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Caustic Ingestion in Children: The Otolaryngologist Perspective
Tanya Shcherbaeva1, Limor Muallem Kalmovich1, Tzippora Shalem2
1From the Department of Otolaryngology-Head and Neck Surgery.
Pediatric Emergency Care
|May 17, 2022
Summary
In pediatric caustic ingestion, upper airway symptoms like stridor and dyspnea are stronger predictors of complications than gastrointestinal symptoms. Early otolaryngological evaluation is crucial for assessing risk in children.
Area of Science:
- Pediatric Gastroenterology
- Otolaryngology
- Emergency Medicine
Background:
- Caustic ingestion in children causes significant morbidity.
- Initial assessment often involves otolaryngologists and gastroenterologists.
- Predicting adverse outcomes requires understanding key clinical indicators.
Purpose of the Study:
- To identify otolaryngological and gastrointestinal signs/symptoms that predict abnormal imaging, esophagogastroduodenoscopy (EGD) findings, and complications.
- To compare the predictive value of laryngopharyngeal versus gastrointestinal symptoms for complications.
Main Methods:
- Retrospective chart review of pediatric patients (≤18 years) admitted for caustic ingestion (January 2007 - November 2019).
- Analysis of clinical signs, symptoms, and outcomes including imaging, EGD, and complication development.
- Statistical analysis to determine associations between symptoms and outcomes.
Main Results:
- Forty-one children were included; 46.3% underwent EGD with 68.4% showing no pathology.
- Liquid, accidental, alkaline ingestions were most common.
- Stridor, dyspnea, drooling, oral findings, dysphagia, and vomiting correlated with abnormal findings or complications (P < 0.05).
- Laryngopharyngeal symptoms predicted higher complication risk (P=0.011) compared to gastrointestinal symptoms (P=0.31).
Conclusions:
- Laryngopharyngeal signs and symptoms are more predictive of complications following caustic ingestion in children than gastrointestinal signs.
- Emphasizes the critical importance of otolaryngological examination upon emergency department arrival for risk stratification.
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