Drain Cleaners Still Pose Risk to Kids
Injuries caused by drinking or eating caustic agents—including cleaners and products used for unclogging drains—are less common with children today, but they continue to be a financial burden to the healthcare system, researchers found.
Based on hospital discharge data, an estimated 807 children and teens (18 and younger) were admitted for a caustic ingestion in 2009, according to Christopher Johnson, MD, and Matthew Brigger, MD, MPH, of Naval Medical Center San Diego.
That is much less than the estimate of 5,000 to 15,000 annual pediatric cases, which comes from studies published in the 1970s and 1980s, that is widely referenced in the literature, the researchers reported in the December issue of Archives of Otolaryngology - Head & Neck Surgery.
“The current public health burden of pediatric caustic ingestion injuries may be less than commonly cited,” they wrote. “This finding supports the notion that legislative efforts have been successful.”
Nevertheless, hospitalizations for caustic ingestions among young people still accounted for an estimated $22.9 million in total hospital charges in 2009, indicating that “these injuries continue to impose a significant burden on healthcare resources,” according to Johnson and Brigger. “Further investigation is necessary to better define specific populations and to identify opportunities for targeted public health intervention,” they wrote. Caustic ingestion injuries became increasingly common after lye became commercially available around the turn of the 20th century. Children are particularly at risk, and injuries can range from mild esophageal burns to necrosis and perforation of the esophagus, stomach, or both, according to the researchers. The severity of the injuries spurred the medical community to pressure legislators to take action, resulting in the Federal Caustic Act of 1927, which improved labeling of caustic substances. In 1970, the Poison Prevention Packaging Act instructed the U.S. Consumer Product Safety Commission to require caustics and other potentially harmful household products to come in childproof containers and carry improved labeling. Over time, the number of caustic ingestion injuries among children has dropped substantially, which “is generally touted as a public health success,” Johnson and Brigger wrote. But the remaining public health burden is not well known, they added. To explore the issue, they examined the 2009 Kids’ Inpatient Database, which is maintained by the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality. It contains data on all pediatric hospital discharges in the U.S. Using diagnostic codes, the researchers estimated that during 2009, about 1.08 children per 100,000 required hospitalization for a caustic ingestion. Most of the injuries (59%) occurred in children younger than 4 years, although there was another spike in cases in the later teenage years. The latter finding “primarily represents intentional ingestions as part of suicide attempts,” Johnson and Brigger wrote. “Patients in the older group have been reported to have significantly higher complication rates because the intentional nature of the injury allows more caustic agent to be ingested.” The average hospital charge per patient was $28,860, with a median of $9,848. The average length of admission was 4.13 days, with a median of 2 days. Overall, 63% of the patients underwent at least one procedure after being hospitalized, including 45% who required an esophagoscopy, 11% who received a direct laryngoscopy, and 9% who received a bronchoscopy. Patients admitted to a teaching hospital were more likely to undergo a procedure compared with those admitted to a nonteaching hospital (P=0.02). “This fact is intriguing in that procedures could have been performed more frequently simply because trainees need the experience but could also be explained by a higher level of acuity at teaching hospitals,” the authors wrote. Boys and patients who lived in areas with a lower median income were significantly more likely to sustain a caustic ingestion injury that required hospitalization (P<0.001 for both). The authors acknowledged that the study was limited by the use of administrative data, which is dependent on the accuracy of the recorded information. In addition, the study captured only those ingestions that resulted in admission to the hospital.