Caustic Ingestion : A Risk-Based Algorithm

Background: Caustic ingestion management could be improved with a diagnostic approach based on risk factors. This study aimed to develop an algorithm derived from predictive factors of poor clinical course, to evaluate its diagnostic accuracy and resource consumption and to compare it with two other approaches, one based on CT (1) and the other on symptoms and endoscopy (2). Methods: All patients over 15 years presenting with caustic ingestion in our tertiary care hospital between 1995 and 2021 were prospectively included. Adverse outcome was defined as intensive care unit admission, emergency surgery or death. Ingestion characteristics, symptoms, laboratory and endoscopic findings were analyzed to determine the most relevant risk factors. Diagnostic accuracy and the number of examinations required were estimated and compared with the other two algorithms applied to our series.Findings: The sample included 532 cases of caustic ingestion, 13.2% (95%CI: 10.3–16.0) of which had adverse outcomes. Volume and type of caustic substance, presence of symptoms and pharyngolaryngeal involvement, neutrophilia, acidosis and endoscopic injury were combined to develop an algorithm which would provide the highest diagnostic odds ratio (167.2; 95%CI: 71.9–388.7). Following this approach, half of the patients (50.6%; 95%CI: 46.2–55.1) would not require any examination and overall, the need for endoscopy (20.0%; 95%CI: 16.4–23.5) and CT (16.3%; 95%CI: 13.0–19.5) would be lower than for the other two algorithms.Interpretation: A risk-based algorithm can improve caustic ingestion management by maintaining high diagnostic accuracy while reducing diagnostic test requirements. Funding Information: This research has not been funded.Declaration of Interests: We declare no competing interests. Ethics Approval Statement: The study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki and its later amendments, as reflected in approval by the institution's human research committee, the Clinical Research Ethics Committee of the Hospital Clinic Universitari de Valencia. We followed STROBE reporting guidelines for observational studies