Evaluation of Pediatric Early Warning System and Drooling Reluctance Oropharynx Others Leukocytosis scores as prognostic tools for pediatric caustic ingestion: a two-center, cross-sectional study
- 21 August 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Environmental Science and Pollution Research
- Vol. 29 (4), 5378-5395
- https://doi.org/10.1007/s11356-021-15988-8
Abstract
Caustic chemicals are widely distributed in our environment. Exposure to caustic agents is a lifelong problem associated with severe tissue and mucous membrane injuries. In pediatrics, corrosive exposure is the most common cause of nonpharmaceutical exposure presenting to poison control centers. Therefore, this study evaluated the role of the Pediatric Early Warning System (PEWS) and Drooling Reluctance Oropharynx Others Leukocytosis (DROOL) scores as early in-hospital outcome predictors following corrosive ingestion. The current study was a two-center, retrospective, cross-sectional study carried out among pediatric patients diagnosed with acute caustic ingestion during the past 4 years. Most exposure occurred accidentally among boys (59.4%) living in rural areas (51.9%) of preschool age (50% were 2–4 years old). Residence, body temperature, respiratory rate, vomiting, skin and mucosal burns, retrosternal pain, respiratory distress, Oxygen (O2) saturation, Glasgow Coma Scale score, HCO3 level, total bilirubin level, anemia, leukocytosis, and presence of free peritoneal fluid were significant predictors of esophageal injuries (p < 0.05). DROOL and PEWS scoring were the most significant predictors of esophageal injuries with worthy predictive power, where odds ratio (95% confidence interval (CI)) was 1.76 (0.97–3.17) and 0.47 (0.21–0.99) for PEWS and DROOL, respectively. At a cutoff of < 6.5, the DROOL score could predict esophageal injuries excellently, with AUC = 0.931; sensitivity, 91.7%; specificity, 72.5%; and overall accuracy, 91.3%. At a cutoff of > 6.5, PEWS could significantly predict unfavorable outcomes, with AUC = 0.893; sensitivity, 94.4%; specificity, 71.9%; and overall accuracy, 89.3%. However, PEWS better predicted the need for admittance to the intensive care unit (ICU). Pediatric Early Warning System (PEWS) and Drooling Reluctance Oropharynx Others Leukocytosis (DROOL) are potentially useful accurate scorings that could predict the esophageal injuries and ICU admission following corrosive ingestion in pediatrics.This publication has 56 references indexed in Scilit:
- Corrosive Poisonings in AdultsMateria Socio-Medica, 2012
- Sensitivity of the Pediatric Early Warning Score to Identify Patient DeteriorationPEDIATRICS, 2010
- Oesophageal corrosive injuries in children: a forgotten social and health challenge in developing countriesBulletin of the World Health Organization, 2009
- Chemical injuries of the oesophagus: aetiopathological issues in NigeriaJournal of Cardiothoracic Surgery, 2009
- Pediatric caustic ingestion: 50 consecutive cases and a review of the literatureDiseases of the Esophagus, 2009
- Development and initial validation of the Bedside Paediatric Early Warning System scoreCritical Care, 2009
- Pattern of corrosive ingestion in southwestern Saudi ArabiaSaudi Journal of Gastroenterology, 2009
- Caustic Gastroesophageal Lesions in Childhood: An Analysis of 473 CasesClinical Pediatrics, 2006
- Understanding Toddlers' In-Home Injuries: I. Context, Correlates, and DeterminantsJournal of Pediatric Psychology, 2004
- What is the Utility of Selected Clinical and Endoscopic Parameters in Predicting the Risk of Death after Caustic Ingestion?Endoscopy, 2002