الفهرس 
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Abstract
Caustic ingestion is a frequent presentation to emergency departments and early identification of poor outcome is essential for early decision making and better management plan. Till now, in our hospitals, there is no early predictor for esophageal injury in cases of acute caustic ingestion because endoscopy –despite being the gold standard in corrosive cases- is not done, as it is invasive, thus carrying the risk of perforation, together with the fact of being an added suffering for a patient that is already in pain. Moreover, it doesn’t visualize accurately the esophageal muscle layer burns and necrosis which lead to esophageal stricture, unlike Computed Tomography (CT) scan which is non-invasive and shows both the esophageal wall and the extramural extent of the disease.
This study aimed to evaluate the role of Multi-detector Computed Tomography (MDCT) scan as an early predictor for esophageal injury and also to compare CT grading system with DROOL score in predicting development of esophageal injury in patients with acute caustic ingestion.
A prospective cohort study was carried out on 50 patients admitted to the Poison Control Center of Ain Shams University hospitals with history of corrosive ingestion within the previous 24 hours from June 2018 to October 2019. The diagnosis of corrosive ingestion was based on history of ingestion of caustic agent and initial symptoms and signs. The collected data was recorded in a special observational sheet for each patient.
The data was tabulated and statistically analyzed and revealed that:
Most of corrosive intoxicated patients in the current study didn’t develop esophageal injury (74.4%) and only (25.6%) of the patients had esophageal injury.
The most common esophageal injury that occurred after ingestion of caustic agents in the current study was stricture formation (21.4%) followed by gastro-esophageal reflux disease (GERD) in (2.3%) of the cases and esophageal scarring with no stricture in (2.3%) of the cases.
In the current study, Drool Score was applied on all patients. It was based on the duration and the severity of the initial symptoms and signs. It was found that Drool Score ≤ 4 can predict esophageal injury in corrosive intoxicated patients with (90.9%) sensitivity, (81.2%) specificity, (83.7%) accuracy.
Multi-detector Computed Tomography (MDCT) scan of the chest and upper abdomen was done for all patients. CT grading system was applied. It was found that CT grades (III and IV) can predict esophageal injury in corrosive intoxicated patients with (90.9%) sensitivity, (87.5%) specificity, (88.4%) accuracy. CT grades III and IV have (96.6%) negative predictive value, meaning that few strictures would be missed if grade I and II on CT are treated conservatively. The current study demonstrates that CT grading system of esophageal damage is a discriminant predictor for esophageal injury after caustic ingestion.
Moreover, the current study showed that the receiver operating characteristic (ROC) curve was used to compare the CT grading system and DROOL score. ROC curve analysis showed that CT outperformed DROOL score in predicting esophageal injury. The CT grading system resulted in larger area under (ROC) curve compared with DROOL score.
CT grading system described higher specificity (87.5%) in predicting esophageal injury compared with DROOL score (81.2%). CT grading also showed higher accuracy (88.4%) in predicting esophageal injury compared with DROOL score (83.7%). The sensitivity of both systems were the same (90.9%).
It was also found that CT was superior to barium study in predicting development of GERD as a complication of caustic ingestion.