Pediatric caustic ingestion injuries ‘much lower than believed’

Jan 2 2013

By Joanna Lyford, Senior medwireNews Reporter

The public health burden associated with children swallowing caustic chemicals is less than widely believed, US researchers report in the Archives of Otolaryngology - Head & Neck Surgery.

The researchers say their findings support the beneficial impact of legislative efforts such as the Poison Prevention Packaging Act in helping to reduce injuries to children from caustics and other household chemicals.

Ingestion of caustic substances such as lye can result in a range of injuries from mild esophageal burns to necrosis and gastrointestinal perforation. Because of the substantial associated mortality and morbidity, the US Consumer Product Safety Commission now requires all potentially harmful household products to be in childproof containers and properly labeled.

"[P]olicies have remained essentially static since 1972," write Christopher Johnson and Matthew Brigger, from Naval Medical Center San Diego in California. "Having accurate epidemiologic data is essential to analyze the effect of these legislative measures better and to investigate national trends and variations."

In the study, Johnson and Brigger assessed the current public health burden of pediatric caustic ingestions using the Kids' Inpatient Database, which provides data on a representative sample of pediatric hospital discharges in the USA.

In 2009, 807 children were hospitalized with caustic ingestion injuries, they estimate.

The associated economic burden was estimated at US$ 22,900,000 (€ 17,396,514) in total hospital charges, and the mean charge per patient was estimated at $ 28,860 (€ 21,924), with a median of $ 9848 (€ 7481). The mean length of hospital admission was 4.13 days with a median of 2 days.

In all, 508 children underwent medical procedures, with esophagoscopy being the most frequent, followed by direct laryngoscopy, and bronchoscopy.

Children in the sample tended to be from less affluent families, note the researchers, and most were admitted to teaching hospitals and hospitals in urban locations. Using logistic regression analysis, male gender and lower median annual income quartile were identified as factors that were independently associated with this type of injury.

Johnson and Brigger conclude: "Based on the weighted estimate, the prevalence of pediatric caustic ingestion injuries in the United States during 2009 appears to be much lower than the figure widely stated in the literature. The finding of a decreased prevalence of caustic injuries makes sense given the public health interventions currently in place."

However, they add: "Despite these successes, children with caustic ingestion injuries are estimated to incur hospital charges greater than $ 22 million [€ 16,713,888] and account for more than 3300 inpatient days in 2009.

"Further investigation is necessary to better define specific populations and to identify opportunities for targeted public health intervention."

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