Yiting Li, MD1, Lan Xu, PhD2, Haifeng Cai, MD3, James Langworthy, MD4, Frank Friedenberg, MD, MS4
1Saint Francis Hospital and Medical Center, Trenton, NJ; 2University of South Florida, Tampa, FL; 3Second Affilated Hospital of Wenzhou, Wenzhou, Zhejiang, China; 4Temple University School of Medicine, Philadelphia, PA
Introduction: Caustic ingestion, whether intentional or unintentional, is a potentially devastating event. In particular, highly alkaline material can result in esophageal liquefactive necrosis. Our aim was to provide an estimate of the incidence and outcomes of caustic ingestion among emergency department (ED) visits across the United States.
Methods: The Nationwide Emergency Department Sample (NEDS) is part of the family of databases developed for the Healthcare Cost and Utilization Project (HCUP). We analyzed NEDS for the period 2010-2014. Patients > 18 years with a diagnosis of caustic ingestion were identified by ICD-9 code. Both ICD-9 and Current Procedural Terminology codes were used to identify individuals undergoing endoscopy. All analyses were performed by SAS, Version 9.4 (SAS Institute, Cary, NC).
Results: After data weighting, from 2010 to 2014, there were 46,870 adult ED visits related to caustic ingestion among 533.8 million visits (8.78/100,000; 95% CI 8.70/100,000-8.86/100,000). Overall, 60.6% were age 18-44 years, 29.0% were 45-64, and 10.4% were > 65 years. There were 45.9% males. Disposition: 82.5% visits for caustic ingestion were discharged from the ED, 14.8% were admitted, and 2.5% were transferred to another hospital or facility. For those admitted, median length of stay was 3 days (range: < 24 hours-213 days). The majority of ingestions were intentional while 6.9% of visits were due to accidental ingestion. Co-morbid diagnoses included mood disorder (2.7%) and suicidal ideation or attempt (18.7%). The weighted estimate for requiring ventilator support was 0.2%. Estimated mortality related to caustic ingestion was 0.3%. Endoscopy was uncommon with only 1.1% undergoing this procedure in the ED and 6.1% as an inpatient. Among all ED visits related to caustic ingestion, acute and chronic complications were rarely recorded: esophagitis (2.9%), perforation of esophagus (0.02%), esophageal stricture (0.2%), esophageal hemorrhage (0.04%), and esophageal necrosis (0.3%).
Discussion: Caustic ingestion is rare among all ED visits, and most are discharged directly from the ED. The implication from NEDS is that very few caustic ingestions seen in US emergency departments involve substances at the extremes of the pH scale and in sufficient volume to cause significant injury. For those admitted for caustic ingestion, there was a significant length of stay however inpatient mortality was relatively low.
Citation: Yiting Li, MD; Lan Xu, PhD; Haifeng Cai, MD; James Langworthy, MD; Frank Friedenberg, MD, MS. P0285 - NATIONWIDE ESTIMATE OF EMERGENCY DEPARTMENT VISITS IN THE U.S. RELATED TO CAUSTIC INGESTION. Program No. P0285. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.