In-Hospital Mortality in Patients with Corrosive Ingestion at A Tertiary Care Hospital

Muhammad  Raza; Ayesha  Tariq; Muhammad  Mukhtar; Ali  Raza

doi:10.54112/bcsrj.v6i6.1830

Authors

Muhammad Raza Nishtar Medical University and Hospital, Multan, Pakistan
Ayesha Tariq Nishtar Medical University and Hospital, Multan, Pakistan
Muhammad Mukhtar Ibn-E-Siena Hospital and Research Institute, Multan, Pakistan
Ali Raza Liaqat National Hospital and Medical College, Karachi, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i6.1830

Keywords:

Corrosive Injuries, Frequency, Hospital Mortality, Pakistan, Socioeconomic Factors, Tertiary Care

Abstract

Corrosive substance ingestion is a critical medical emergency that can lead to serious complications, including in-hospital mortality. The clinical outcomes often depend on the intent of ingestion, socioeconomic factors, and timely management. In developing countries, the burden of corrosive intake-related morbidity and mortality remains significant, yet underreported. Objective: To evaluate the frequency of in-hospital mortality among patients with corrosive ingestion at a tertiary care hospital in Pakistan. Methods: This descriptive case-series study was conducted at the Department of Thoracic Surgery, Nishtar Hospital, Multan, from June 4, 2023, to June 3, 2024. A total of 276 patients hospitalised with corrosive ingestion were enrolled using non-probability consecutive sampling. Patients were followed from admission until discharge to determine in-hospital mortality. A structured proforma was used to collect data on demographics (age, gender, marital status, residential status, education), socioeconomic status, and cause of ingestion (accidental, suicidal, or homicidal). Statistical analysis was performed using SPSS version 25.0. The Chi-square test was applied to determine associations, with a 95% confidence interval and p-value <0.05 considered statistically significant. Results: Out of 276 patients, 117 (42.4%) were male and 159 (57.6%) were female. The most common cause of ingestion was suicidal (87.0%), followed by accidental (10.5%) and homicidal (2.5%). In-hospital mortality was recorded in 19 patients (6.9%). A statistically significant association was observed between socioeconomic status and mortality, with 73.7% of deaths occurring in the low-income group and 22.3% in the lower-middle-income group (p = 0.003). Mortality was noted in 15.8% of accidental cases, 68.4% of suicidal cases, and 15.8% of homicidal instances, though this association was not statistically significant (p = 0.618). Conclusion: Although the overall in-hospital mortality rate from corrosive ingestion was not exceedingly high, it was significantly associated with lower socioeconomic status. Effective and timely management, multidisciplinary care, and psychological intervention remain essential to improve clinical outcomes in these patients.

Downloads

Download data is not yet available.

References

Kamat R, Gupta P, Reddy YR, Kochhar S, Nagi B, Kochhar R. Corrosive injuries of the upper gastrointestinal tract: A pictorial review of the imaging features. Indian J Radiol Imag. 2019;29(1):6. https://doi.org/10.4103/ijri.ijri_349_18

Meena BL, Narayan KS, Goyal G, Sultania S, Nijhawan S. Corrosive injuries of the upper gastrointestinal tract. J Digest Endosc. 2017;8(04):165-9. https://doi.org/10.4103/jde.JDE_24_16

Chibishev A, Markoski V, Smokovski I, Shikole E, Stevcevska A. Nutritional therapy in the treatment of acute corrosive intoxication in adults. Mat Soc Med. 2016;28(1):66. https://doi.org/10.5455/msm.2016.28.66-70

Ray D, Chattopadhyay G. Surgical management of gastric outlet obstruction due to corrosive injury. Indian J Surg. 2015;77(2):662-5. https://doi.org/10.1007/s12262-013-0969-2

Hashmi MU, Ali M, Ullah K, Aleem A, Khan IH. Clinico-epidemiological Characteristics of Corrosive Ingestion: A Cross-sectional Study at a Tertiary Care Hospital of Multan, South-Punjab, Pakistan. Cureus. 2018;10(5). https://doi.org/10.7759/cureus.2704

Chen RJ, O’Malley RN, Salzman M. Updates on the Evaluation and Management of Caustic Exposures. Emergency Medicine Clinics. 2022 May 1;40(2):343-64. https://doi.org/10.1016/j.emc.2022.01.013

Kalipatnapu S, Reddipogu JS, George SV, Abraham V, Samarasam I. Corrosive injuries of the upper gastrointestinal tract: A review of management practices. Current Medical Issues. 2018;16(3):92. https://doi.org/10.4103/cmi.cmi_34_18

Gupta V, Kurdia KC, Sharma A, Mishra AK, Yadav TD, Kochhar R. Tracheoesophageal fistula in adults due to corrosive ingestion: challenges in management. Update Surg. 2015;67(1):75-81. https://doi.org/10.1007/s13304-015-0292-5

Chen CM, Chung YC, Tsai LH, Tung YC, Lee HM, Lin ML, et al. A nationwide population-based study of corrosive ingestion in Taiwan: incidence, gender differences, and mortality. Gastroenterol Res Pract. 2016;2016. https://doi.org/10.1155/2016/7905425

Qureshi S, Ghazanfar S, Leghari A, Tariq F, Niaz SK, Quraishy MS. Benign oesophagal strictures: Behaviour, pattern and response to dilatation. J Pak Med Assoc. 2010;60(8):656. PMID: 20726198

Poley JW, Steyerberg EW, Kuipers EJ, Dees J, Hartmans R, Tilanus HW, et al. Ingestion of acid and alkaline agents: outcome and prognostic value of early upper endoscopy. Gastrointest Endosc. 2004;60:372–377. https://doi.org/10.1016/S0016-5107(04)01722-5

Ertekin C, Alimoglu O, Akyildiz H, Guloglu R, Taviloglu K. The results of caustic ingestions. Hepato-gastroenterol. 2004;51(59):1397-400. PMID: 15362762

Rigo GP, Camellini L, Azzolini F, Guazzetti S, Bedogni G, Merighi A, et al. What is the utility of selected clinical and endoscopic parameters in predicting the risk of death after caustic ingestion? Endoscopy. 2002;34:304–310. https://doi.org/10.1055/s-2002-23633

Qureshi U, Ghazanfer R, Hasan SW, Ahmed HB, Siddique S, Khan JS, et al. Implications of Social Factors and Management Outcomes Among Patients with Corrosive Ingestion. Dent. 2022;11(4):22-28. DOI: https://doi.org/10.36283/PJMD11-4/004

Bharath Kumar C, Chowdhury SD, Ghatak SK, Sreekar D, Kurien RT, David D, et al. Immediate and long-term outcomes of corrosive ingestion. Indian J Gastroenterol. 2019;38(4):356-61. https://doi.org/10.1007/s12664-019-00978-z

Mahmoud A, Mohammed E, Al Husseini R, Bilal S. Risk Factors Predicting Stricture Formation and Death in Patients with Caustic Ingestion. Ain Shams J Forensic Med Clin Toxicol. 2019;32(1):10-9. https://doi.org/10.21608/ajfm.2019.23377

Jalal G, Windy M, Badrane N, Rhalem N, Soulaymani-Bencheikh R. Descriptive study of reported cases of intoxication by caustic household" hydrochloric acid" in Morocco. CLIN TOXICOL 2014;52(4):429-429.

Challine A, Maggiori L, Katsahian S, Corté H, Goere D, Lazzati A, et al. Outcomes associated with caustic ingestion among adults in a National Prospective Database in France. JAMA Surg. 2022;157(2):112-19. https://doi.org/10.1001/jamasurg.2021.6368

Struck MF, Beilicke A, Hoffmeister A, Gockel I, Gries A, Wrigge H, et al. Acute emergency care and airway management of caustic ingestion in adults: single-centre observational study. Scand J Trauma Resusc Emerg Med. 2016;24(1):1-8. https://doi.org/10.1186/s13049-016-0240-5

Datta A, Nath A, Debbarma J. A cross-sectional study of poisoning deaths by rubber latex processing acid in Tripura, India. Med J Armed Forces India. 2022. https://doi.org/10.1016/j.mjafi.2022.11.003