Diagnostic Accuracy of Computed Tomography Scan in Detection of Upper Gastrointestinal Tract Injuries Following Caustic Ingestion
Archives of Academic Emergency Medicine,
Vol. 5 No. 1 (2017),
1 January 2017
,
Page e61
https://doi.org/10.22037/aaem.v5i1.186
Abstract
Introduction:Â Endoscopy is an invasive procedure and finding noninvasive alternative tools in detection of probable upper gastrointestinal (GI) tract injuries following caustic ingestion is an area of interest. The present study aimed to evaluate the screening performance characteristics of thoraco-abdominal computed tomography (CT) scan in this regard.
Methods:Â This prospective cross sectional study was conducted on patients presenting to emergency department following acute caustic ingestion. The findings of CT scan and endoscopy regarding the presence of upper GI tract damage were compared and screening performance characteristics of CT scan were calculated using MedCalc software.
Results: 34 patients with the mean age of 35.38±13.72 years were studied (58.8% male). The agreement rate between CT scan and endoscopy regarding the grade of esophageal and gastric injuries was moderate (K= 0.38; p = 0.001) and fair (K= 0.17; p = 0.038), respectively. The sensitivity and specificity of CT scan in detection of esophageal damage were 96.29) 79.11- 99.80) and 57.14 (20.23 - 88.19), respectively. These measures were 89.65 (71.50 - 97.28) and 40.00 (7.25 - 82.95), respectively for gastric damage. The area under the ROC curve of CT scan in detection of esophageal and gastric damages was 0.76 (95% CI: 0.52 – 1.00) and 0.64 (95% CI: 0.35 – 0.94), respectively.
Conclusion:Â Based on the findings of the present study, CT scan could be considered as a sensitive tool in ruling out upper gastrointestinal mucosal injuries following acute caustic ingestions. However, the correlation between endoscopy and CT scan findings regarding the grading of injury is not high enough to eliminate the need for endoscopy.Â
- Caustics
- eating
- Burns
- Chemical
- Tomography
- X-Ray Computed
- Endoscopy
How to Cite
References
Quingking CG, Dioquino C, Pascual J. Predictive Factors of Gastrointestinal Caustic Injury According to Clinical and Endoscopic Findings. Asia Pacific Journal of Medical Toxicology. 2013;2(1):19-22.
Alipour Faz A, Arsan F, Peyvandi M, Oroei M, Shafagh O, Yousefi M, et al. Epidemiologic Features and Outcomes of Caustic Ingestions; a 10-Year Cross-Sectional Study. Emergency. 2017;5(1): e56.
Cheng H-T, Cheng C-L, Lin C-H, Tang J-H, Chu Y-Y, Liu N-J, et al. Caustic ingestion in adults: the role of endoscopic classification in predicting outcome. BMC gastroenterology. 2008;8(1):31.
Cello JP, Fogel RP, Boland CR. Liquid caustic ingestion spectrum of injury. Archives of internal medicine. 1980;140(4):501-4.
Mittal BR, Bhoil A, Kashyap R, Bhattacharya A, Dutta U, Kochhar R. 99mTc-Pertechnetate Scintigraphy and Endoscopy in Assessment of Caustic-Induced Gastric Mucosal Injury. Clinical nuclear medicine. 2013;38(3):e146-e7.
Bonnici K, Wood D, Dargan P. Should computerised tomography replace endoscopy in the evaluation of symptomatic ingestion of corrosive substances? Clinical Toxicology. 2014;52(9):911-25.
Tewfik T, Schloss M. Ingestion of lye and other corrosive agents--a study of 86 infant and child cases. The Journal of otolaryngology. 1980;9(1):72-7.
Azadegan M, Ranjbar H. Clinical signs and endoscopic findings of the upper gastro intestinal tract in patients admitted at Toxication Department of Loghman Hakim Hospital in Tehran with the history of caustic substances ingestion (acid or alkaline) in 2007. Pejouhandeh. 2009;14(3).
Celik B, Nadir A, Sahin E, Kaptanoglu M. Is esophagoscopy necessary for corrosive ingestion in adults? Diseases of the Esophagus. 2009;22(8):638-41.
Ananthakrishnan N, Parthasarathy G, Kate V. Acute corrosive injuries of the stomach: a single unit experience of thirty years. ISRN gastroenterology. 2010;2011.
Keh SM, Onyiioc N, McManus K, McGuigan J. Corrosive injury to upper gastrointestinal tract: Still a major surgical dilemma. World journal of gastroenterology. 2006;12(32):5223.
Lurie Y, Slotky M, Fischer D, Shreter R, Bentur Y. The role of chest and abdominal computed tomography in assessing the severity of acute corrosive ingestion. Clinical Toxicology. 2013;51(9):834-7.
Contini S, Scarpignato C. Caustic injury of the upper gastrointestinal tract: a comprehensive review. World J Gastroenterol. 2013;19(25):3918-30.
Zargar SA, Kochhar R, Mehta S, Mehta SK. The role of fiberoptic endoscopy in the management of corrosive ingestion and modified endoscopic classification of burns. Gastrointestinal endoscopy. 1991;37(2):165-9.
Munoz SR, Bangdiwala SI. Interpretation of Kappa and B statistics measures of agreement. Journal of Applied Statistics. 1997;24(1):105-12.
Palao R, Monge I, Ruiz M, Barret J. Chemical burns: pathophysiology and treatment. Burns. 2010;36(3):295-304.
Bhoil A, Mittal B, Kashyap R, Bhattacharya A, Kochhar R. Meckel’s scan for triage in caustic injury patients: Alternative to endoscopy. Journal of Nuclear Medicine. 2012;53(supplement 1):2128-.
Ramasamy K, Gumaste VV. Corrosive ingestion in adults. Journal of clinical gastroenterology. 2003;37(2):119-24.
Ryu HH, Jeung KW, Lee BK, Uhm JH, Park YH, Shin MH, et al. Caustic injury: can CT grading system enable prediction of esophageal stricture? Clinical Toxicology. 2010;48(2):137-42.
Chirica M, Bonavina L, Kelly MD, Sarfati E, Cattan P. Caustic ingestion. Lancet (London, England). 2016.
Billiar T, Andersen D, Hunter J, Brunicardi F, Dunn D, Pollock RE. Schwartz's principles of surgery: McGraw-Hill Professional; 2004.
- Abstract Viewed: 308 times
- PDF Downloaded: 164 times
- HTML Downloaded: 56 times
