1
|
Sharif AF, Gameel DEGE, Abdo SAEF, Elgebally EI, Fayed MM. Evaluation of Pediatric Early Warning System and Drooling Reluctance Oropharynx Others Leukocytosis scores as prognostic tools for pediatric caustic ingestion: a two-center, cross-sectional study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:5378-5395. [PMID: 34420162 PMCID: PMC8380116 DOI: 10.1007/s11356-021-15988-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/11/2021] [Indexed: 06/13/2023]
Abstract
Caustic chemicals are widely distributed in our environment. Exposure to caustic agents is a lifelong problem associated with severe tissue and mucous membrane injuries. In pediatrics, corrosive exposure is the most common cause of nonpharmaceutical exposure presenting to poison control centers. Therefore, this study evaluated the role of the Pediatric Early Warning System (PEWS) and Drooling Reluctance Oropharynx Others Leukocytosis (DROOL) scores as early in-hospital outcome predictors following corrosive ingestion. The current study was a two-center, retrospective, cross-sectional study carried out among pediatric patients diagnosed with acute caustic ingestion during the past 4 years. Most exposure occurred accidentally among boys (59.4%) living in rural areas (51.9%) of preschool age (50% were 2-4 years old). Residence, body temperature, respiratory rate, vomiting, skin and mucosal burns, retrosternal pain, respiratory distress, Oxygen (O2) saturation, Glasgow Coma Scale score, HCO3 level, total bilirubin level, anemia, leukocytosis, and presence of free peritoneal fluid were significant predictors of esophageal injuries (p < 0.05). DROOL and PEWS scoring were the most significant predictors of esophageal injuries with worthy predictive power, where odds ratio (95% confidence interval (CI)) was 1.76 (0.97-3.17) and 0.47 (0.21-0.99) for PEWS and DROOL, respectively. At a cutoff of < 6.5, the DROOL score could predict esophageal injuries excellently, with AUC = 0.931; sensitivity, 91.7%; specificity, 72.5%; and overall accuracy, 91.3%. At a cutoff of > 6.5, PEWS could significantly predict unfavorable outcomes, with AUC = 0.893; sensitivity, 94.4%; specificity, 71.9%; and overall accuracy, 89.3%. However, PEWS better predicted the need for admittance to the intensive care unit (ICU). Pediatric Early Warning System (PEWS) and Drooling Reluctance Oropharynx Others Leukocytosis (DROOL) are potentially useful accurate scorings that could predict the esophageal injuries and ICU admission following corrosive ingestion in pediatrics.
Collapse
Affiliation(s)
- Asmaa Fady Sharif
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Dina El Gameel El Gameel
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
- Poison Control Center, Aseer, Saudi Arabia
| | - Sanaa Abd El-Fatah Abdo
- Public Health and Community Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Elsayed Ibrahim Elgebally
- Department of Pediatric, Menoufia University, Shebeen Al-kom, Egypt
- Pediatric Department, Saudi German Hospital, Aseer, Saudi Arabia
| | - Manar Maher Fayed
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
| |
Collapse
|
2
|
Yen CW, Lee EP, Cheng SC, Hsia SH, Huang JL, Lee J. Household cleaning products poisoning in a pediatric emergency center: A 10- year cross-sectional study and literature review. Pediatr Neonatol 2021; 62:638-646. [PMID: 34332912 DOI: 10.1016/j.pedneo.2021.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/10/2021] [Accepted: 05/20/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Poisoning by household cleaning products(HCPs) is common in children. Some HCPs are toxic and may cause severe complications. We assessed HCP poisonings treated in a pediatric emergency department(PED). METHODS This was a retrospective study of patients aged under 18 years with HCP poisoning admitted to the largest PED in Taiwan from 2011 to 2020 were recruited. RESULTS The records over a 10-year period from 103 children admitted to the PED because of HCP poisoning(70 boys [68%] and 33 girls [32%]), mean age 3.54 years(standard deviation [SD] = 3.15 years) were evaluated. Most poisonings were unintentional(99%, n = 102) and occurred at home(96%, n = 99). The HCPs included alkaline(74%, n = 76), acidic(25%, n = 26), and neutral(1%, n = 1) agents. Most were orally ingested(86%, n = 89). Panendoscopy was performed in 25 patients(24%), and the endoscopic(Zargar) grade was used to determine the severity of injury. Medications(steroids [9%, n = 9], antibiotics [10%, n = 10], or antacids [30%, n = 23]) were prescribed. Alkaline HCP ingestion induced severe esophageal injury(p = 0.04) and esophageal stricture(p = 0.04). Five patients(5%) exhibited esophageal strictures and required balloon dilation. On multivariate analysis, alkaline HCP ingestion(p = 0.04), severe esophageal caustic injury(Zargar grade ≥ 3) (p < 0.001), and medications(steroids [p < 0.001], antibiotics [p < 0.001], and antacids [p = 0.001]) were associated with esophageal stricture. CONCLUSION Alkaline HCP ingestion and severe esophageal caustic injury(Zargar grade ≥ 3) were associated with esophageal stricture. Physicians tended to prescribe medications(steroids, antibiotics, or antacids) for patients with severe esophageal injuries to reduce the risk of esophageal stricture. The usefulness of these medications requires further study.
Collapse
Affiliation(s)
- Chen-Wei Yen
- Division of Nephrology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - En-Pei Lee
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Chuan Cheng
- Department of Family Medicine, China Medical University Hospital, Taipei, Taiwan
| | - Shao-Hsuan Hsia
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Jing-Long Huang
- Division of Pediatric Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Jung Lee
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
| |
Collapse
|
3
|
Chen CC, Chen AC, Wu SF. Alkaline substances gastroesophageal injury in young children: emphasis on Asian food preparation habits. J Formos Med Assoc 2021; 120:1907-1913. [PMID: 33422399 DOI: 10.1016/j.jfma.2020.12.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 12/15/2020] [Accepted: 12/24/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Ingestion of alkaline substances should not be disregarded because a small amount can cause chemical burns in the esophagus, with esophageal stricture being the most common late complication. METHODS We enrolled children with alkaline corrosive damage receiving treatment at China Medical University Children's Hospital's emergency department between 2008 and 2018. Patients were divided into groups A (ingested causative agents other than alkaline oil), and B (ingested alkaline oil). RESULTS Altogether, 40 (27 [67.5%] male and 13 [32.5%] female) patients aged 7 months-7 years were enrolled. The most commonly ingested agent was alkaline oil (13 cases, 32.5%), followed by oven and drainage cleaners (8 cases, 20%), bleach (6 cases, 15%), laundry and dish cleaners (4 cases, 10%), sodium hydroxide (4 cases, 10%), sodium carbonate (2 cases, 5%), sodium phosphate (2 cases, 5%), and sodium citrate (1 case, 2.5%). High proportions of children had esophagitis (40/40, 100%), erosive gastritis (7/40, 17.5%), and gastric ulcer (6/40, 15%). The incidence of esophageal stricture was 38.4% (5/13) and 7.4% (2/27) in groups B and A, respectively. In group B, 4 children developed growth stunting or malnutrition during the first decade after onset, with reduced immunity and feelings of inferiority. CONCLUSION Alkaline ingestion usually results in esophageal injury that is difficult to cure. Corrosive esophageal strictures cause swallowing difficulties and growth stunting in children. Young children who ingested alkaline oil have more complications. Given that alkaline corrosive injuries are often accidental, prevention of corrosive agent ingestion is crucial.
Collapse
Affiliation(s)
- Chin-Chiang Chen
- Department of Pediatrics Gastroenterology, Children's Hospital of China Medical University, Taichung, Taiwan; Department of Pediatrics, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - An-Chyi Chen
- Department of Pediatrics Gastroenterology, Children's Hospital of China Medical University, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Shu-Fen Wu
- Department of Pediatrics Gastroenterology, Children's Hospital of China Medical University, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan.
| |
Collapse
|
4
|
Speidel AJ, Wölfle L, Mayer B, Posovszky C. Increase in foreign body and harmful substance ingestion and associated complications in children: a retrospective study of 1199 cases from 2005 to 2017. BMC Pediatr 2020; 20:560. [PMID: 33339520 PMCID: PMC7747382 DOI: 10.1186/s12887-020-02444-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 11/24/2020] [Indexed: 01/08/2023] Open
Abstract
Background Children with a history of caustic or foreign body ingestion (FBI) seem to be presenting more frequently to emergency departments. This study aims to elucidate the clinical presentation, diagnostic procedures, and complications associated with the ingestion of different object categories over a 13-year time period. Methods A structured retrospective data analysis of patients who presented between January 2005 and December 2017 to the University Medical Centre Ulm was performed. Patients up to 17 years of age with food impaction or foreign body or harmful substance ingestion were included by selection of the corresponding International Statistical Classification of Diseases and Related Health Problems (ICD10-GM) codes. Descriptive statistics, parametric or non-parametric tests, and linear regression analysis were performed. Result In total, 1199 patients were analysed; the mean age was 3.3 years (SD 3.12; range 7 days to 16 years), the male to female ratio was 1.15:1, and 194 (16.2%) were hospitalized. The number of patients seen annually increased from 66 in 2005 to 119 in 2017, with a rise in percentage of all emergency patients from 0.82% in 2010 to 1.34% in 2017. The majority of patients (n = 619) had no symptoms, and 244 out of 580 symptomatic patients complained of retching or vomiting. Most frequently, ingested objects were coins (18.8%). Radiopaque objects accounted for 47.6%, and sharp objects accounted for 10.5% of the ingested foreign bodies, both of which were significantly more often ingested by girls (p < 0.001 for both). Button battery ingestion was recorded for 63 patients with a significant annual increase (R2 = 0.57; β = 0.753; p = 0.003). The annual rate of complications also increased significantly (R2 = 0.42; β = 0.647; p = 0.017). Conclusion We found an alarming increase in the number of children who presented to our emergency department with FBI and associated complications. A standardized diagnostic and therapeutic approach may reduce and prevent serious complications. Further preventive measures within the home environment are needed to stop this trend.
Collapse
Affiliation(s)
- Arne Jorma Speidel
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Eythstr. 24, 89075, Ulm, Germany
| | - Lena Wölfle
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Eythstr. 24, 89075, Ulm, Germany
| | - Benjamin Mayer
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Carsten Posovszky
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Eythstr. 24, 89075, Ulm, Germany.
| |
Collapse
|
5
|
Dorterler ME, Günendi T. Foreign Body and Caustic Substance Ingestion in Childhood. Open Access Emerg Med 2020; 12:341-352. [PMID: 33177894 PMCID: PMC7649222 DOI: 10.2147/oaem.s241190] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 07/14/2020] [Indexed: 01/08/2023] Open
Abstract
Foreign body and caustic substance ingestion in childhood are common and require accurate and timely diagnosis to provide appropriate management consistent with the ingested substance/foreign body and clinical presentation as well as the associated risk status to prevent significant complications and morbidity. The aim of this paper was to present foreign body and caustic ingestion in childhood in terms of epidemiology, pathophysiology, diagnostic work-up and appropriate management and potential complications in accordance with clinical presentation and the type of ingested substance/foreign body.
Collapse
Affiliation(s)
| | - Tansel Günendi
- Harran University Faculty of Medicine, Department of Pediatric Surgery, Sanliurfa, Turkey
| |
Collapse
|
6
|
Abstract
Corrosive (caustic) material ingestion remains a major health issue, particularly in developing countries. The management strategy after corrosive ingestion should be planned according to the signs and symptoms. The management of corrosive ingestion based on endoscopic grading, nothing by mouth, and barium studies should be abandoned. With the new management protocol, esophageal stricture can be predicted with high accuracy using the simple new prognostic DROOL score (≤ 4) rather than endoscopic grading, reduced by immediate oral feeding as soon as the patient can swallow saliva instead of nothing by mouth, diagnosed earlier (10-14 days) by fluoro-endoscopic balloon-assisted esophageal examination for patients with persistent dysphagia instead of relying on a barium study (≥ 21 days), and adequately treated by initiating balloon dilation earlier during the same anesthesia procedure. Fluoroscopically guided balloon dilatation with large balloons (18-20 mm) seems to be safe, with a low frequency of complications and a high success rate. If dilatation fails after a few months, esophagectomy and replacement surgery using the stomach should be considered. The increased risk of developing esophageal carcinoma after ingestion of corrosive substances should be kept in mind.
Collapse
Affiliation(s)
- Ibrahim Uygun
- Department of Pediatric Surgery, Faculty of Medicine, Kutahya Health Sciences University, Evliya Celebi Training and Research Hospital, Merkez, 43040, Kutahya, Turkey.
| | - Salih Bayram
- Clinic of Pediatric Surgery, Artvin Government Hospital, Artvin, Turkey
| |
Collapse
|
7
|
Mehrpisheh S, Taftachi F, Abdolkarimi L, Memarian A. Injuries due to caustics ingestion in children: A psychological approach to the suspicion of childish jealousies. Med Leg J 2018; 87:21-23. [PMID: 30379111 DOI: 10.1177/0025817218796918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Most injuries from caustics ingestion occur due to parental negligence, but other causes such as psychological tendency or childish jealousy or behaviour may be the major cause for harming. Here, we describe a case of injury in a neonate who ingested a caustic substance, probably induced by his brother, but not as a consequence of the negligence of his parents. The mother said she had fed the child toilet bleach instead of water and was very concerned about the child's condition. However, when the baby's older brother was interviewed he did not show concern and was very confused and provided contradictory responses about his knowledge of the poisoning. Later, it was revealed that the baby's brother had prepared the milk and knew what was in it. In our case, damage by caustics ingestion may have been intentional due to psychological problems in parents causing child abuse or in other children due to childish jealousy.
Collapse
Affiliation(s)
- Shahrokh Mehrpisheh
- 1 Neonatology Department Ghazvin University of Medical Science, Ghazvin, Iran
| | - Farrokh Taftachi
- 2 Forensic Medicine Department, Rasoul Akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Leila Abdolkarimi
- 2 Forensic Medicine Department, Rasoul Akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Azadeh Memarian
- 2 Forensic Medicine Department, Rasoul Akram Hospital, Iran University of Medical Science, Tehran, Iran
| |
Collapse
|
8
|
Elkaramany M. An overview of corrosive injury of the upper gastrointestinal tract: Discussion of types, clinical evaluation, and management procedures. ADVANCES IN DIGESTIVE MEDICINE 2018. [DOI: 10.1002/aid2.13091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
9
|
Long-Term Outcomes of Caustic Esophageal Stricture with Endoscopic Balloon Dilatation in Chinese Children. Gastroenterol Res Pract 2018; 2018:8352756. [PMID: 30158970 PMCID: PMC6109481 DOI: 10.1155/2018/8352756] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 05/31/2018] [Accepted: 07/04/2018] [Indexed: 12/12/2022] Open
Abstract
Caustic esophageal stricture (CES) in children still occurs frequently in developing countries. We aimed to evaluate the long-term outcomes of endoscopic balloon dilatation (EBD) in treating CES in children and the influencing factors associated with outcome. We retrospectively reviewed the data of all patients who had a diagnosis of CES and underwent EBD from August 1, 2005, to December 31, 2014. The primary outcome was EBD success, which was defined as the maintenance of dysphagia-free status for at least 12 months after the last EBD. The secondary outcome was to analyze influencing factors associated with EBD success. Forty-three patients were included for analysis (29 males; mean age at first dilatation 44 months with range 121 months). 26 (60.5%) patients had long segment (>2 cm) stricture. A total of 168 EBD procedures were performed. Twenty-six (60.5%) patients were considered EBD success. Seventeen (39.5%) patients failed EBD and required stent placement and/or surgery. Patients in the EBD success group had significantly shorter stricture segments when compared to the EBD failure group (t = 2.398, P = 0.018, OR = 3.206, 95% OR: 1.228-8.371). Seven (4.4%) esophageal perforations occurred in 6 patients after EBD. Stents were placed in 5 patients, and gastric tube esophagoplasty was performed in 14 patients. In conclusion, 26 (60.5%) of 43 children with CES had EBD success. Length of stricture was the main influencing factor associated with EBD treatment outcome.
Collapse
|
10
|
Rumbach AF, Cremer R. Dysphagia and Speech-Language Pathology Involvement Following Chemical Ingestion Injury: A Review of 44 Cases Admitted to a Quaternary Australian Hospital (2008-2012). AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 26:1120-1128. [PMID: 28800373 DOI: 10.1044/2017_ajslp-16-0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 04/13/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE This study aimed to explore the clinical characteristics of an adult chemical ingestion population and examine the course of return to oral intake post injury and speech-language pathologist (SLP) involvement during the initial acute-care admission. METHOD A retrospective chart review of adults admitted to a quaternary hospital for the treatment of an acute chemical ingestion injury between 2008 and 2012 was conducted. RESULTS Forty-four adults (23 men, 21 women) were identified as receiving treatment for ingestion injury, of whom 18 (40.91%) required altered oral intake. Of those requiring altered oral intake, 50% were referred to SLPs. Individuals requiring altered oral intake were significantly (p < .05) older, more likely to be men, and present with more severe injuries requiring longer ICU and hospital admissions following intentional chemical ingestions than those who were able to commence a normal oral diet without any alteration or nonoral supplementation. By discharge, 15.91% (n = 7) of the total cohort had not resumed normal oral intake. CONCLUSIONS Return to oral intake post chemical ingestion injury can be protracted and complex. Referrals to SLPs were limited. These data may aid prognostic insight as well as provide (a) collateral information to assist discharge planning and follow-up and (b) background for evaluating the potential for SLP involvement.
Collapse
Affiliation(s)
- Anna F Rumbach
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Rebecca Cremer
- Speech Pathology Department, Royal Brisbane and Women's Hospital, Metro North Hospital Health Service, Queensland Health, Brisbane. Australia
| |
Collapse
|
11
|
Oral Chemical Burns Reported to the Poisons Information Centre in Erfurt, Germany, from 1997 to 2014. J Burn Care Res 2017; 38:e913-e922. [PMID: 28319530 DOI: 10.1097/bcr.0000000000000518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Devastating oral burns often followed by lifelong complications can result from ingestion of caustic substances. However, although being one of the most challenging situations in clinical practice, literature data on the epidemiology of oral burns are still scarce. Retrospective analysis of all cases of oral burns after ingestion of corrosive substances reported to the Poisons Information Centre in Erfurt, Germany, from 1997 to 2014 was performed. In total, 482 calls because of oral burns were registered, with no change in the numbers of cases during the years. In the majority of the instances (47%), toddlers were affected, followed by middle-aged adults (33%). In both age groups, the male sex prevailed. Ingestion of corrosive substances with babies, schoolchildren, adolescents, and elderly were much less frequent. In most cases (78%), the injury occurred accidentally and only in 5% of the instances in suicidal intent; 85% of the suicidal attempts were committed by middle-aged adults and 15% by elderly. Main agents involved in oral burns were cleansing agents (37%), remedies (12%), disinfectants (7%), acids or bases (6%), technical fluids (6%), cosmetics (5%), and foods (5%). Mostly, the calls came from emergency department doctors (58%), in 19% laymen were calling from home, and in 18% the calls came from a doctor's office. Most of the injuries occurred accidentally, in the domestic setting and in toddlers, and would have been preventable. Thus, a more comprehensive education of the population, especially of parents, regarding the dangers arising from household chemicals is still needed.
Collapse
|
12
|
Rumbach AF, Cremer R, Chatwood A, Fink S, Haider S, Yee M. The Challenges of Dysphagia Management and Rehabilitation in Two Complex Cases Post Chemical Ingestion Injury. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2016; 25:470-480. [PMID: 27626140 DOI: 10.1044/2016_ajslp-15-0043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 03/03/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE Dysphagia is common sequelae of chemical ingestion injury, resulting from damage to critical swallowing structures. From a speech-language pathology perspective, this study outlines the physiological deficits in 2 individuals with severe injury (1 woman, acid; 1 man, alkali) and the pattern of dysphagia rehabilitation and recovery. METHOD A retrospective chart review of clinical and instrumental assessments was conducted to examine swallow characteristics and speech-language pathology management (compensatory and rehabilitation strategies) at multiple time points. RESULTS Chemical ingestion injury resulted in severe pharyngeal dysphagia for both participants, warranting speech-language pathology management. Dysphagia was characterized by poor base of tongue mobility and reduced laryngeal excursion. Decreased airway patency and protection, secondary to mucosal sloughing, widespread edema, and structural deficits necessitated tracheostomy. Recovery was complicated by physical alterations of pharyngeal and laryngeal structures (e.g., interarytenoid adhesions) and esophageal strictures. Participant 1 was discharged (Day 135) consuming a texture-modified diet; Participant 2 remained nil by mouth (Day 329). CONCLUSIONS Dysphagia recovery subsequent to chemical ingestion is protracted and complex. Clinical outcomes may be improved through individualized and intensive rehabilitation by speech-language pathologists.
Collapse
Affiliation(s)
| | - Rebecca Cremer
- Royal Brisbane and Women's Hospital, Metro North Hospital Health Service, Queensland Health, Brisbane, Australia
| | | | - Sari Fink
- The University of Queensland, Australia
| | | | | |
Collapse
|
13
|
Follent AM, Rumbach AF, Ward EC, Marshall J, Dodrill P, Lewindon P. Dysphagia progression and feeding skills following pediatric alkali ingestion injury: two case reports. Disabil Rehabil 2016; 39:2452-2459. [DOI: 10.1080/09638288.2016.1231848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Anna M. Follent
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Anna. F. Rumbach
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Elizabeth C. Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Centre for Functioning and Health Research, Queensland Health, Brisbane, QLD, Australia
| | - Jeanne Marshall
- Lady Cilento Children’s Hospital, Queensland Health, Brisbane, QLD, Australia
| | - Pamela Dodrill
- Department of Otolaryngology, Boston Children’s Hospital, Boston, MA, USA
| | - Peter Lewindon
- Lady Cilento Children’s Hospital, Queensland Health, Brisbane, QLD, Australia
| |
Collapse
|
14
|
Caustic oesophagitis in children: prevalence, the corrosive agents involved, and management from primary care through to surgery. Curr Opin Otolaryngol Head Neck Surg 2016; 23:423-32. [PMID: 26371603 DOI: 10.1097/moo.0000000000000198] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW Caustic substance ingestion (CSI) remains a major health issue, particularly in developing countries, where laws are not effectively enforced. This review offers a thorough analysis of the current epidemiology, clinical features, management, treatment, and long-term complications of CSI in children. RECENT FINDINGS Strong alkalis sold in liquid and granular forms, particularly crystalline grease cleaners (concentrated sodium hydroxide), are the principal causes of severe oesophageal damage. Currently, early endoscopy to assess the gastro-oesophageal mucosa is not considered necessary for all CSI cases. Oesophageal stricture is a major complication developing after CSI, and should be diagnosed and treated earlier, 10-14 days after CSI via commencement of a dilation program. Fluoroscopically guided oesophageal balloon dilatation seems to be safe, with a low frequency of complications and a high success rate. However, it should commence earlier than is currently the case, and should be performed gently, using balloons of gradually increasing diameter. If dilation fails after a few months, oesophageal replacement surgery should be performed. SUMMARY Unfortunately, neither dilatation treatment nor oesophageal bypass surgery can prevent the development of oesophageal carcinoma, the incidence of which is high after CSI. The continuing unacceptably high incidence of CSI accidents would be reduced if corrosive materials were sold in their original childproof containers, highlighting the need for preventive and adult education programmes.
Collapse
|
15
|
Miller CK, Rutter MJ, von Allmen D, Stoops M, Putnam P, Stevens L, Willging JP. Swallowing dynamics status post caustic ingestion in a pediatric patient: A multidisciplinary case report. Int J Pediatr Otorhinolaryngol 2016; 86:4-8. [PMID: 27260570 DOI: 10.1016/j.ijporl.2016.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 03/31/2016] [Accepted: 04/01/2016] [Indexed: 12/27/2022]
Abstract
A case report of a 10 year old male illustrates the effect of damage to the tongue base, hypopharynx, cricopharyngeus, and esophagus on the sensory and motor components of the swallowing mechanism. The characteristics of the dysphagia were manifested clinically, radiographically, and endoscopically. A myectomy was required to restore functional swallowing as scar tissue formation in the cricopharyngeus severely interfered with the dynamic components of swallowing. A collaborative approach facilitated communication and effective treatment planning; the multidisciplinary components in the management of this case are discussed.
Collapse
Affiliation(s)
- Claire Kane Miller
- Aerodigestive and Esophageal Center, Cincinnati Children's Hospital, Cincinnati, OH 45229-3039, USA.
| | - Michael J Rutter
- Division of Pediatric Otorhinolaryngology, Cincinnati Children's Hospital Medical Center, Aerodigestive and Esophageal Center, University of Cincinnati - Head and Neck Surgery, Cincinnati, OH, USA
| | - Daniel von Allmen
- Division of Pediatric Surgery, Cincinnati Children's Aerodigestive and Esophageal Center, Cincinnati, OH, USA
| | - Marilyn Stoops
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Aerodigestive and Esophageal Center, Cincinnati, OH, USA
| | - Philip Putnam
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Aerodigestive and Esophageal Center, Cincinnati, OH, USA
| | - Luann Stevens
- Division of Speech-Language Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - J Paul Willging
- Division of Pediatric Otolaryngology, University of Cincinnati - Head and Neck Surgery, Cincinnati, OH, USA; Cincinnati Children's Aerodigestive and Esophageal Center, Cincinnati, OH, USA
| |
Collapse
|
16
|
Botwe BO, Anim-Sampong S, Sarkodie BD, Antwi WK, Obeng-Nkansah J, Ashong GGNA. Caustic soda ingestion in children under-5 years presenting for fluoroscopic examinations in an Academic Hospital in Ghana. BMC Res Notes 2015; 8:684. [PMID: 26576563 PMCID: PMC4650304 DOI: 10.1186/s13104-015-1629-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 10/26/2015] [Indexed: 12/30/2022] Open
Abstract
Background Disastrous effects and lifelong complications, ranging from respiratory and gastrointestinal burns to death can result from caustic soda ingestion. Accidental and non-accidental ingestions occur in different age groups. However, it is very troubling to find ingestion of caustic soda a very common occurrence among children below 5 years since they do not have the developmental level required to independently weigh up risks and are also under parental and societal protections.
This study was therefore planned to investigate the ingestions of caustic soda by these children for purposes of proposing measures to curb the problem. Methods Descriptive survey was employed for this study. A 14-item, semi-structure questionnaire was purposively issued to 57 parents/guardians whose wards had ingested caustic soda. Data was analysed with SPSS V.20. Results Twenty-seven (47.4 %) children got access to the soda at storage, 1 (1.86 %) was administered accidentally by a sibling while 29 (50.9 %) ingested during soap preparation. In respect of the former, the majority got access because it was stored in soft drink and water bottles in their parents/guardians rooms or kitchen. For the later, the children got access to the left-over soda because the soap-makers failed to adhere to good storage and disposal practices. Conclusion Storage of caustic soda in soft drink and water bottles in accessible places, and training of children to drink directly from bottles influence caustic soda ingestion in children under five. Non-compliance to good practices of storage and disposal of caustic soda during soap preparation increases exposure and access of children to caustic soda ingestion.
Collapse
Affiliation(s)
- Benard Ohene Botwe
- Department of Radiography, School of Biomedical and Allied Health Sciences, University of Ghana, P.O Box KB 143, Accra, Ghana.
| | - Samuel Anim-Sampong
- Department of Radiography, School of Biomedical and Allied Health Sciences, University of Ghana, P.O Box KB 143, Accra, Ghana.
| | | | - William K Antwi
- Department of Radiography, School of Biomedical and Allied Health Sciences, University of Ghana, P.O Box KB 143, Accra, Ghana.
| | - Jeannette Obeng-Nkansah
- Department of Radiography, School of Biomedical and Allied Health Sciences, University of Ghana, P.O Box KB 143, Accra, Ghana.
| | - Gabriel G N A Ashong
- Department of Radiography, School of Biomedical and Allied Health Sciences, University of Ghana, P.O Box KB 143, Accra, Ghana.
| |
Collapse
|
17
|
Rollin M, Jaulim A, Vaz F, Sandhu G, Wood S, Birchall M, Dawas K. Caustic ingestion injury of the upper aerodigestive tract in adults. Ann R Coll Surg Engl 2015; 97:304-7. [PMID: 26263940 DOI: 10.1308/003588415x14181254789286] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Adult ingestion of caustic substances is an unusual but serious surgical problem, with injuries likely to be more extensive than those in the corresponding paediatric population. After initial stabilisation and airway management, clinicians are presented with a complex multisystemic problem, frequently requiring a multidisciplinary approach involving several surgical disciplines and associated therapies. A new multidisciplinary team was convened to discuss complex ingestion injury in adults and established techniques were used to bring forward a proposed treatment algorithm. An algorithm may potentially improve clinical efficacy and risk in the management of these complex patients.
Collapse
Affiliation(s)
- M Rollin
- University College London Hospitals NHS Foundation Trust , UK
| | - A Jaulim
- University College London Hospitals NHS Foundation Trust , UK
| | - F Vaz
- University College London Hospitals NHS Foundation Trust , UK
| | - G Sandhu
- Imperial College Healthcare NHS Trust , UK
| | - S Wood
- Imperial College Healthcare NHS Trust , UK
| | - M Birchall
- University College London Hospitals NHS Foundation Trust , UK
| | - K Dawas
- University College London Hospitals NHS Foundation Trust , UK
| |
Collapse
|
18
|
Amadasi A, Gentile G, Rancati A, Zoja R. Macroscopic and histopathological aspects of chemical damage to human tissues depending on the survival time. Int J Legal Med 2015; 130:743-9. [PMID: 26384506 DOI: 10.1007/s00414-015-1265-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 09/10/2015] [Indexed: 12/31/2022]
Abstract
The ingestion of corrosive substances is a widely treated topic in clinical and forensic practice, as an accidental event or as a consequence of voluntary assumption to commit suicide. However, thorough macroscopic and microscopic surveys focused on the correlation between the ingestion of the substance and different survival times have never been performed. Are the ingestion and the metabolism of the substance within the human tissues still recognizable? How could it be related to death? The study concerns a retrospective analysis on ten cases (two accidental, eight suicides) of lethal ingestion of different types of liquid caustic substances, without instant death and survival times ranging from 12 h to 6 months. For each case, a full autopsy and histological examination of the internal organs were performed. The results showed that the early direct effect of the substances is exerted mainly on the gastrointestinal tract, but as survival time increased, the metabolism of the substance exerted its effects in different target organs. When the cause of death was not directly linkable to the ingestion of the substance (i.e., related to cardiac stress, electrolyte disorders, pneumonia) and macroscopic findings were nonspecific, histological analyses allowed for providing crucial elements towards a link between death and assumption of the substance.
Collapse
Affiliation(s)
- Alberto Amadasi
- Sezione di Medicina Legale e delle Assicurazioni - Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 37, Milano, Italy.
| | - Guendalina Gentile
- Sezione di Medicina Legale e delle Assicurazioni - Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 37, Milano, Italy
| | - Alessandra Rancati
- Sezione di Medicina Legale e delle Assicurazioni - Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 37, Milano, Italy
| | - Riccardo Zoja
- Sezione di Medicina Legale e delle Assicurazioni - Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 37, Milano, Italy
| |
Collapse
|
19
|
Defagó V, Moyano J, Bernhardt C, Sambuelli G, Cuestas E. Protective effect of early placement of nasogastric tube with solid dilator on tissue damage and stricture formation after caustic esophageal burns in rabbits. J Pediatr Surg 2015; 50:1264-8. [PMID: 25783296 DOI: 10.1016/j.jpedsurg.2014.11.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 11/19/2014] [Accepted: 11/21/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND The ingestion of caustic substances remains an important public health issue worldwide. Children represent 80% of the ingestion injury population globally. Accidental alkaline material accounts for most caustic ingestions. There is no conclusive evidence of tissue damage and stricture protection of a nasogastric-tube with a solid dilator in the literature, therefore it was hypothesized that early intraesophageal tube placement does not cause additional histopathologic damage and prevents strictures. METHODS An exploratory study on experimental caustic esophageal burns in a rabbit model was designed. In the treated group a silicone tube was placed immediately after causing the burns, while the untreated group followed the natural course of the burn. On the twenty-secondday, an esophagectomy was performed on all animals for microscopic (Histopathologic Damage Score and Stenosis Index) and macroscopic analysis. RESULTS Forty animals were randomly divided into two groups. The Histopathologic Damage Score was 3.7±1.1 in the treated group versus 3.9±1.2 in the untreated group (p=.9690). The Stenosis Index was 0.6±0.1 in treated rabbits versus 2.3±0.2 in untreated (p<.0001). CONCLUSION The early placement of an intraesophageal tube with solid dilator prevents stenosis formation and does not produce greater tissue damage.
Collapse
Affiliation(s)
- Victor Defagó
- Department of Pediatric Surgery, Faculty of Medical Sciences, National University of Cordoba, Cordoba, Argentina
| | - Jimena Moyano
- Department of Pediatric Surgery, Faculty of Medical Sciences, National University of Cordoba, Cordoba, Argentina
| | - Celina Bernhardt
- Department of Pathology, Faculty of Medicine, Catholic University of Cordoba, Cordoba, Argentina
| | - Gabriela Sambuelli
- Department of Pathology, Faculty of Medicine, Catholic University of Cordoba, Cordoba, Argentina
| | - Eduardo Cuestas
- Health Sciences Research Institute-National University of Cordoba-National Scientific and Technical Research Council (INICSA-UNC-CONICET), Cordoba, Argentina.
| |
Collapse
|
20
|
Abstract
Caustic ingestion continues to be a significant problem world-wide especially in developing countries and particularly in the under 6 years age group. The presence or absence of symptoms or oral lesions does not reliably predict the existence or severity of oesophageal lesions. Upper endoscopy remains the mainstay diagnostic modality for evaluation to define the extent and severity of the injury. The best predictor of morbidity and mortality is the extent of injury as assessed during initial evaluation. Early management strategies for caustic ingestion are well defined. Controversy still surrounds the use of steroids, antibiotics, antacid therapy in the acute phase, and the use of oesophageal stents and the frequency, timing and method of dilatation in the prevention and management of oesophageal strictures. There is a pressing need for non-invasive diagnostic modalities and effective therapeutic options to evaluate and treat the complications associated with caustic ingestion. Indications for definitive surgery or bypass and the type of procedure to use are also subject to ongoing debate.
Collapse
|
21
|
Abstract
Accidental caustic ingestion occurs mainly in the 2- to 3-year-old age group. Up to 33% of patients develop long-term complications that principally involve the gastroesophageal tract, whereas their occurrence at the level of pharyngeal and laryngeal structures is less frequent. When present, strictures are the main disorders that can be observed. In this pathological situation, surgery is the treatment of choice, and several procedures have been described. We report the history of a 3-year-old boy affected by pharyngolaryngeal stenosis due to accidental caustic ingestion. After careful diagnosis, the child underwent surgery by transoral CO2laser. The patient had immediate improvement and restarted oral feeding 1 day after the surgical procedure. An analysis of diagnosis and treatment of this long-term complication is also presented.
Collapse
Affiliation(s)
- Marco Berlucchi
- Department of Pediatric Otorhinolaryngology, Spedali Civili, Brescia, Italy
| | - Diego Barbieri
- Department of Otorhinolaryngology, University of Brescia, Brescia, Italy
| | | | - Stefania Stefini
- Department of Pediatric Otorhinolaryngology, Spedali Civili, Brescia, Italy
| | - Giorgio Peretti
- Department of Otolaryngology, University of Genoa, Genoa, Italy
| |
Collapse
|
22
|
Sens MA, Koponen MA, Meyers S. Other Pediatric Accidental Deaths. FORENSIC PATHOLOGY OF INFANCY AND CHILDHOOD 2014. [PMCID: PMC7123499 DOI: 10.1007/978-1-61779-403-2_30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
|
23
|
Hardwicke J, Bechar J, Bella H, Moiemen N. Cutaneous chemical burns in children – A comparative study. Burns 2013; 39:1626-30. [DOI: 10.1016/j.burns.2013.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Revised: 04/10/2013] [Accepted: 04/11/2013] [Indexed: 11/25/2022]
|