Rate of pediatric caustic ingestion injuries quite low

The prevalence of caustic ingestion injuries among children and adolescents in the United States is quite low, estimated to be only 1.08 per 100,000 population, according to a report in the December issue of Archives of Otolaryngology and Head & Neck Surgery.

This represents a substantial decrease from figures widely stated in the literature, which are based on data from the 1970s and 1980s, when public health measures were first taken to reduce children’s exposure to lye and other caustics, said Dr. Christopher M. Johnson and Dr. Matthew T. Brigger of the department of otolaryngology, Naval Medical Center, San Diego.

"The burden of caustic ingestion injuries in children appears to have decreased over time, and past public health interventions appear to have been successful," Dr. Johnson and Dr. Brigger wrote.

They examined this issue in part because of the paucity of epidemiologic data regarding caustic ingestions. To assess the current public health burden of these pediatric injuries, they analyzed information in the Kids’ Inpatient Database (KID), a national resource maintained by the Agency for Healthcare Research and Quality, which collects nationally representative samples of all pediatric hospital discharges each year.

The researchers assessed KID data for 2009, when 3,407,146 pediatric hospitalizations were sampled.

Extrapolating the data to the entire U.S. population, the investigators estimated that there were 807 hospitalizations nationwide for caustic ingestion injuries among patients aged 0-18 years in 2009, for a prevalence of 1.08 per 100,000.

Previously published estimates ranged from 5,000 to 15,000 cases each year but were based on outdated data, the investigators noted (Arch. Otolaryngol. Head Neck Surg. 2012;138:1111-5).

Even though the actual prevalence of these injuries has dropped so precipitously, children with caustic ingestion injuries still accounted for more than $22 million in hospital charges and more than 3,300 inpatient days in 2009, they reported.

Approximately 60% of these ingestions occurred in children aged 4 years and younger. A second peak in prevalence occurred in the adolescent age group, presumably because of intentional ingestions in suicide attempts.

Only about half of all pediatric patients hospitalized for caustic ingestion underwent esophagoscopy in 2009. Since this procedure is recommended for all children with a "strongly suggestive" history as well as for those who are symptomatic, "a logical conclusion is that a large proportion of children are admitted to the hospital for observation, even if suspicion of significant injury is low," Dr. Johnson and Dr. Brigger said.

"We found a higher burden of injury in urban hospitals and in patients who lived in zip codes in the bottom quartile of median annual income in the United States. This finding is consistent with available pediatric poisoning data that indicate that low-income urban households are more likely to store dangerous household products improperly," they added.

No financial conflicts of interest were reported.

The prevalence of caustic ingestion injuries among children and adolescents in the United States is quite low, estimated to be only 1.08 per 100,000 population, according to a report in the December issue of Archives of Otolaryngology and Head & Neck Surgery.

This represents a substantial decrease from figures widely stated in the literature, which are based on data from the 1970s and 1980s, when public health measures were first taken to reduce children’s exposure to lye and other caustics, said Dr. Christopher M. Johnson and Dr. Matthew T. Brigger of the department of otolaryngology, Naval Medical Center, San Diego.

"The burden of caustic ingestion injuries in children appears to have decreased over time, and past public health interventions appear to have been successful," Dr. Johnson and Dr. Brigger wrote.

They examined this issue in part because of the paucity of epidemiologic data regarding caustic ingestions. To assess the current public health burden of these pediatric injuries, they analyzed information in the Kids’ Inpatient Database (KID), a national resource maintained by the Agency for Healthcare Research and Quality, which collects nationally representative samples of all pediatric hospital discharges each year.

The researchers assessed KID data for 2009, when 3,407,146 pediatric hospitalizations were sampled.

Extrapolating the data to the entire U.S. population, the investigators estimated that there were 807 hospitalizations nationwide for caustic ingestion injuries among patients aged 0-18 years in 2009, for a prevalence of 1.08 per 100,000.

Previously published estimates ranged from 5,000 to 15,000 cases each year but were based on outdated data, the investigators noted (Arch. Otolaryngol. Head Neck Surg. 2012;138:1111-5).

Even though the actual prevalence of these injuries has dropped so precipitously, children with caustic ingestion injuries still accounted for more than $22 million in hospital charges and more than 3,300 inpatient days in 2009, they reported.

Approximately 60% of these ingestions occurred in children aged 4 years and younger. A second peak in prevalence occurred in the adolescent age group, presumably because of intentional ingestions in suicide attempts.

Only about half of all pediatric patients hospitalized for caustic ingestion underwent esophagoscopy in 2009. Since this procedure is recommended for all children with a "strongly suggestive" history as well as for those who are symptomatic, "a logical conclusion is that a large proportion of children are admitted to the hospital for observation, even if suspicion of significant injury is low," Dr. Johnson and Dr. Brigger said.

"We found a higher burden of injury in urban hospitals and in patients who lived in zip codes in the bottom quartile of median annual income in the United States. This finding is consistent with available pediatric poisoning data that indicate that low-income urban households are more likely to store dangerous household products improperly," they added.

No financial conflicts of interest were reported.

The prevalence of caustic ingestion injuries among children and adolescents in the United States is quite low, estimated to be only 1.08 per 100,000 population, according to a report in the December issue of Archives of Otolaryngology and Head & Neck Surgery.

This represents a substantial decrease from figures widely stated in the literature, which are based on data from the 1970s and 1980s, when public health measures were first taken to reduce children’s exposure to lye and other caustics, said Dr. Christopher M. Johnson and Dr. Matthew T. Brigger of the department of otolaryngology, Naval Medical Center, San Diego.

"The burden of caustic ingestion injuries in children appears to have decreased over time, and past public health interventions appear to have been successful," Dr. Johnson and Dr. Brigger wrote.

They examined this issue in part because of the paucity of epidemiologic data regarding caustic ingestions. To assess the current public health burden of these pediatric injuries, they analyzed information in the Kids’ Inpatient Database (KID), a national resource maintained by the Agency for Healthcare Research and Quality, which collects nationally representative samples of all pediatric hospital discharges each year.

The researchers assessed KID data for 2009, when 3,407,146 pediatric hospitalizations were sampled.

Extrapolating the data to the entire U.S. population, the investigators estimated that there were 807 hospitalizations nationwide for caustic ingestion injuries among patients aged 0-18 years in 2009, for a prevalence of 1.08 per 100,000.

Previously published estimates ranged from 5,000 to 15,000 cases each year but were based on outdated data, the investigators noted (Arch. Otolaryngol. Head Neck Surg. 2012;138:1111-5).

Even though the actual prevalence of these injuries has dropped so precipitously, children with caustic ingestion injuries still accounted for more than $22 million in hospital charges and more than 3,300 inpatient days in 2009, they reported.

Approximately 60% of these ingestions occurred in children aged 4 years and younger. A second peak in prevalence occurred in the adolescent age group, presumably because of intentional ingestions in suicide attempts.

Only about half of all pediatric patients hospitalized for caustic ingestion underwent esophagoscopy in 2009. Since this procedure is recommended for all children with a "strongly suggestive" history as well as for those who are symptomatic, "a logical conclusion is that a large proportion of children are admitted to the hospital for observation, even if suspicion of significant injury is low," Dr. Johnson and Dr. Brigger said.

"We found a higher burden of injury in urban hospitals and in patients who lived in zip codes in the bottom quartile of median annual income in the United States. This finding is consistent with available pediatric poisoning data that indicate that low-income urban households are more likely to store dangerous household products improperly," they added.

No financial conflicts of interest were reported.