Summary

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

María Codinach-Martín11, Antonio Francisco Caballero-Bermejo2,3, María Teresa Maza-Vera4, Valle Molina-Samper5, Clara Serrano-Ferrer6, Oriol Pallás-Villaronga7, Antonio Dueñas-Ruiz8, Belén Ruiz-Antoran2,3, Pere Planellas-Giné9, Antoni Codina-Cazador9, Jordi Puiguriguer-Ferrando10

Affiliation of the authors

1Servicio de Urgencias, Hospital Doctor Josep Trueta, Girona, Spain. 2Unidad de Toxicología Clínica, Servicios de Urgencias y Farmacología Clínica, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain. 3Facultad de Medicina y Ciencias de la Salud, Universidad Nebrija, Madrid, Spain. 4Servicio de Urgencias, Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo, Vigo, Spain. 5Servicio de Urgencias, Hospital Universitario de Navarra, Navarra, Spain. 6Servicio de Medicina Intensiva, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain. 7Servicio de Urgencias, Hospital del Mar, Barcelona, Spain. 8Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Valladolid, Spain. 9Servicio de Cirugía General, Hospital Doctor Josep Trueta, Girona, Spain. 10Servicio de Urgencias, Hospital Son Espases, Palma de Mallorca, Spain.

DOI

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Codinach-Martín M, Caballero-Bermejo AF, Maza-Vera MT, Molina-Samper V, Serrano-Ferrer C, Pallás-Villaronga O, et al. Caustic ingestion. Spanish multicenter study on prognostic severity factors and diagnostic test performance. Emergencias. 2026;38:269-75

Summary

Objective.

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.

Methods.

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.

Results.

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.

Conclusions.

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.

 

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