HSC Section 3 - Trauma, Critical Care and Sleep Medicine

Reprinted by permission of Clin Otolaryngol. 2017; 42(3):701-708.

Controversies in the management of caustic ingestion injury: an evidence-based review Bird, J.H., Kumar, S., Paul, C. & Ramsden, J.D.

O R I G I N A L A R T I C L E

ENT Department, John Radcliffe Hospital, University of Oxford, Oxford, UK

Accepted for publication 24 December 2016 Clin. Otolaryngol. 2017, 42 , 701 – 708

Background: Caustic ingestion of acid or alkaline sub- stances can cause damage to the upper respiratory and upper digestive tract. Initial presentation following caustic inges- tion can include oropharyngeal pain, dysphagia and stridor. It is due to this clinical presentation that the resident otolaryngologist is consulted to review and examine these patients to assess for airway compromise and commence initial management and care until airway concern has passed. Objective of review: This review aims to provide evidence- based guidance in the management of those presenting with acute ingestion injury so that informed initial medical therapy can be commenced and appropriate investigations are arranged to optimize patient outcome. Type of review and search strategy: A literature review searched PubMed citing variations on the areas of contro- versies with ‘caustic ingestion’, ‘corrosive ingestion’, ‘acid ingestion’ and ‘alkali ingestion’ – from 1956 to present with language restrictions. Evaluation method: The bibliographies of articles were searched for relevant references. The references were then compiled and reviewed independently by two authors (JB Caustic ingestion of either acid or alkaline substances can cause damage to the upper respiratory and upper digestive tract. 1,2 The resultant injury can range from non-significant to life-threatening or chronic. From 2010 to 2011, there were over 1000 admissions resulting from the ingestion or complication of corrosive substances on the upper aerodi- gestive tract in England. 3 Up to 80% of all cases are paediatric due to accidental ingestion. 4 Adult cases are most common in those who attempt suicide, those with a psychiatric history and in those with a history of alcohol addiction. 5,6

and SK), overseen by the senior authors (CP and JR). The review process was conducted independently, with the results then collated, with the aim of identifying the highest levels of evidence in each of the areas of controversy. Results: Over 100 full-text articles were retrieved. Several specific areas of controversy were identified and addressed, with the highest available evidence referenced for each area. Conclusions: In caustic ingestion injury, the urgent assessment of the airway is the first priority with a definitive airway secured in those with airway compromise. In those patients with a stable airway and no clinical or radiological sign of perforation, then medical therapy should be commenced and an urgent oesophagogastroduodenoscopy (OGD) is arranged and this should take place within the first 24 h to grade the degree of injury and establish long-term prognosis. In suspected perforation, a surgical opinion should be sought. For those adults who are asymptomatic following ingestion an OGD may not be necessary; however, asymptomatic paediatric patients should be treated with more caution and a period of observation is important. Those who are at risk of developing late complications must be followed up. Initial presentation following caustic ingestion can include oropharyngeal pain, dysphagia, vomiting, drooling and stridor. 7 It is often due to this clinical presentation that the resident otolaryngologist is consulted primarily to review and examine these patients to assess for airway compromise and commence initial management until airway concern has passed. To date, there is not a clear algorithm to help guide the otolaryngologist in the initiation of medical therapy, requesting of investigations and the involvement of other medical specialties including anaesthetists, radiologists and gastroenterologists. The aim of this review is to help formulate an evidence-based guideline so that these patients can be optimally managed and investigated with appropriate involvement of other medical specialties in a timely fashion.

Correspondence: J.H. Bird, Department of ENT Surgery, Royal Berkshire Hospital, Reading, UK. Tel: 07931 102910; fax: 0118 322 5111; e-mail: jonathan.bird83@googlemail.com

© 2016 John Wiley & Sons Ltd Clinical Otolaryngology 42 , 701–708

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