Table 4.

Management

Author(year)	Title	Country and income status	Setting and population	Study design	Number of subjects	Intervention description	Outcome measurements and reported outcomes	Barriers	Recommendations
Das et al. (2020) [63]	A study on the effectiveness of educational intervention regarding first aid management of selected medical emergencies among adolescents at a school in Kolkata	India (LMIC)	School: children 14-19	Quasi experimental	201	School-based lecture and practical sessions	KAP scores: pre-intervention knowledge regarding poisoning management: 17.9%; post-intervention: 65.7% (P < 0.001)	School-based study- taking class time may be difficult to replicate	Repeated, hands-on on and interaction educational sessions
Wafik et al. (2014) [64]	Effectiveness of a first-aid intervention program applied by undergraduate nursing students to preparatory school children	Egypt (LMIC)	School: children 11-16	Quasi experimental	100	School-based lecture and practical sessions led by nursing students	KAP Scores: students with satisfactory knowledge of first aid regarding poisoning: 5% pretest, 98% post-test, and 99% at follow up test two months later (P < 0.001); students with adequate first aid skill pretest = 0%, post-test: 91%, follow up 59% (P < 0.001)	Decline in knowledge and practice scores over time	Repeated practice sessions should be held so as not to lose skills
Bek et al. (2008) [65]	Charcoal hemoperfusion in amitriptyline poisoning: experience in 20 children	Turkey (LMIC)	Tertiary care hospital: children 1-15 with amitriptyline poisoning	Case series	20	Charcoal hemoperfusion	Clinical progression: all patients returned to consciousness during or immediately following hemoperfusion; all patients had resolution of abnormal electrocardiogram findings; all able to discontinue mechanical ventilation	Early management crucial; 95% of patients received within 1-2 h of presentation	If cardiac or respiratory compromise seen in patient with amitriptyline overdose, consider early charcoal hemoperfusion
Eddleston et al. (2007) [66]	The hazards of gastric lavage for intentional self-poisoning in a resource poor location.	Sri Lanka (LMIC)	Multiple hospitals: children 15-18 who received gastric lavage after intentional ingestion	Case series	3	Gastric lavage	Procedure details and clinical progression: significant physical restraint; large volume of fluid administration for all patients with significant gagging and coughing; airway not preserved in any of the patients; all patients aspirated and were started on IV antibiotics after procedure	N/A	Sri Lankan national guidelines call for intubation prior to lavage if at risk for aspiration, minimal physical restraint, and low volume lavage. These were not followed in these cases, recommend additional education for providers.
Musumba et al. (2004) [67]	Salicylate poisoning in children: Report of three cases	Kenya (LIC)	District hospital: children 3-4 who presented with salicylate poisoning	Case series	2	Sodium bicarbonate	Clinical progression: case #1 died due to cardiopulmonary arrest (presented 48 h after ingestion); case #2 regained consciousness after infusion and was discharged after three days (presented 24 h after ingestion)	Often unable to measure salicylate levels which limited the ability to manage resuscitation	Increased access to timely laboratory access; accurate labeling of salicylate containing products in shops
Ozdemir et al. (2011) [68]	Fatal poisoning in children: acute colchicine intoxication and new treatment approaches	Turkey (LMIC)	Tertiary care hospital: children 0-16 with colchicine poisoning	Case series	23	Medication administration depending on dose ingested	Clinical Progression: children who ingested lower doses of colchicine all survived (received activated charcoal/gastric lavage); one low dose poisoning case required intensive management, associated with delayed presentation; lethal dose poisoning case began therapy within 45 min of ingestion and survived without lasting effects. Two other children with poisoning ≥1.0mg/kg both died	Early administration of interventions after ingestion is imperative, delay can lead to increased morbidity and mortality	Any patient suspected of having ingested colchicine should be started immediately on fluid/electrolyte resuscitation, and consider activated charcoal/gastric lavage
Singhi et al. (2003) [69]	Acute iron poisoning: clinical picture, intensive care needs and outcome	India (LIC)	Tertiary care hospital	Case Series	21	Medication administration	Clinical progression: all received gastric lavage; IV deferoxamine given to 16; often unable to obtain serum iron levels, decision to pursue chelation therapy supported by proxy of presenting symptoms, limited close management of resuscitation; majority of patients arrived <6 h of ingestion, one who presented on day four died	Team unable to procure deferoxamine for one patient; limitations in timely laboratory results regarding iron levels and management monitoring	All children ingested bright colored sugar-coated iron tablets given to their mothers by the Reproductive and Child Health program; increased education through this program should be initiated to prevent these poisonings

h – hours, kg – kilograms, LIC – low income country, LMIC – low-middle income country, mg – miligrams, min – minutes