Clinical features and predictors of severity in adolescents with acute oral poisoning aged 10–16 years: a single-center retrospective study

Objective To characterize the clinical features and toxicant spectrum of acute oral poisoning in adolescents aged 10–16 years and to identify factors associated with severe poisoning in the emergency setting. Methods This retrospective study included adolescents aged 10–16 years with acute oral poisoning who were treated at our hospital between January 2020 and December 2025. Severity was assessed using the maximum Poisoning Severity Score (PSS) during the clinical course; severe poisoning was defined as maximum PSS 3–4 and non-severe poisoning as maximum PSS 0–2. Demographic data, poisoning intent, toxicant categories, and severity distribution were analyzed. Firth’s penalized logistic regression analysis was performed to identify independent factors associated with severe poisoning. Model discrimination was evaluated using the area under the receiver operating characteristic curve (AUC). Results Of 522 adolescents (median age 13 years; 71.1% female), intentional self-poisoning accounted for 69.3% and pharmaceutical agents (70.7%) and pesticides (14.4%) were the most common toxicants. Severe poisoning (maximum PSS 3–4) occurred in 57 patients (10.9%), including 8 deaths; all deaths were pesticide-related, and pesticide poisoning carried the highest severity burden (28.0% severe or fatal vs. 8.1% for all other toxicants; OR 4.44, 95% CI 2.42–8.16, P < 0.001). Five factors independently predicted severe poisoning - severe neurological manifestations (aOR 62.10, 95% CI 13.96-605.63), pesticide poisoning (aOR 49.34, 95% CI 11.82-456.88), intentional self-poisoning, no definite exposure history and respiratory symptoms. The model showed excellent apparent discrimination in the derivation cohort (AUC 0.944, 95% CI 0.922–0.966; optimism-corrected AUC 0.933 on bootstrap internal validation)), with consistent findings in the sensitivity analyses. Conclusion Acute oral poisoning in adolescents aged 10–16 years has distinct clinical and exposure characteristics, with intentional self-poisoning involving pharmaceutical agents or pesticide poisoning being particularly prominent. Early risk stratification in the emergency setting may help identify high-risk patients and support timely management; however, the model was developed and internally validated in a single center only, and its calibration and performance in other populations remain unknown. External multicenter validation is required before the model can be used clinically. In addition, poisoning prevention strategies should be strengthened for this age group. Clinical trial number Not applicable.