الفهرس 
Corrosive
Epidemiology and incidenceOnly 14 pages are availabe for public view
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Abstract
Caustic ingestion continues to be a major health hazard in developed and developing countries. A large number of patients have mild post-corrosive injuries and most often recover without serious complications, but significant number of patients have severe chemical injuries and complications of the upper gastrointestinal tract and a high percentage of mortality.
Prediction of the presence and severity of esophageal injury following ingestion of a caustic substance is a challenging problem. The use of initial symptoms and signs or laboratory tests to predict the outcome of esophageal injury is controversial.
One study developed a new score known as DROOL Score, which is a new prognostic method based on initial symptoms and signs to predict stricture formation without endoscopic grading.
The aim of this work was to study the value of the intoxication data, clinical findings and certain laboratory parameters in the early prediction of the outcome following corrosive ingestion, and test the applicability of DROOL Score as a prognostic indicator of esophageal stricture.
The present study is a prospective cohort study performed on patients admitted to poison control center of Ain Shams University Hospital (PCCA) with history of corrosive ingestion during the period from the 1st of June 2015 to the 30th of November 2015. During the period of the present study the total number of patients with corrosive poisoning that presented to the emergency department were 1010, 92 patient were subjected in the current study,6 patients died.
An observational sheet was designed and was fed by patients̓ data on admission and during the hospital stay and the following were studied:
A. Sociodemographic data.
B. Intoxication data.
C. Clinical data.
D. Investigations.
E. Therapeutic intervention.
F. The DROOL Score results.
G. Outcome.
The data were tabulated and statistically analyzed and revealed that:
The majority of cases were children less than 5 years old (66.2%) and more than half of the patients were males (54.3%). Most of the patients were from rural areas (76.1%). Most of the patients or the parents of the intoxicated patients had secondary educational level (42.4%), and most of them were unemployed (81.5%).
The main mode of exposure was accidental exposure (85.9%). The most common caustic agents in the current study was alkali agents (48.9%), they were stored mainly in non-original containers (81.5%). Liquid form was the most common form (88%) and the ingested amount was unknown in almost all patients in the current study (97.8%). The mean value of the delay time was 5.82 ± 7.762 hours. Most of the cases were admitted in summer months (80.4%).
Most of corrosive intoxicated patients in the current study recovered without complication (72.8%), stricture formation occurred in 17 patients (18.4%) and only 6 patients died (6.5%). The most common complication that occurred after ingestion of caustic agents in the current study was stricture formation (18.4%).
In the current study the relation between intoxication data and the outcome of corrosive intoxicated patients was studied. It was found that the preconsultation treatment and the delay time were significantly related to the incidence of stricture formation. While mode of exposure had a significant relation with the mortality of intoxicated patients.
In the current study the gastrointestinal system was the most common affected system after ingestion of caustic agents. The relation between the clinical manifestations and the outcome of corrosive intoxicated patients were studied. It was found that the presence of hoarseness of voice, drooling of saliva, abdominal pain, dysphagia, odynophagia, oral lesions, tachypnea and dyspnea as initial manifestations and the development of chest infection and persistent fever during hospital stay were significant manifestations that can predict the occurrence of stricture in corrosive intoxicated patients.Regarding the mortality of intoxicated patients, the presence of hematemesis, melena, dysphagia, drooling of saliva, tachypnea and respiratory distress as initial manifestations can predict high risk of mortality in corrosive intoxicated patients.
Also some laboratory parameters as blood pH and TLC can predict the outcome of corrosive intoxicated patients. In the current study it was concluded that TLC ≥ 20,000 can predict both the incidence of stricture formation and the mortality, while blood pH ˂ 7.2 can predict only the mortality of corrosive intoxicated patients.
In the current study the Drool Score was applied which was easily applied and non-invasive, it was based on the duration and the severity of the initial symptoms and signs to predict the incidence of stricture formation. It was found that Drool Score can predict both the incidence of stricture formation and the mortality of corrosive intoxicated patients. Also a new value (≤ 5.5) that was more sensitive and specific to predict the outcome of corrosive intoxicated patients was concluded.