The Prognostic Value of Some Initial Clinical Manifestations and Biochemical Parameters for Evaluating the Outcome in Corrosives Poisoned Children

Abstract

Corrosive products ingestions in children pose potentially devastating presentations and lifelong complications which remain one of the most challenging concerns encountered in medical practice. Prompt diagnosis and management are of outmost importance in decreasing mortality and achieving optimal long-term outcomes. Aim of the work: to investigate the predictability of the severity of corrosive poisoning outcome from some clinical findings and laboratory data at presentation. Patients and Methods: The study enrolled children with corrosive substances poisoning admitted to Poison Control Center-Ain Shams University during the period from January 2015 till September 2016. Demographic variables, on admission clinical findings, routine laboratory data and the outcome variables (length of hospital stay, development of stricture and mortality rate) were recorded. Patients were classified into two groups; the non-complicated group and the complicated group. Results: 106 patients, 56 males (52.8%) with median age (3.06±2.57 years) met inclusion criteria. Signs and symptoms as (vomiting, dysphagia, drooling, hematemesis and respiratory distress) were found to be significantly higher in the complicated group as compared to the non-complicated group, while oral lesions and stridor showed insignificant difference between the two groups. Initial vomiting, drooling, dysphagia and hematemesis, but not respiratory distress, exhibited significant correlation with poor outcome (longer hospital stay, developing stricture/stenosis and increased mortality rate) together with high sensitivity and specificity prediction of stricture/stenosis formation 21 days post-ingestion (95.65%-70%, 91.49%-55.56%, 95.35%-45.5%, 92.86%-42.86% respectively). Lower pH and Hb levels were more evident in the complicated group and were correlated with poor outcome. While, higher WBCs were only correlated with longer hospital stay time. Acidosis and anemia had significant sensitivity (91.30%-90.91% respectively) and specificity (44.43%-41.67% respectively) prediction of stricture/stenosis formation.Conclusion: In children corrosive ingestion, some clinical manifestations as vomiting, drooling, dysphagia and hematemesis together with laboratory data as decreased pH and Hb levels and increased WBCs count on admission, were more obvious in the complicated cases and were found to be reliable predictors of outcome severity. Recommendations: It is recommended to carefully monitor initial signs and symptoms together with laboratory data to predict the outcome severity and avoid complications early enough.

Retrospective Study of Acute Pediatric Intoxication Cases by Household Products Presented to the Poison Control Center of Ain-Shams University Hospitals

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