Risk Management and Healthcare Policy (Sep 2020)
The Association Between Caustic Ingestion and Psychiatric Comorbidity Based on 396 Adults Within 20 Years
Abstract
Yu-Jhou Chen,1,2,* Chen-June Seak,2– 4,* Chien-Cheng Chen,2,5,6 Tsung-Hsing Chen,1,2,5 Shih-Ching Kang,7 Chip-Jin Ng,2,4 Chao-Wei Lee,8 Ming-Yao Su,2,9,10 Hsin-Chih Huang,1,2,9 Chun-Hsiang Ooyang,7 Sen-Yung Hsieh,1,2 Hao-Tsai Cheng1,2,5,9 1Department of Gastroenterology and Hepatology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; 2College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; 3Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 23652, Taiwan; 4Department of Emergency Medicine, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; 5College of Medicine, Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan 33302, Taiwan; 6Department of Medical Image and Intervention, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; 7Division of Trauma and Emergent Surgery, Department of Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; 8Division of General Surgery, Department of Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; 9Department of Gastroenterology and Hepatology, Department of Internal Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 23652, Taiwan; 10Board of Directors and Supervisors, Taiwan Association for the Study of Small Intestinal Disease (TASSID), Taoyuan 33305, Taiwan*These authors contributed equally to this workCorrespondence: Hao-Tsai ChengDepartment of Gastroenterology and Hepatology, New Taipei Municipal TuCheng Hospital, No 6, Sec. 2, Jincheng Road, Tucheng Dist., New Taipei City 236, Taiwan (Republic Of China)Tel +886-2-22630588 ext. 6185Fax +886-2-22732688Email [email protected]: High prevalence of psychiatric comorbidities (PCs) has been widely documented in caustic substance ingestion cases. However, their effect on the clinical features and prognostic outcomes remains unclear due to the paucity of discussion. We report on detailed clinical courses with long-term multifaceted outcomes and review the association between caustic ingestion and each specific PC.Patients and Methods: The retrospective chart review included 396 adults (median follow-up, 16.6 months) with and 377 without (control group) PCs treated between 1999 and 2018 at Chang Gung Memorial Hospital. All PCs were diagnosed/confirmed by psychiatrists through face-to-face interviews.Results: The PCs predicted serious esophagogastroduodenoscopy grading, higher rates of admission/surgery/intensive care unit stay, increments of systemic/gastrointestinal complications, and poorer 5-year overall survival rates. The poor survival among patients with PCs was highly consistent with their baseline characteristics. Significantly advanced age, more non-PCs, alcoholism, illicit drug abuse, and baseline unhealthy status resulted in statistically higher risks of severe complications and limited recovery.Conclusion: PCs changed clinical patterns and had critical roles in the survival outcomes of caustic injury victims. Clinical awareness achieves benefit by limiting injuries in mild cases or allowing emergent interventions in severe cases. Future studies based on worldwide populations are essential for realizing geographic differences.Keywords: caustic, corrosive, psychiatric, endoscopy, complications, long-term survival
