Is Multi-detector Computed Tomography an Early Predictor for Esophageal Injury Following Acute Caustic Ingestion?

Document Type : Original Article

Authors

1 Department of Forensic Medicine and Clinical Toxicology, Poison Control Center, Faculty of Medicine, Ain Shams University Hospitals, Cairo, Egypt.

2 Department of Radiology, faculty of medicine, Ain Shams University, Cairo, Egypt.

Abstract

Background: Caustic ingestion is considered severe condition with poor outcome that mandate early diagnosis to improve the management. Although endoscopy is considered the gold standard of diagnosis worldwide, some authors urge caution in developing treatment plans for patients with caustic ingestion based only on endoscopic findings. Besides, it is not considered as routine management at Ain Shams University hospitals. Recent studies suggests that computed tomography (CT) scan can accurately predict risk of stricture formation and also guide towards more judicious use of surgical management. Aim of the Work: Evaluating the role of Multi-detector Computed Tomography (MDCT) as an early predictor for esophageal injury following acute caustic ingestion and comparing MDCT grading system and DROOL score, for patients with acute caustic ingestion. Subjects and Methods: A prospective cohort study carried out on 50 pediatric patients admitted to Poison Control Center-Ain Shams University Hospitals (PCCASUHs) with history of corrosive ingestion within 24 hours post ingestion. Results: In the current study, (25.6%) of the patients included in the current study had esophageal injury while (74.4%) of them had no esophageal injury. DROOL score (≤ 4) could predict the development of esophageal injury with sensitivity of (90.9%), specificity of (81.2%) and accuracy of (83.7%),(62.5%) positive and (96.3%) negative predictive values. Also CT grades III and IV could predict the development of esophageal injury with sensitivity of (90.9%), specificity of (87.5%) and accuracy of (88.4%), (71.4%) positive and (96.6`%) negative predictive values. AUC for CT grading system (AUC = 0.88) was larger than that for the DROOL scoring system (AUC =0.83). CT grading system had higher specificity and accuracy than DROOL score. Conclusion and Recommendations: The current study concluded that CT grading system can be used as an early predictor for esophageal injury following acute caustic ingestion. It is recommended to evaluate the esophageal injury by doing MDCT for all cases admitted with caustic ingestion even those with mild signs and symptoms.
Received in original form: 8 December 2021 Accepted in a final form: 30 December 2021

Keywords

Ain Shams Journal of Forensic Medicine and Clinical Toxicology
Volume 38, Issue 1
January 2022
Pages 110-118

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