Among 138 pediatric cannabis intoxication cases, 38% required ICU admission, with younger age and polysubstance exposure being the strongest predictors of severe outcomes.
Emergency medicine physicians, pediatric toxicologists, cannabis product regulators
38% ICU admission rate; polysubstance use increased severe outcome odds 16-fold
What the researchers found
Of 138 pediatric patients presenting with cannabis intoxication, 52 (38%) were admitted to ICU including one death. Polysubstance ingestion (aOR 16.3) and younger age (P=0.001) were strong independent predictors of severe outcome. All children 10 and younger ingested edibles. Among teens over 10, only polysubstance use predicted severe outcomes (aOR 37.1).
Why it matters
As cannabis legalization expands and edible products proliferate, understanding which pediatric exposures lead to severe outcomes can inform product safety regulations and anticipatory guidance for parents.
The numbers in context
138 patients; 54% male; median age 14.0 years; 38% ICU admission; 1 death; polysubstance aOR 16.3 (95% CI 4.6-58.3); all children <=10 exposed to edibles; teen polysubstance aOR 37.1 (95% CI 6.2-221.2)
How the study worked
Prospective cohort study from the Toxicology Investigators Consortium, collecting data on all pediatric patients (<18 years) presenting with cannabis intoxication from August 2017 to June 2020 across participating US emergency departments. Multivariable logistic regression identified predictors.
What this study cannot tell us
Participating toxicology sites may see more severe cases, overestimating overall severity. Cannot determine population-level incidence rates. Small sample limits subgroup analysis precision. Wide confidence intervals for some estimates.
How to read the evidence
Multi-center prospective study with standardized data collection, but relatively small sample produces wide confidence intervals for some estimates.
When this study was published
Published 2023 using 2017-2020 data
The bigger picture
Severe pediatric cannabis outcomes fall into two distinct patterns: young children accidentally ingesting edibles, and teenagers combining cannabis with other substances. Prevention strategies need to address both scenarios differently.
Questions still open
- Would child-resistant packaging reduce accidental edible ingestions in young children? What specific substances combined with cannabis produce the worst teen outcomes?
Common questions
How serious are pediatric cannabis intoxications?
What makes pediatric cannabis cases more dangerous?
Read the original research
Severe outcomes following pediatric cannabis intoxication: a prospective cohort study of an international toxicology surveillance registry.
Clinical toxicology (Philadelphia, Pa.), 61(8), 591-598
Citation
Cohen, Neta; Mathew, Mathew; Brent, Jeffrey; Wax, Paul; Davis, Adrienne L; Obilom, Cherie; Burns, Michele M; Canning, Joshua; Baumgartner, Kevin; Koons, Andrew L; Wiegand, Timothy J; Judge, Bryan; Hoyte, Christopher; Chenoweth, James A; Froberg, Blake; Farrar, Henry; Carey, Jennifer L; Hendrickson, Robert G; Hodgman, Michael; Caravati, E Martin; Christian, Michael R; Wolk, Brian J; Seifert, Steven A; Bentur, Yedidia; Levine, Michael; Farrugia, Lynn A; Vearrier, David; Minns, Alicia B; Kennedy, Joseph M; Kirschner, Ron I; Aldy, Kim; Schuh, Suzanne; Campleman, Sharan; Li, Shao; Myran, Daniel T; Feng, Lisa; Freedman, Stephen B; Finkelstein, Yaron. (2023). Severe outcomes following pediatric cannabis intoxication: a prospective cohort study of an international toxicology surveillance registry.. Clinical toxicology (Philadelphia, Pa.), 61(8), 591-598. https://doi.org/10.1080/15563650.2023.2238121
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