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Abstract
Objective: To determine the association between clinical features documented at emergency department (ED) arrival and emergency airway intervention among adults with suspected kala pathar (paraphenylenediamine, PPD) ingestion, and to estimate the frequency and type of that intervention.
Study Design: Prospective, observational, analytical, cross-sectional study.
Setting: Accident and Emergency Department, Jinnah Postgraduate Medical Centre (JPMC), Karachi.
Period: Four month from December 2024 to March 2025.
Material & Methods: 384 adults with suspected PPD ingestion were enrolled by non-probability purposive sampling. A structured one-page proforma recorded dysphagia, altered voice, tongue swelling, face/neck swelling, stridor, respiratory rate, room-air SpO₂ and Glasgow Coma Scale (GCS) at first clinician assessment, before the airway decision wherever feasible. The primary outcome was emergency airway intervention (endotracheal intubation or emergency surgical airway) during the initial ED encounter. Associations were tested with the chi-square/Fisher exact test and independent-samples t/Mann-Whitney U test, followed by multivariable logistic regression, using SPSS version 26; two-sided p<0.05 was taken as significant.
Results: Emergency airway intervention was performed in 139/384 patients (36.2%): 85 (61.2%) tracheostomies and 54 (38.8%) endotracheal intubations. All five prespecified arrival signs, respiratory rate, SpO₂ and prior supplemental oxygen were associated with intervention on bivariate analysis (p<0.05). After adjustment for age, time since ingestion and the five arrival signs, visible tongue swelling (adjusted OR 2.75, 95% CI 1.37–5.51, p=0.004) and audible stridor (adjusted OR 2.97, 95% CI 1.61–5.47, p=0.001) remained independently associated with intervention.
Conclusion: Visible tongue swelling and audible stridor recorded at first ED assessment independently identified kala pathar ingestion patients who went on to need emergency airway intervention, supporting their use for rapid bedside triage in this setting.