Do young children with known cannabis intoxication benefit from further neurological-based testing or imaging?

Background: Recent work has demonstrated that children with unintentional cannabis ingestions often undergo extensive ancillary testing such as head imaging or lumbar puncture. To better understand the yield of these tests, our objective was to describe the frequency of additional significant diagnoses in children with cannabis ingestion.Methods: We performed a retrospective cross-sectional study of the Pediatric Health Information System (PHIS) database, including ED encounters from January 2016 to April 2023 with a diagnosis indicating cannabis expo-sure in children <6 years of age. We assessed the frequency of co-diagnoses that would be found on head imag-ing, lumbar puncture, or toxicology testing.Results: We included 4132 ED encounters for cannabis ingestion from 47 hospitals. Of these, 1243 (30%) received head imaging and 130 (3.1%) underwent lumbar puncture. There were 23 children (0.6%) with diagnosis of skull fracture or intracranial hemorrhage, 4 (<0.1%) with intracranial neoplasm, and 0 (0%) with a diagnosis for men-ingitis or intracranial abscess. Presence of discharge diagnosis for other drugs was also uncommon. The most fre-quent drug ingestion co-diagnoses were cocaine in 43 (1.0%) and opioids in 22 (0.5%) encounters.Conclusion: In children with cannabis intoxication, high rates of head imaging and lumbar puncture are likely driven by the signs of altered mental status at presentation. These data suggest that if cannabis ingestion is con-sidered early and identified quickly with testing, neuroimaging, particularly that with ionizing radiation, may be low yield.(c) 2023 Elsevier Inc. All rights reserved.

Automated summary

Recent research indicates that children who unintentionally ingest cannabis often undergo extensive additional testing, such as head imaging or lumbar puncture. However, the yield of these tests is limited. While head imaging and lumbar puncture are frequently performed, diagnoses such as skull fracture, intracranial hemorrhage, intracranial neoplasm, meningitis, or intracranial abscess are rare. Additionally, discharge diagnoses related to other drugs are infrequent. The most common co-diagnoses are cocaine and opioids. Therefore, prompt consideration of cannabis ingestion and quick identification through testing may result in more effective neuroimaging outcomes.