Caustic ingestion in children: A prospective analysis of poor outcome key predictors useful for clinical management optimization.

OBJECTIVES

Endoscopic examination is the main diagnostic test to evaluate the extent and severity of any mucosal lesions after caustic ingestion, in order to target the most appropriate treatment and follow-up. Our main aim was to evaluate clinical, biochemical, and instrumental parameters in order to identify possible key predictors of poor outcome and therefore identify possible subgroups of asymptomatic or paucisymptomatic children who may benefit from the endoscopic examination.

METHODS

All children admitted for caustic ingestion were prospectively enrolled. Poor outcome was defined as the presence of mucosal lesions with severe/uncertain prognosis: Zargar score 2b to 4 or severe gastric/duodenal lesions.

RESULTS

Two hundred and eighty-three children were enrolled. No asymptomatic patient showed poor outcome (p < 0.01). Children showing hematemesis, drooling, vomiting, oropharyngeal or labial lesions showed a higher risk of developing severe mucosal lesions (p < 0.01). The ingestion of caustic substances inappropriately stored in plastic glasses or bottles was found to be a risk factor for unfavorable outcome (p < 0.01).

CONCLUSIONS

Asymptomatic children should not undergo endoscopic examination since severe mucosal lesions are associated with the development of at least one sign or symptom. However, this recommendation may not apply to children under 18 months of age or those with delayed psychomotor development or neuropsychiatric pathologies, likely because they are unable to reliably report symptoms.