title: Caustic ingestion in children: is endoscopy always indicated? The results of an Italian multicenter observational study.
abstract: BACKGROUND
  The ingestion of caustic substances can represent a serious medical problem in children.
  
  
  OBJECTIVE
  Whether or not an urgent endoscopy should be performed is still a matter of debate, particularly in asymptomatic patients.
  
  
  METHODS
  We conducted a multicenter observational study to investigate the predictive value of signs and symptoms in detecting severe esophageal lesions.
  
  
  METHODS
  The records of 162 children who presented with accidental caustic substance ingestion were analyzed.
  
  
  METHODS
  Signs and symptoms were divided into minor (oral and/or oropharyngeal lesions and vomiting) and major (dyspnea, dysphagia, drooling, and hematemesis). An endoscopy was performed in all patients within 12 to 24 hours of the substance being ingested.
  
  
  METHODS
  The types of substance ingested, signs and symptoms, age, sex, and severity of esophageal injury were correlated.
  
  
  RESULTS
  Mild esophageal lesions were identified in 143 of 162 patients (88.3%), and severe (third degree) esophageal lesions in 19 patients (11.7%). The risk of severe esophageal lesions without signs and/or symptoms was very low (odds ratio [OR] 0.13 [95% CI, 0.02-0.62], P = .002). Indeed, the presence of 3 or more symptoms is an important predictor of severe esophageal lesions (OR 11.97 [95% CI, 3.49-42.04], P = .0001). Multivariate analysis showed that the presence of symptoms is the most significant predictor of severe esophageal lesions (OR 2.3 [95% CI, 1.57-3.38], P = .001).
  
  
  CONCLUSIONS
  The results demonstrated that the incidence of patients with third-degree lesions without any early symptoms and/or signs is very low, and an endoscopy could be avoided. The risk of severe damage increases proportionally with the number of signs and symptoms, and an endoscopy is always mandatory in symptomatic patients.
authors.affiliation: Pediatric Surgery Clinic, University of Padova, Padova, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Betalli
authors.forename: Diego
authors.initials: D
authors.lastname: Falchetti
authors.forename: Stefano
authors.initials: S
authors.lastname: Giuliani
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pane
authors.forename: Luigi
authors.initials: L
authors.lastname: Dall'Oglio
authors.forename: Gian Luigi
authors.initials: GL
authors.lastname: de Angelis
authors.forename: Mariano
authors.initials: M
authors.lastname: Caldore
authors.forename: Claudio
authors.initials: C
authors.lastname: Romano
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Gamba
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Baldo
mesh_terms: D000061:Accidents, Home; D002057:Burns, Chemical / Q000175:diagnosis* / Q000209:etiology; D002424:Caustics / Q000009:adverse effects*; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D004502:Education, Medical, Continuing; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000379:methods / Q000639:trends; D004940:Esophageal Stenosis / Q000139:chemically induced* / Q000175:diagnosis; D004945:Esophagoscopy / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D007558:Italy; D008297:Male; D015999:Multivariate Analysis; D019370:Observation; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011336:Probability; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D019564:Unnecessary Procedures
chemical_list: D002424:Caustics