Evaluation of clinical findings in predicting the development of serotonin syndrome: can the Hunter’s criteria be used in children?
Postgraduate Medicine, cilt.137, sa.8, ss.807-813, 2025 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 137 Sayı: 8
- Basım Tarihi: 2025
- Doi Numarası: 10.1080/00325481.2025.2592356
- Dergi Adı: Postgraduate Medicine
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, Educational research abstracts (ERA), EMBASE
- Sayfa Sayıları: ss.807-813
- Anahtar Kelimeler: Serotonin syndrome, intoxication, cyproheptadine, Hunter's criteria, pediatrics
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Objectives: Serotonin syndrome (SS) is a life-threatening emergency that develops as a result of increased serotonin amount or activity in the synaptic cleft. The present study aimed to determine the clinical findings in serotonergic drug intoxications in children that may alert clinicians about the development of SS. Methods: The patients aged between 1 to 18 years, who were admitted to the pediatric emergency department (PED) because of drug intoxications between September 2022 and August 2024, were analyzed retrospectively. Patients with a history of taking one or more serotonergic drugs were included in the study. Patients were divided into two groups: SS and without SS. The sensitivity, specificity, negative and positive predictive value (PPV) of the Hunter’s criteria and SS-related symptoms were evaluated. Results: A total of 162 patients were included in the study. SS developed in 25 (15.4%) of the patients. SS developed in 23 (21.1%) of 109 patients receiving SSRI group drugs, while SS developed in two (4.8%) of 42 patients receiving non-SSRI group drugs (p = 0.015). Nineteen (76%) of the patients diagnosed with serotonin syndrome were also diagnosed with SS according to Hunter’s criteria, and the sensitivity and specificity of Hunter’s criteria in the diagnosis of SS in pediatric patients were 76% and 100%, respectively. The specificity and PPV were 100% for spontaneous clonus, inducible clonus, ocular clonus, hyperreflexia, and hyperthermia in the diagnosis of serotonin syndrome. The symptoms with the highest sensitivity were mydriasis (76%) and tremor (64%). All patients with serotonin syndrome were treated with cyproheptadine, and clinical findings improved. Conclusion: SS developed in 15.4% of patients with serotonergic drug intoxication, and the sensitivity of Hunter’s criteria for the diagnosis of SS was 76%. The combined use of Hunter’s criteria and clinician decision in the diagnosis of childhood SS may be more useful.