Economic impact andjudicial consequences of corrosive ingestion in children

Abstract

Objective: The ingestion of caustic agents is a major public health problem in our region. We carried out a study to investigate economic impact and judicial consequences incurred by children who ingested corrosive materials. Material and Methods: Between January 1999 and April 2007, 259 patients (145 boys and 114 girls) admitted to our department with accidental caustic agent ingestion were evaluated retrospectively. Direct medical cost incurred by corrosive agent ingestion was calculated. All cases were reported as judicial cases according to the legislation at first admission to the hospital. Judicial follow-up data of these children were derived from their files in the police department and other official records. Results: The mean age of the children was 3,4±2,28 (1-14) years. Five cases had other home accident. Either sisters or brothers of ten cases had a history of corrosive ingestion or extravehicular traffic accident. One case ingested corrosive material repeatedly. One case had a history of drug intoxication. Mostly HNO3 solution was ingested in different concentrations (32 %). First degree esophageal burn was detected in 42 % of the cases. In 2.3 % of the cases esophageal stricture was observed. Three patients operated due to gastric outlet obstruction and one patient for gastroesophageal reflux. The mean duration of hospital stay was 3.5±4,6 days (1-41). The mean total direct medical cost of care calculated per patient was $$214±177 ($$26-2021). The direct medical cost of care increased with the duration of hospital stay. Judicial decision was in favour of acquittal in all cases. Conclusion: Corrosive ingestion is a totally preventable disease and the cost of preventing corrosive ingestion is uncomparably higher relative to it's mortality, morbidity and cost of care. In our opinion the parents should undergo further detailed judicial investigation and Social Service Specialist should be involved in all cases. The sale of chemicals should be in sealed containers with special security lids. All firms violating the related regulations should be penalized.