Clinico-epidemiological Study of Caustic Substance Ingestion Accidents in Children in Anatolia: The DROOL Score as a New Prognostic Tool

• Published in: Acta chirurgica belgica 2012-09, Vol.112 (5), p.346-354
• Main Authors: Uygun, I., Aydogdu, B., Okur, M.H., Arayici, Y., Celik, Y., Ozturk, H., Otcu, S.
• Format: Article
• Language: English
• Subjects: Accidents, Home - statistics & numerical data; Adolescent; Biological and medical sciences; Caustics - administration & dosage; Caustics - poisoning; Child; Child, Preschool; Deglutition Disorders - etiology; Eating; Endoscopy, Digestive System; Epidemiology; Female; General aspects; Humans; Infant; Male; Medical sciences; Miscellaneous; Poisoning - diagnosis; Poisoning - therapy; Prognosis; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; Turkey
• ISSN: 0001-5458
• DOI: 10.1080/00015458.2012.11680850

Background : To examine the clinico-epidemiological details of paediatric caustic substance ingestion (CSI) accidents in Turkey. To present the new DROOL Score (DS), which the authors developed based on the severity and duration of initial signs and symptoms (ISSs) to predict oesophageal stricture (OS) without endoscopy, and to present our management protocol based on immediate feeding, early detection, and oesophageal balloon dilatation (OBD) of OS with no barium study. Methods : We prospectively reviewed the records of 202 children admitted with a history of CSI within 48 hours. Patient, parent, caustic substance, and accident characteristics were noted in detail. Patients were fed as soon as they could swallow saliva. Diagnoses of OS were made earlier via timely endoscopy (mean, 10-14 days after CSI) for patients with persistent dysphagia and OBD was started earlier. ISSs and DSs were analyzed. OS treatment results were compared between early (10-14 days) and late (> 21 days) dilatation patients who were referred for OBD by other hospitals. Results : In total, 144 (71%) incidents occurred within the parents' home and 44 (22%) occurred at another individual's home. The caustic substances were frequently sold in non-original containers (68.8%). Most patients' parents had low incomes and were poorly educated. Ninety-six children had no ISSs, whereas 106 patients had ISSs. Seventeen symptomatic patients had persistent dysphagia after 10-14 days. Timely endoscopy was performed within 10-14 days for these patients only, and OS was diagnosed and successfully treated. DSs were significantly lower in patients with OS than those without (p < 0.001). A DS < 4 was a significant predictor of OS (100% sensitivity, 96% specificity, 85% positive and 100% negative predictive values). Results were significantly more satisfactory in early (n = 17) than in late (n = 6) dilatation patients. Conclusions : Paediatric CSI accidents might decrease if caustic substances were sold in the original child-proof containers. OS can be highly predicted by a simple DS instead of endoscopic grading, and can be diagnosed earlier (10-14 days) via endoscopy only in patients with persistent dysphagia, instead of a late barium study (> 21 days). OBD can then also be started earlier in these patients.