Acute poisoning, including intentional self-harm, remains a leading cause of adolescent mortality and a critical global public health concern (1). According to World Health Organization data, poisoning ranked fifth among unintentional injury-related deaths in children and adolescents aged 0–17 years worldwide in 2008 (2). Beyond fatalities, acute poisoning in this age group frequently necessitates invasive medical interventions, disrupts education, and causes long-term health sequelae, imposing substantial socioeconomic and psychological burdens on families and society (2–4). Comprehensive epidemiological data are urgently needed to guide public health interventions, optimize clinical management, and inform evidence-based prevention strategies.

The epidemiology of adolescent poisoning shows considerable regional variation influenced by socioeconomic, cultural, and policy-related factors (5). However, detailed epidemiological studies on acute adolescent poisoning remain scarce in Beijing, one of the world’s most densely populated metropolises. As a major tertiary referral center for poisoning emergencies in North China, the Fifth Medical Center of Chinese People’s Liberation Army (PLA) General Hospital manages the vast majority of adolescent acute poisoning cases in Beijing, providing representative epidemiological data for this study cohort. We retrospectively analyzed the clinical data of adolescent acute poisoning cases admitted to our center between 2021 and 2023 to characterize the local epidemiological profile. The findings aim to enhance clinicians’ recognition and management of adolescent acute poisoning and to inform evidence-based policies for regional poisoning control systems.

This retrospective cohort study analyzed epidemiological patterns of acute poisoning among adolescents from a major tertiary poisoning referral center in Beijing, China. To our knowledge, it is the first large-scale study to provide a comprehensive characterization of acute adolescent poisoning in this metropolitan area.

The findings reveal age-related vulnerabilities. An Italian study reported a mean age of 15.8 ± 2.0 years in their adolescent acute poisoning cohort (6), while French data indicated a peak incidence in pediatric poisoning at age 13 for males and 14 for females (7). Our cohort exhibited similar peaks at age 15 for males and 14 for females, suggesting common psychosocial stressors during adolescence across cultures. In China, the 14–16-year age group coincides with secondary school entrance examinations. Academic pressure combined with ongoing neurocognitive development may increase the risk of intentional self-poisoning among adolescents with poor coping mechanisms. Females constituted 72.5% of cases, aligning with reports from both developed and developing countries over the past decade (1, 8–18). This confirms the association between female sex and heightened vulnerability to deliberate self-harm among adolescents (19, 20), highlighting the need for sex-specific mental health interventions targeting adolescent females. While the deep-seated cultural and psychosocial drivers (e.g., gendered social expectations, family dynamics) warrant dedicated investigation, such an analysis extends beyond the descriptive scope of this study and points to a crucial direction for future research.

Oral ingestion was the primary exposure route, with intentional self-harm accounting for the overwhelming majority (94.5%) of cases, which emerged as the predominant pattern of poisoning.in our cohort. Neuropsychiatric disorders were documented in 60.1% of patients, consistent with studies linking self-poisoning to psychiatric conditions (6, 13, 15, 17). Immaturity in prefrontal-limbic circuitry and adolescent psychosocial challenges may increase suicide risk (21–23). Neuropsychiatric disorders represent a key risk factor, with female sex, adolescence, and prior psychiatric care as predictors of self-harm (24). These findings, driven by this predominance of self-harm, underscore the need for mental health promotion and early intervention for at-risk adolescents.

Urban residents accounted for a higher proportion of cases (58.9%) compared to rural residents (22.6%), consistent with patterns in Iran and Zambia (17, 18). This disparity may reflect that in urban areas, while toxic agents (particularly pharmaceuticals) are more readily available, there is also faster access to medical care after exposure. Urban cases also showed greater female predominance than rural cases, possibly influenced by academic and familial pressures. These findings support implementing geographically tailored, gender-sensitive prevention strategies. For instance, urban-focused efforts should prioritize secure medication storage, mental health literacy in schools, and accessible adolescent counseling services. In rural areas, prevention must address the high lethality of pesticide exposures through safer storage practices, community education on early recognition of poisoning, and strategies to reduce pre-hospital delays in seeking care.

Seasonal patterns showed distinct variations: incidence peaked in autumn and was lowest in winter. The September–October surge, particularly among females, aligns with academic transitions (e.g., selective high school entrance), where scholastic pressure may elevate poisoning risk, consistent with U.S. data (12). This timing underscores the critical need for proactive mental health screening and support within schools at the start of the academic year. Exposures peaked at 18:00–24:00, followed by 12:00–18:00, matching global reports (11, 25). Circadian-mediated emotional dysregulation during these hours may increase deliberate self-poisoning risk. Enhanced supervision during high-risk periods could help mitigate this vulnerability. Practical measures may include structured evening activities, increased family engagement during these hours, and ensuring real-time accessibility of crisis support hotlines.

Pharmaceuticals were the predominant toxic agents, with antipsychotics and antidepressants as main subclasses. Pesticides ranked second, mainly herbicides such as paraquat and diquat. Pharmaceutical exposures were more frequent in females, whereas pesticides, industrial/household chemicals, ethanol, and other toxins were more common in males. Urban areas showed higher pharmaceutical prevalence (63.6%), while rural areas had more pesticide poisonings (53.8%). These patterns align with Chinese and global reports (5, 11, 13, 14, 16–18), necessitating context-specific interventions like mental health access, medication regulation, and pesticide safety education. The low incidence of acute ethanol intoxication in this clinical cohort contrasts with higher prevalence reported in community-based surveys or emergency settings in regions with different drinking cultures (1, 26), likely reflecting our study’s focus on severe, referral-based poisonings within a specific socio-regulatory context. This pattern is consistent with reports from other regions in China (5, 27). Narcotics-related poisonings were rare (0.2%), contrasting with Iran (30.8%) (17), Egypt (6%) (14), and U.S. fentanyl overdoses (8), likely due to China’s stringent narcotics control policies.

Regional disparities existed in adolescent poisoning management. The ICU admission rate (10.3%) exceeded Rome’s 7.9% (6), suggesting greater poisoning severity in our cohort. Despite guidelines discouraging routine gastric lavage or induced emesis (28), gastrointestinal decontamination occurred in over 50% of cases, consistent with other regions where 45.8% received guideline-concordant decontamination (29). The variation in extracorporeal elimination rates— 22.3% in our cohort versus 0.7% reported from Rome (6) — is likely attributable to the higher proportion of severe pesticide and industrial chemical poisoning in our region, as well as differences in institutional protocols (30), highlighting the need for multicenter trials to formulate standardized detoxification strategies.

Compared with pharmaceutical poisonings, pesticide exposure was associated with higher general ward and ICU admission rates. These cases also required more frequent gastrointestinal decontamination, antidote administration, extracorporeal elimination, and mechanical ventilation, along with longer treatment durations. A similar pattern was observed for industrial chemical exposures, indicating both most pesticides and industrial chemicals cause greater toxicity. In contrast, ethanol intoxication showed lower hospitalization and ICU admission rates and shorter treatment duration, consistent with its low acute toxicity. These characteristics, supported by subclass analyses, align with the inherent toxicological and toxicokinetic properties of the substances. Among pesticide subclasses, herbicide exposures (e.g., paraquat and diquat) were associated with higher hospitalization and ICU admission rates compared to insecticides and rodenticides, likely due to their higher intrinsic toxicity (31).

Overall outcomes were largely favorable, although 1.2% of patients experienced unfavorable outcomes. The mortality rate observed in this study exceeded reported global adolescent poisoning mortality rates (0–0.7%) (8, 9, 12, 14, 15, 17, 18). U.S. 2023 data indicated that analgesics, chemicals, antidepressants, and cardiovascular agents were the primary causes of poisoning-related mortality in adolescents, with no documented pesticide-related fatalities in this population (8). In contrast, diquat and paraquat poisonings were associated with high mortality in this region. The accessibility of these toxic agents has increased through online e-commerce platforms, elevating the risk of intentional and accidental exposure. These findings highlight the need for stricter regulatory measures — including controlled distribution and sales restrictions — as well as coordinated public health campaigns to reduce adolescent poisoning mortality.

Multivariable analysis identified independent predictors of hospitalization requirement: younger age, prehospital interventions, preexisting neuropsychiatric disorders, pesticide exposure, multi-category exposures, industrial chemical poisoning, and intentional self-harm. These align with Brazilian pediatric poisoning data linking hospitalization to high-lethality agents and intentional self-harm (32). Two universal determinants of severity were identified: exposure to highly toxic agents (such as herbicides) and deliberate self-poisoning, both predicting the need for intensive clinical interventions. Notably, prehospital interventions were associated with 1.75-fold higher hospitalization odds, likely because severe cases more frequently received prehospital care.

Several limitations of this study should be acknowledged. First, the retrospective design is susceptible to selection bias, and some patients were excluded owing to incomplete medical records. This inconsistency also prevented the systematic use of a standardized poisoning severity score (e.g., PSS). Second, the data were derived from a single tertiary referral center. This setting may inherently select for more severe cases, which should be considered when extrapolating findings to all community-level adolescent poisoning incidents. Nevertheless, as the largest poisoning treatment center in Beijing — receiving referrals from the city and surrounding regions — our cohort provides a valid epidemiological profile of poisoning cases severe enough to reach higher-level care in this area. Third, the investigation period (2021–2023) coincided with the COVID-19 pandemic, during which public health control measures may have influenced healthcare-seeking behavior.

Acute poisoning among adolescents in Beijing and surrounding regions demonstrates a significant female predominance, with a peak incidence observed between ages 14 and 15. Most cases were associated with preexisting neuropsychiatric disorders, and psychotropic medications represented the most common toxic agents. Pesticide exposures exhibited the highest case-fatality rate. Key prevention strategies should include strengthening psychological support, enforcing stricter regulation of psychotropic medications, and restricting access to highly toxic pesticides to reduce incidence. Additionally, integrated toxicological and clinical research is essential to develop effective antidotes and treatment protocols for lowering mortality.