIntentional\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003csub\u003e13(37.1)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003csub\u003e14(31.1)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003csub\u003e27(33.8)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003csub\u003e0.57\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003csub\u003eAccidental\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003csub\u003e22(62.9)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003csub\u003e31(68.9)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003csub\u003e53(66.3)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003csub\u003eTotal\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003csub\u003e35(100)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003csub\u003e45(100)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003csub\u003e80(100)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003csub\u003eTotal\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003csub\u003eIntentional\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003csub\u003e45(14.6)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003csub\u003e83(28.6)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003csub\u003e128(21.4)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003csub\u003e0.0001\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003csub\u003eAccidental\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003csub\u003e263(85.4)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003csub\u003e207(71.4)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003csub\u003e470(78.6)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003csub\u003eTotal\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003csub\u003e308(100)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003csub\u003e290(100)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003csub\u003e598(100)\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e demonstrated that there was not any intentional intoxication with hydrocarbons. There were not any statistical difference between intoxication with detergents and other substances between two groups (p\u0026thinsp;=\u0026thinsp;0.65) and (p\u0026thinsp;=\u0026thinsp;0.57) respectively.\u003c/p\u003e\u003cp\u003eThe methods of poisoning were the consumption of tablets (45.8%), liquids and syrups (43.5%), inhalation and smoke (9.4%).\u003c/p\u003e\u003cp\u003e\u003cb\u003eSeasonal Variation\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e showed that the highest poisoning was reported in the month May (90 cases, 15.1%) and the lowest in the month February (15 cases, 2.5%). During pandemic May (19.2%) and after pandemic July (15.9%) were the highest month with intoxication. Spring and summer seasons were the highest intoxication admission during and after pandemic retrospectively. There were a statistically differences between two groups regarding month and season admission. (Chi-square\u0026thinsp;=\u0026thinsp;62.24, df\u0026thinsp;=\u0026thinsp;11, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) (Chi-square\u0026thinsp;=\u0026thinsp;24.75, df\u0026thinsp;=\u0026thinsp;3, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eIn multiple logistic regression analysis after covid19 pandemic, season of admission in Spring was 0.24 [AOR\u0026thinsp;=\u0026thinsp;0.24 (95% CI 0.13\u0026ndash;0.44)], Summer was 0.61 [AOR\u0026thinsp;=\u0026thinsp;0.61 (95% CI 0.34\u0026ndash;1.11)] and Autumn was 0.61 [AOR\u0026thinsp;=\u0026thinsp;0.61 (95% CI 0.32\u0026ndash;1.14)] respectively (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eCovid19 pandemics had many impactions on pediatrics health especially visiting Emergency department. There were some articles about the comparison the changes in poisoning in pediatrics population before and during covid19 pandemics, but according to our knowledge there is not any survey about the impact of covid19 on poisoning after pandemics. In this study, After Covid19 pandemic the number of referral cases of poisoned children had increased and a significant difference was reported between intentional poisoning, the upper 10 years old age and the gender of girls and hospitalization in the emergency department compared to Covid19 period.\u003c/p\u003e\u003cp\u003e\u003cb\u003eGender Distribution\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAlthough Park`s study (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) found no significant changes in admission of girls before and during Covid19 period, the gender distribution of poisoning cases in this study showed a significant trend over the study years, with a notable increase in female cases, especially post-COVID-19. This trend aligns with findings from Beauchamp et al. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), who reported a higher prevalence of intentional pharmaceutical poisonings among female adolescents. Similarly, Lee et al. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) and Salman (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) found that while younger children were predominantly male, female adolescents had higher rates of intentional poisonings. This increase in female poisoning cases, particularly in the post-pandemic period, may be due to increased psychological stressors faced by adolescent girls. These findings underscore the need for targeted mental health interventions for this demographic.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAge Distribution\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study found that the majority of poisoning cases were accidental and in the 1\u0026ndash;4 years age group, with a significant increase in cases among the 10\u0026ndash;17 years age group post-pandemic. This aligns with Beauchamp et al. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) and Lee et al. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), and Salman (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) who reported higher rates of accidental intoxication in less than 6 years old and intentional poisonings among adolescents. In Raffa j `s (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) study it was highlighted that intentional poisoning among youth and unintentional poisoning among less than 6 years old during pandemic increased, and in Park`s survey (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) the average of age of patients during pandemic was significant higher than before pandemic and showed that the middle adolescent age were more than before pandemics. Although the mentioned studies described the during pandemic situation that showed the increased in intentional poisoning among adolescent group, in the current study the increase in older children presenting with poisoning, particularly intentional poisoning after pandemic in compare with during pandemic, highlights the critical need for mental health support and preventive measures specifically targeted at adolescents in stressful condition.\u003c/p\u003e\u003cp\u003e\u003cb\u003eHospitalization and Admission Patterns\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDuring pandemic about 45% of poisoning patients refuse the admission in the hospital that was because of fear of Covid19 virus, but there was a significant increase in the percentage of pediatric patients admitted to the emergency ward post-pandemic. In Delvin`s study (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) despite dramatic decreases in hospital admission during pandemic, the number of poisoning did not change and Wang`s survey (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) reported that in adolescents; drug overdose, suicidal attempt and death compare with before pandemic were increased. This finding is supported by Sinanoglu (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), who reported high rates of intensive care admissions for pediatric poisoning cases during pandemics. In Park`s survey (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) the admission rate and length of stay in the hospital were significantly higher in Covid19 period. In comparison with mentioned studies this current survey showed that the length of stay and admission in the hospital after Covid19 was higher than during pandemics; which may be due to increased severity or complications in poisoning cases and the high rate of intentional poisoning among adolescents.\u003c/p\u003e\u003cp\u003e\u003cb\u003eCauses of poisoning\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study found a significant increase in intentional poisonings, particularly among females and older children after pandemic. This trend is consistent with Tay et al. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) and Gonz\u0026aacute;lez-Urdiales et al. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), who found that intentional self-poisoning cases were predominantly among adolescents and more common in females. The review showed that pharmaceuticals, illicit drugs, and hydrocarbons were the most common causes of poisoning, with an increase in opioid poisonings over the years. In Park`s study (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) pharmacologic drugs was the main cause of poisoning, in Salman`s survey (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) non- pharmacologic agents were the main cause in accidental poisoning and in intentional poisoning pharmacologic drugs were the most. In Raffa`s survey(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) during pandemic 13% of adults initiating substance use to cope with stress and caregivers reported worsening mental health following pandemic, this increased used of illicit drugs by caregivers may lead to exposure to illicit drugs by adolescents and children that cause rise in poisoning in this groups. Although after pandemic school reopened and travel has resumed, the situation and the mental health of people were not return to pre-pandemic norms.(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) The rise in intentional poisonings underscores the urgent need for mental health interventions and preventive strategies to address psychological distress among adolescents.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSeasonal Variations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn this study Spring and Summer seasons were the highest intoxication admission during and after pandemic retrospectively. There were a statistically differences between two groups regarding month and season admission. This finding is similar to Tiwari et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) and Kutluturk \u0026amp; Aslan (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), and Salman (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) who reported higher incidences of poisoning during summer and spring suggesting seasonal trends linked to school vacations and less supervision because of gardening and agricultural work and cleaning the house. These discrepancies highlight the importance of context-specific analyses and suggest that preventive measures should consider regional and seasonal factors. The systematic review also noted higher poisoning rates in summer, likely due to increased outdoor activities and reduced parental supervision during this period. During pandemic poisoning with detergents were higher than after pandemic, that was may be due to increased use of detergents during isolation and lockdown periods.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAdditional Discussion Points\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003ePsychological Impact Post-COVID-19\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe significant increase in intentional poisonings, particularly among adolescents, suggests a heightened need for mental health resources (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Screening tools for depression, anxiety, and other psychiatric disorders in schools could help identify at-risk individuals early and provide necessary interventions specifically during stressful situation in community that may lead to behavioral and psychological health crisis\u003c/p\u003e\u003cp\u003e\u003cb\u003eAccidental Poisoning and Parental Supervision\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study underscores the importance of safe storage of toxic substances and better parental supervision to prevent accidental poisonings, particularly in younger children. Educational campaigns should address these issues to reduce the incidence of accidental poisonings. Care givers specifically drug abusers should be informed about the storage of substances in places inaccessible to children and adolescents and avoiding use of these drugs for calming in younger children. Additionally, relevant authorities should strengthen their supervision over how these individuals care for children.\u003c/p\u003e\u003cp\u003e\u003cb\u003eRegistry and Follow-Up\u003c/b\u003e\u003c/p\u003e\u003cp\u003eEstablishing a child poisoning registry and ensuring follow-up for cases discharged against medical advice are critical steps to monitor and manage poisoning cases effectively. This can help in identifying patterns, assessing intervention efficacy, and reducing mortality and morbidity rates. Adolescents hospitalized due to drug poisoning should be evaluated by a child and adolescent psychologist. Furthermore, their mental health and family circumstances should be monitored through follow-up evaluations to support their emotional well-being.\u003c/p\u003e\u003cp\u003e\u003cb\u003eImplications\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe significant increase in pediatric poisoning cases post-COVID-19, particularly intentional poisonings among adolescent girls, underscores the need for comprehensive mental health support. Public health interventions should include regular psychological screenings in schools, enhanced public awareness campaigns about the dangers of toxic substances, and improved safe storage practices for household chemicals and medications. The establishment of a comprehensive pediatric poisoning registry would also be beneficial for monitoring trends and evaluating the effectiveness of interventions.\u003c/p\u003e\u003cp\u003eLimitation:\u003c/p\u003e\u003cp\u003eThere are some limitation that was related to a retrospective analysis of documents, some of data was missed and omitted from analysis.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eFindings of this study contribute to the growing body of literature on pediatric poisoning, highlighting significant shifts in demographic patterns and causes of poisoning post-pandemic. By comparing these findings with existing studies, it becomes clear that targeted interventions are necessary to address the unique risks faced by different age groups and genders. Implementing these recommendations can significantly reduce the incidence of pediatric poisonings and improve outcomes for affected children.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIQR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInterquartile Range\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAOR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAdjusted Odds Ratio\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eConfidence Interval\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was the result of a research project approved by the Research Council and the Regional Ethics Committee of Golestan University of Medical Sciences (GOUMS) with the code of ethics IR.GOUMS.REC.1404.140. All patients\u0026rsquo; parents or legal guardians after admitted their children in the hospital asked for participation in an academic research and if they agreed, informed consent for review of their records were obtained. \u0026nbsp; In this retrospective study all ethical standards for research involving human subjects were considered.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent could not be obtained for our retrospective study. Data were anonymized. This was also declared to the ethics committee.\u003cbr\u003e \u003cstrong\u003e\u003cbr\u003e\u0026nbsp;Availability of data and materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request\u003cbr\u003e\u0026nbsp;\u003cbr\u003e \u003cstrong\u003eCompeting Interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was not supported by any grant.\u003cbr\u003e \u003cstrong\u003e\u003cbr\u003e\u0026nbsp;Authors\u0026apos; contributions\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Leila Barati (L.B) contributed to the conceptualization, methodology, data curation, investigation, project administration, supervision, and writing and editing of the manuscript.\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Omid Mehrpour (O.M) contributed to the conceptualization, methodology, investigation, and writing and editing of the manuscript.\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Mohammadali Vakili (M.V) contributed to data analysis, supervision, and writing and editing of the manuscript.\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Mehrdad Teimoorian (M.T) contributed to conceptualization, methodology, data curation, investigation, project administration, supervision, and writing and editing of the manuscript.\u003cbr\u003e\u0026nbsp;\u003cbr\u003e \u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank the Neonatal and Children\u0026rsquo;s Health Research Centre at Golestan University of Medical Sciences for scientific support and the families of children for participation in this survey.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e- Salman H, Salman Z, Ak\u0026ccedil;am M. Childhood poisoning during the COVID-19 pandemic. Turkish archives Pediatr. 2023;58(3):268.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-Vila\u0026ccedil;a L, Volpe FM, Ladeira RM. Accidental poisoning in children and adolescents admitted to a referral toxicology department of a Brazilian emergency hospital. Rev Paul Pediatr. 2019;38:e2018096. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1590/1984-0462/2020/38/20180966\u003c/span\u003e\u003cspan address=\"10.1590/1984-0462/2020/38/20180966\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-Zhu F, Wang C. Epidemiological analysis of pesticide poisoning in children aged 0\u0026ndash;14 in Bengbu from 2007 to 2018. Chin J Sch Health. 2019;12:1210\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-Aydın O, Hanalıoğlu D, \u0026Uuml;nal B, G\u0026uuml;ng\u0026ouml;r E, Kaynak MO, Yiğit H, Mercan UB, Kuzu A, Teksam \u0026Ouml;. What has changed in injury-related presentations during COVID-19 pandemic? A single-center experience from a pediatric emergency department. Turkish archives Pediatr. 2022;57(4):453.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e- Levy M, Lestrade V, Said C, Jouvet P, Kawaguchi A. Consequences of social distancing measures during the COVID-19 pandemic first wave on the epidemiology of children admitted to pediatric emergency departments and pediatric intensive care units: a systematic review. Front Pead. 2022;10:874045.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e- Zhang EW, Davis A, Finkelstein Y, Rosenfield D. The effects of COVID-19 on poisonings in the paediatric emergency department. Paediatr Child Health. 2022;27(Supplement1):S4\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-Lelak KA, Vohra V, Neuman MI, Farooqi A, Toce MS, Sethuraman U. COVID-19 and pediatric ingestions. Pediatrics. 2021;148(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-Centers for Disease Control and Prevention, National Center for Health Statistics; July 14. 2021. Accessed March 15, 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/\u003c/span\u003e\u003cspan address=\"https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e 20210714. htm.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-Raffa BJ, Schilling S, Henry MK, Ritter V, Bennett CE, Huang JS, Laub N. Ingestion of illicit substances by young children before and during the COVID-19 pandemic. JAMA Netw Open. 2023;6(4):e239549.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-Goldstick JE, Cunningham RM, Carter PM. Current causes of death in children and adolescents in the United States. N Engl J Med. 2022;386(20):1955\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-Poison statistics: national data 2020. Poison Control National Capital Poison Center. 2022. Accessed June 14, 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.poison.org/poison-statistics-national\u003c/span\u003e\u003cspan address=\"https://www.poison.org/poison-statistics-national\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e- Mahmoud NF, Al-Mazroua MK, Afify MM. Toxicology practice during COVID-19 pandemic: experience of the dammam poison control Center-Eastern Province, Saudi Arabia. Int J Toxicol. 2021;40(4):388\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-Sahar AH, Hasnae H, Hajar M, Mohammed C, Sana C, Sanae A, Ilham T, Moustapha H. Children\u0026rsquo;s poisoning profile during the Covid-19 pandemic\u0026ndash;Experience of Hassan II University Hospital in Fez, Morocco. InE3S Web of Conferences 2021 (Vol. 319, p. 01077). EDP Sciences.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-Devlin G, Addo N, Shaahinfar A, Chen CC, Grupp-Phelan J, Kornblith AE. Toxic exposures among young children one year into the covid-19 pandemic: a retrospective review of three San Francisco Bay area emergency departments. J Emerg Med. 2023;64(2):263\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-Alwan IA, Brhaish AS, Awadh AI, Misnan A, Rahim NA, Tangiisuran B, Abdul Majid MI. Poisoning among children in Malaysia: A 10-years retrospective study. PLoS ONE. 2022;17(4):e0266767.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e- Lee J, Fan NC, Yao TC, Hsia SH, Lee EP, Huang JL, Wu HP. Clinical spectrum of acute poisoning in children admitted to the pediatric emergency department. Pediatr Neonatology. 2019;60(1):59\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e- Park J, Jeon W, Ko Y, Choi YJ, Yang H, Lee J. Comparison of the clinical characteristics of pediatric poisoning patients who visited emergency department before and during the COVID-19 pandemic. J Korean Med Sci. 2022;37(47).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-Beauchamp GA, Carey JL, Cook MD, Cannon RD, Katz KD, Yoon J, Kincaid H, Ely BJ, Pollack E, Mazzaccaro RJ, Greenberg MR. Sex differences in pediatric poisonings by age group: a toxicology investigators\u0026rsquo; consortium (ToxIC) analysis (2010\u0026ndash;2016). J Med Toxicol. 2020;16:423\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-Wang GS, Leonard J, Cornell A, Hoyte C. Adolescent US poison center exposure calls during the COVID-19 pandemic. J Adolesc Health. 2022;71(6):764\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e- Sinanoğlu MS, Berk E. Clinical Spectrum of Acute Poisoning Cases Admitted to the Pediatric Emergency Department. HAYDARPAŞA NUMUNE Med J. 2023;63(3):316\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-Tay EY, Tan GF, Yeo AW, Tham EH. Intentional poisoning in pediatric patients: examining the risk factors. Pediatr Emerg Care. 2021;37(12):e1510\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGonzalez-Urdiales P, Kuppermann N, Dalziel SR, Prego J, Benito J, Mintegi S. Pediatric intentional self-poisoning evaluated in the emergency department: an international study. Pediatr Emerg Care. 2021;37(12):e1631\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-Tiwari A, Trivedi P, Mishra S, Sachdev M, Panda S, Malini G. Clinical Profile and Outcome of Poisoning in Children Admitted to a Tertiary Care Hospital. Asian J Pediatr. 2020;6(3):240\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-Kutluturk K, Aslan M. Evaluation of drug poisoning cases in pediatric emergency department.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e-Czeisler M\u0026Eacute;. Mental health, substance use, and suicidal ideation during the COVID-19 pandemic\u0026mdash;United States, June 24\u0026ndash;30, 2020. MMWR. Morbidity and mortality weekly report. 2020;69.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Adolescent, Child, Covid19 Pandemic, Intoxication, Poisoning, Pediatric","lastPublishedDoi":"10.21203/rs.3.rs-7152014/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7152014/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e\u003cp\u003eThe causes and demographic factors affecting children's poisoning change over time and is always a challenge for emergency department physicians. Evaluation the changes of pediatrics poisoning due to Covid19 pandemic was the purpose of this study.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e\u003cp\u003eIn this cross-sectional study, the documents of all patients referred to the Taleghani Hospital in Gorgan during (April 2020\u0026ndash;2022) and after Covid19 pandemic (April 2022\u0026ndash;2023) due to poisoning were investigated. Demographic information, causes of poisoning was statistically analyzed.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e\u003cp\u003eIn this study, 598 patients were registered in the hospital due to poisoning. The IQR age of the patients during and after pandemic were 3 (\u003cspan additionalcitationids=\"CR3 CR4 CR5\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) and 4 (\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) years respectively. Multiple logistic regression analysis showed that after Covid19 pandemic, females were 1.4; [AOR\u0026thinsp;=\u0026thinsp;1.43 (95% CI 1.01\u0026ndash;2.02)], intentional poisoning were 2.09; [AOR\u0026thinsp;=\u0026thinsp;2.09 (95% CI 1.35\u0026ndash;3.25)], admission in the Emergency ward were 2.82; [AOR\u0026thinsp;=\u0026thinsp;2.82 (95% CI 1.85\u0026ndash;4.29)] and children upper 10 years old were 2.35, [AOR\u0026thinsp;=\u0026thinsp;2.35 (95% CI 1.58\u0026ndash;3.47)] more than during pandemic admitted for poisoning. During pandemic intentional intoxication in pharmacologic and illicit drugs were 17.3% and 14.4%, but after pandemic were 42% and 30.9% respectively.\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e\u003cp\u003eAfter Covid19 pandemic, the number of referral cases of children due to poisoning had increased and a significant difference was reported between intentional poisoning, the upper 10 years old age and the gender of girls and hospitalization in the emergency department. It showed that the pandemic has severely affected adolescent mental health, especially among girls.\u003c/p\u003e","manuscriptTitle":"Cross-sectional Comparative Acute Poisoning in Children and Adolescents During and After COVID-19 Pandemic (2020-2023)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-27 06:31:05","doi":"10.21203/rs.3.rs-7152014/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"165a02dc-40ee-44ee-8175-efacec8942f8","owner":[],"postedDate":"August 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-09T14:08:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-27 06:31:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7152014","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7152014","identity":"rs-7152014","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}