A clinical decision rule for triage of children under 5 years of age with hydrocarbon (kerosene) aspiration in developing countries.
BACKGROUND
Unintended hydrocarbon ingestion is a common reason for pediatric hospitalization in the developing world.


OBJECTIVE
To derive a clinical decision rule, to identify patients likely to require a higher level facility (resource-requiring cases), that can be used at primary health care facilities with limited diagnostic and therapeutic resources.


METHODS
A prospective study of children 2 to 59 months old presenting to a poison treatment facility within 2 hours of oral hydrocarbon exposure. History and objective signs were recorded at admission and at 6, 12, 24 and, if present, 48 hours. Inclusion in the resource-requiring outcome group required: oxygen saturation <94%; any CNS depression; any treatment with (salbutamol); any care in the ICU; or death.


RESULTS
256 met the inclusion criteria and completed the study. Of these, 170 had a course requiring resources unavailable at most primary health care facilities, and 86 did not. The presence of wheezing, any alteration in consciousness (lethargy or any restlessness), or a rapid respiratory rate for age (RR >or= 50/min if age < 12 mo, >or= 40/min if age >or= 12 mo) at presentation identified 167 of 170 of these patients (sensitivity 0.98). Thirty-six of 86 patients classified as non-resource requiring were correctly identified (specificity 0.42). No combination of clinical symptoms provided better discrimination while preserving sensitivity.


CONCLUSIONS
This study suggests a triage decision rule based on the presence of wheezing, altered consciousness, or a rapid respiratory rate within 2 hours of hydrocarbon exposure. Such a rule requires validation in other settings.
Drug and Poison Information Center, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio, USA. randall.bond@cchmc.org
Bond
G R
GR
Pièche
S
S
Sonicki
Z
Z
Gamaluddin
H
H
El Guindi
M
M
Sakr
M
M
El Seddawy
A
A
Abouzaid
M
M
Youssef
A
A
D000284:Administration, Oral; D015362:Child Nutrition Disorders / Q000150:complications; D002675:Child, Preschool; D003243:Consciousness / Q000187:drug effects; D003625:Data Collection; D003906:Developing Countries; D004534:Egypt; D005260:Female; D006801:Humans; D007223:Infant; D007648:Kerosene / Q000506:poisoning*; D008297:Male; D011320:Primary Health Care; D011446:Prospective Studies; D015656:Respiratory Mechanics / Q000187:drug effects; D012135:Respiratory Sounds / Q000503:physiopathology; D016896:Treatment Outcome; D014218:Triage / Q000941:ethics / Q000379:methods*
D007648:Kerosene