A clinical decision rule for triage of children under 5 years of age with hydrocarbon (kerosene) aspiration in developing countries

Abstract

Background. Unintended hydrocarbon ingestion is a common reason for pediatric hospitalization in the developing world. Objective. To derive a clinical decision rule, to identify patients likely to require a higher level facility (resource-requiring cases), that can be used at primary health care facilities with limited diagnostic and therapeutic resources. Methods. A prospective study of children 2 to 59 months old presenting to a poison treatment facility within 2 hours of oral hydrocarbon exposure. History and objective signs were recorded at admission and at 6, 12, 24 and, if present, 48 hours. Inclusion in the resource-requiring outcome group required: oxygen saturation <94%; any CNS depression; any treatment with (salbutamol); any care in the ICU; or death. Results. 256 met the inclusion criteria and completed the study. Of these, 170 had a course requiring resources unavailable at most primary health care facilities, and 86 did not. The presence of wheezing, any alteration in consciousness (lethargy or any restlessness), or a rapid respiratory rate for age (RR ≥50/min if age < 12mo, ≥ 40/min if age ≥ 12 mo) at presentation identified 167 of 170 of these patients (sensitivity 0.98). Thirty-six of 86 patients classified as non-resource requiring were correctly identified (specificity 0.42). No combination of clinical symptoms provided better discrimination while preserving sensitivity. Conclusions. This study suggests a triage decision rule based on the presence of wheezing, altered consciousness, or a rapid respiratory rate within 2 hours of hydrocarbon exposure. Such a rule requires validation in other settings.

Keywords: :

• Aspiration
• Hydrocarbon
• Kerosene
• Pediatric
• Poisoning

Acknowledgments

The authors wish to thank Dr. Ligia Fruchtengarten (Poison Control Centre of Sao Paulo, Sao Paulo, Brazil), Dr. A. Mandil (Public Health Institute, University of Alexandria, Alexandria, Egypt), and Dr. M. Gadallah (Ain Shams University, Cairo, Egypt) for their helpful review of the study protocol, and Dr. S. Farhoud (WHO, Cairo, Egypt) for her support to the study.

Funding for the study was provided by the World Health Organization Regional Office for the Eastern Mediterranean (WHO EMRO). The results of this study were presented at the North American Congress of Clinical Toxicology, Orlando, Florida, USA on September 11, 2005 and appeared in abstract form in Clinical Toxicology 2005; 43:634.