Prediction of complications following unintentional caustic ingestion in children. Is endoscopy always necessary?

Abstract

The records of 115 children hospitalized following caustic ingestion over an 18.5-year period from 1976 to 1994 were reviewed. The relationship between types of product ingested, signs and symptoms, degree of esophageal injury and complications was analyzed. All complications were the result of strong alkali ingestion (sensitivity = 1.0). Among the 102 incident patients, 36.8% of lye ingestions resulted in complications, whereas only 2.7% (one) of automatic dishwasher detergent (ADD) ingestions caused any complications (p < 0.01). Endoscopy 6 h to 4 days after injury was accurate in predicting or identifying complications in all types of strong alkali ingestions. In lye ingestions, endoscopy was not superior to the test, "one or more signs or symptoms" in predicting complications (predictivity = 1.0). Endoscopy is recommended to establish or confirm a prognosis, or to identify acute respiratory complications, in symptomatic ingestions of lye or ammonia water, in children with respiratory symptoms, and in rare cases of severe symptoms following ADD or strong acid ingestion. It is suggested that children who are non-symptomatic following unintentional ingestions are not at risk of complications and do not need endoscopic examination.

Initial Signs and Symptoms as Prognostic Indicators of Severe Gastrointestinal Tract Injury Due to Corrosive Ingestion

“…All of our patients ingested liquid substances, which would put them at higher risk of esophageal injury. In children, respiratory distress symptom is a predictor of severe digestive lesion (9,10). All but one of our subjects was adult, and we did not find this symptom.…”

“…On the other hand, the routine use of endoscopic examination after corrosive ingestions is a matter of some debate (9 -12). Christesen reported that no patient with grade 0, 1, or 2a esophageal injury developed treatment-demanding complication (9). However, whether initial signs and symptoms were useful in assessing the degree of upper gastrointestinal tract injury was still contentious (5,9,10).…”

“…If the absence of complications can be predicted, unnecessary hospitalization and treatment may be avoided (9).…”

Traumatic supraglottitis

“…Chemical supraglottitis may result from ingestion or aspiration of caustic or corrosive substances [8,[11][12][13][14]. Supraglottic edema may occur as a component of allergic reactions; angioneurotic edema; adverse drug reactions, such as from angiotensin-converting enzyme inhibitors; or as a consequence of diseases such as toxic epidermal necrolysis [15].…”

Emergency Medicine Questions (EMQs): Theme: Chemical injury

“…Endoscopy is recommended if excessive drooling or dysphagia is present or if there is evidence of significant visible mucosal burns in the mouth or throat on examination. If there is doubt regarding the composition of the ingested substance or it is known to be a high-risk ingestion (as determined by pH, pK a and volume ingested), endoscopy is indicated regardless of presence/absence of these clinical indicators 9 10…”