Related Experiment Videos
Prediction of complications following unintentional caustic ingestion in children. Is endoscopy always necessary?
1Department of Pediatrics, Aarhus University Hospital, Denmark.
Insights
Strong alkali ingestion in children, particularly lye, significantly increases complication risks compared to automatic dishwasher detergent (ADD). Endoscopy effectively predicts complications in symptomatic cases, but is unnecessary for asymptomatic children.
Area of Science:
- Pediatric Gastroenterology
- Toxicology
- Emergency Medicine
Background:
- Caustic ingestion is a significant cause of pediatric hospitalization.
- Understanding the relationship between ingested substances and esophageal injury is crucial for patient management.
Purpose of the Study:
- To analyze the relationship between ingested products, symptoms, esophageal injury, and complications in children.
- To evaluate the predictive value of endoscopy in identifying complications following caustic ingestion.
Main Methods:
- Retrospective review of 115 children hospitalized for caustic ingestion (1976-1994).
- Analysis of ingested product type, clinical signs/symptoms, and endoscopic findings.
- Correlation of ingestion type with complication rates and predictive accuracy of endoscopy.
Main Results:
- All recorded complications resulted from strong alkali ingestion.
- Lye ingestion led to complications in 36.8% of cases, while automatic dishwasher detergent (ADD) ingestion caused complications in only 2.7% (p < 0.01).
- Endoscopy accurately predicted or identified complications in all strong alkali ingestions and was comparable to clinical symptoms for lye ingestions.
Conclusions:
- Strong alkali ingestion, especially lye, poses a higher risk of complications in children.
- Endoscopy is valuable for prognosis and identifying acute respiratory issues in symptomatic ingestions.
- Asymptomatic children with unintentional ingestions are unlikely to develop complications and do not require endoscopy.
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.