Challine at al identified predictors for mortality following caustic ingestion by an adult. These can help to identify a patient who may benefit from more aggressive management. The authors are from multiple institutions in France.
Patient: adult (ages 16 to 96) following caustic ingestion
Rate of complications: 34%
Mortality rate: 8%
Predictors of mortality from multivariate model:
(1) old age (median 65)
(2) high comorbidity on Charlson Comorbidity Index
(3) ICU admission
(4) emergency surgery for digestive necrosis
Additional factors that may affect prognosis:
(1) suicidal/intentional ingestion
(2) treatment in a low volume center (< 2 patients per year)
Complications:
(1) gastrointestinal hemorrhage
(2) gastrointestinal necrosis
(3) deep abscess
(4) deep vein thrombosis and pulmonary embolism
(5) pulmonary complications
(6) renal failure
One recommendation was that a low volume center should refer patients to a tertiary care center if possible, rather than to attempt on-site management.
