SickKids researchers conduct the first systematic study of malicious poisonings

Malicious poisoning (MP), where an individual is the victim of another person’s intent to harm them through poisoning, is uncommon in the overall population of poisoned patients. While uncommon overall, data collected by the American Association of Poison Control Centers suggest that children are more at risk of death compared to adults when maliciously poisoned.

Using this as a starting point of concern, The Hospital for Sick Children (SickKids) conducted the first-ever systematic study of MP in North American adult and paediatric populations, exploring the circumstances, characteristics of victims and outcomes of individuals who have been deliberately poisoned by others. Dr. Yaron Finkelstein, a Staff Physician in Emergency Medicine and Clinical Pharmacology and Toxicology and Associate Senior Scientist in the Research Institute at SickKids and Dr. Magali Gauthey, Principal Investigator and a previous Emergency Medicine Clinical Fellow at SickKids, worked with researchers from the Toxicology Investigators Consortium (ToxIC) and drew upon data from the 47 sites in the ToxIC registry. The registry, established in 2010 by the American College of Medical Toxicology, compiles information on cases seen by toxicology services at the bedside.

The results are published in the January 14 of Clinical Toxicology. Finkelstein, Senior Author, shares more about the study’s findings.

Can you explain the key findings of your study?

Overall, we identified 60 cases of MP. The most striking finding was the disproportionally high number of infants and very young children; almost a third of all victims of MP were infants and toddlers younger than two. Moreover, children were more severely affected by the poisoning and more likely to require intensive medical care, such as mechanical ventilation, than adults.

What is the significance of these findings?

MP is a sporadic event that often hits the media but has not been systematically studied before. Using a large research network allowed us to collect enough cases to draw conclusions on their patterns and characteristics.  

Were you surprised by the results?

Although still a relatively small cohort, our finding that almost a third of all victims of MP were infants and children younger than two is surprising and worrisome. Infants are highly vulnerable, suffered more harm than adults in the cases we examined, and have no ability to verbally communicate and provide information about the circumstances of the overdose, which frequently involved caregivers.

Are there clinical applications based on your research that can be applied in the next few years?

Our study should enhance health-care providers’ knowledge and awareness about MP and potentially help identify possible victims.

What are some of the limitations to this research?

Due to the nature of the database, we did not have access to more detailed information about the exact circumstances of each event, background data on the patients, the relationship to the offender in each event or their actual motivations and goals. Also, we were limited to voluntary reporting within the consortium’s sites and did not have access to cases from other North American centres.

What are the next steps for this research?

We hope that by unveiling and characterizing this phenomenon in a systematic study, these findings will spark additional research on an even larger scale into this phenomenon through pre-existing national and international poison information centre networks. With a more detailed exploration and understanding of the characteristics of victims and offenders as well as the circumstances of the poisonings, we might be able to better identify MP events and maybe even prevent some of them.