PEDIATRICS Vol. 71 No. 5 May 1983, pp. 767-770
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Predictability of Esophageal Injury from Signs and Symptoms: A Study of Caustic Ingestion in 378 Children

Pierre Gaudreault MD1, Marcelle Parent RN1, Michael A. McGuigan MD1, Luc Chicoine MD1, and Frederick H. Lovejoy Jr MD1

1 From the Department of Medicine and Clinical Pharmacology/Toxicology Unit, The Children's Hospital Medical Center and Departments of Pediatrics and Pharmacology, Harvard Medical School, Boston; Department of Pediatrics, Hospital Sainte-Justine, Montreal; and Department of Pediatrics, The Hospital for Sick Children, Toronto

The accuracy of signs and symptoms as predictors of the presence and severity of esophageal injury was evaluated in 378 children admitted to three pediatric hospitals between 1970 and 1980. The signs and symptoms analyzed included nausea, vomiting, dysphagia, refusal to drink, abdominal pain, increased salivation, oropharyngeal burns, and abdominal tenderness. The severity of lesions found at esophagoscopy in 378 children was graded from grade 0, no lesion, to grade 3, perforation. Of the 298 patients demonstrating signs or symptoms, 243 (82%) had a grade 0 or 1 lesion, 55 (18%) had a grade 2 lesion, none had a grade 3 lesion, and five (2%) developed a stricture of the esophagus. Among the 80 patients without signs or symptoms, 70 (88%) had a grade 0 or 1 lesion, ten (12%) had a grade 2 lesion, none had a grade 3 lesion, and one (1%) developed a stricture of the esophagus. When individual signs or symptoms were correlated with the severity of esophageal lesion, vomiting (33%) followed by dysphagia (25%), excessive salivation (24%), and abdominal pain (24%) were most frequently associated with a grade 2 or 3 esophageal lesion. A similar percentage of a grade 0 or 1 (82% v 85%), a grade 2 (18% v 15%), and a grade 3 (0%) esophageal lesion followed the ingestion, respectively, of an alkali (324 patients) or an acid (54 patients). In six patients (2%) stricture occurred only following an alkali ingestion. These data demonstrate that signs and/or symptoms do not adequately predict the presence or severity of an esophageal lesion following the ingestion of a caustic substance.

Key Words: caustic ingestion • esophageal burn • esophageal stricture • esophagoscopy

Submitted on May 24, 1982
Accepted on August 3, 1982




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