Department of Internal Medicine, Seton Hall University School of Health and Medical Sciences, Saint Francis Medical Center, Trenton, NJ, USA.
Gastroenterology and Hepatology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
Dis Esophagus. 2020 Jun 15;33(6). doi: 10.1093/dote/doaa012.
Caustic ingestion, whether intentional or unintentional, may result in significant morbidity. Our aim was to provide an estimate of the incidence and outcomes of caustic ingestion among emergency department (ED) visits across the United States.
The Nationwide Emergency Department Sample (NEDS) is part of the family of databases developed for the Healthcare Cost and Utilization Project. We analyzed NEDS for the period 2010-2014. Adults (≥18 years of age) with a diagnosis of caustic ingestion were identified by ICD-9 codes. The weighted frequencies and proportions of caustic ingestion-related ED visits by demographic characteristics and disposition status were examined. A weighted multivariable logistic regression model was performed to examine factors associated with inpatient admission for caustic ingestion-related visits.
From 2010 to 2014, there were 40,844 weighted adult ED visits related to caustic ingestion among 533.8 million visits (7.65/100,000, 95% CI 7.58/100,000-7.73/100,000), resulting in over $47 million in annual cost. Among ED visits related to caustic ingestion, 28% had comorbid mental and substance use disorders. Local and systemic complications were rare. There was significant regional, gender, and insurance variability in the decision as to perform endoscopy. Males, insured patients, patients domiciled in the Southeast region of the United States, and patients with mental or substance use disorders had significantly higher percentages of receiving endoscopic procedures. Overall, 6,664 (16.27%) visits resulted in admission to the same hospital and 1,063 (2.60%) visits resulted in transfer to another hospital or facility. The risk factors for admission were increasing in age, male gender, local or systemic complications related to caustic ingestion, and comorbid mental and substance use disorders. A total of 161 (0.39%) patients died related to caustic ingestion.
Our results from NEDS provide national estimates on the incidence of caustic ingestions involving adults seen in US EDs. Further studies are needed to examine the standard management of caustic ingestion and investigate the factors causing variability of esophagogastroduodenoscopy performance and caustic ingestion care.
腐蚀性物质摄入，无论是故意还是无意的，都可能导致严重的发病率。我们的目的是提供美国急诊科就诊的腐蚀性物质摄入发生率和结果的估计。
国家急诊科样本（NEDS）是为医疗保健成本和利用项目开发的数据库家族的一部分。我们分析了 2010-2014 年期间的 NEDS。通过 ICD-9 代码识别出有腐蚀性物质摄入诊断的成年人。按人口统计学特征和处置状态检查腐蚀性物质摄入相关急诊科就诊的加权频率和比例。进行加权多变量逻辑回归模型以检查与腐蚀性物质摄入相关就诊的住院相关因素。
从 2010 年到 2014 年，在 5.333 亿次就诊中，有 40844 次成人急诊科就诊与腐蚀性物质摄入相关（7.65/100000，95%CI 7.58/100000-7.73/100000），每年造成超过 4700 万美元的费用。在与腐蚀性物质摄入相关的急诊科就诊中，28%有合并的精神和物质使用障碍。局部和全身并发症罕见。内镜检查的决策存在明显的区域、性别和保险差异。男性、有保险的患者、居住在美国东南部的患者以及有精神或物质使用障碍的患者，接受内镜检查的比例显著更高。总体而言，6664 次（16.27%）就诊导致在同一家医院住院，1063 次（2.60%）就诊导致转至另一家医院或设施。住院的危险因素包括年龄增长、男性、与腐蚀性物质摄入相关的局部或全身并发症以及合并的精神和物质使用障碍。共有 161 名（0.39%）患者因腐蚀性物质摄入死亡。
我们从 NEDS 获得的结果提供了美国急诊科就诊的成年腐蚀性物质摄入发生率的全国估计。需要进一步研究来检查腐蚀性物质摄入的标准管理，并调查导致食管胃十二指肠镜检查表现和腐蚀性物质摄入护理差异的因素。
