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National trends in endotracheal intubation among pediatric patients less than six years old with single-substance intoxication: a fifteen-year retrospective study
Journal article   Peer reviewed

National trends in endotracheal intubation among pediatric patients less than six years old with single-substance intoxication: a fifteen-year retrospective study

Chia Ming Chang, Rita Farah, Conner T McDonald, Scott Schmalzried and Nathan P Charlton
Clinical toxicology (Philadelphia, Pa.)
06/15/2026
DOI: 10.1080/15563650.2026.2675037
PMID: 42290621

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Abstract

Endotracheal intubation is a rare but critical intervention in the management of pediatric toxicologic exposures. This study aims to characterize single-substance exposures resulting in endotracheal intubation among children less than six years old reported to America's Poison Centers , identify frequently implicated substances, and assess trends over 15 years. This retrospective analysis used National Poison Data System data from January 1, 2009, to December 31, 2023. Pediatric patients less than six years old with single-substance exposures resulting in endotracheal intubation were identified. Data extracted included patient demographics, exposure characteristics, clinical effects, level of care, and outcomes. Substances were classified using standardized generic codes, and clinical effects were categorized by physiological system. Trends in intubation rates and substance-specific patterns were analyzed over time. Among 15,099,965 pediatric exposures reported during the study period, 6,768 intubation cases met inclusion criteria. The intubation rate increased from 31.5 per 100,000 exposures in 2009 to 50.7 in 2023. Most patients were one-year-olds (33.8%) and experienced acute (88.9%) and unintentional (87.7%) exposures. Male patients comprised 55.6%. Major effects were documented in 50.9% and 4.0% mortality rates. Common symptoms included central nervous system depression (67.4%), respiratory depression (33.4%), seizures (16.3%), and cardiovascular effects such as tachycardia (23.7%), bradycardia (19.2%), and hypotension (14.4%). Clonidine was the most frequently implicated substance throughout the study. Marijuana edibles emerged in 2017 and showed a marked increase through 2023. Of exposures, 88.9% were acute, and 87.7% were unintentional. Clinical manifestations necessitating intubation predominantly involve neurological and respiratory compromise. Clonidine remains the most frequently implicated agent associated with the need for intubation. Clonidine accounts for a significant proportion of pediatric substance exposures requiring advanced airway management. The escalating incidence of marijuana edible exposure among young children highlights an evolving toxicological threat.
 Clonidine National Poison Data System endotracheal intubation pediatric toxicology substance exposure

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