Caustic ingestion. Spanish multicenter study on prognostic severity factors and diagnostic test performance

To characterize the clinical profile of patients treated for oral caustic injury, describe the use of diagnostic tests in emergency departments (EDs), and analyze factors associated with severity and prognosis.

Multicenter, retrospective, observational study including patients treated in EDs for caustic substance ingestion over a 7-year period (2015-2021). Epidemiological, clinical, and diagnostic variables were analyzed, and the prognostic performance of esophagogastroduodenoscopy (EGD) and computed tomography (CT) was evaluated.

A total of 225 patients were included, with a mean age of 44 (SD, 24) years; 52.4% were women. Intentional ingestion accounted for 49.3% of cases. The most prevalent caustic agents were sodium hypochlorite (48.9%) and hydrochloric acid (16.4%). EGD was performed in 84.4% of patients, CT in 24.9%, and both in 20.4%. In the final predictive model, prognostic factors associated with severe injury (Zargar $ IIb and/or Ryu > 2) were: intentional ingestion with OR, 4.19 ( 95% CI 1.71-10.26; P = .002), ammonia with OR, 11.39 ( 95% CI 2.07-62.65; P = .005), and the initial presence of digestive and/or respiratory symptoms. CT showed acceptable performance for detecting initial severe lesions, with a negative predictive value of 75% and a negative likelihood ratio of 0.28; however, it does not definitively replace EGD in less severe cases.

Suicidal intent and the use of highly corrosive caustic agents, together with initial clinical findings, are associated with worse prognosis. CT is useful but does not replace EGD in mild or moderate cases.