Tosca et al reported a prognostic score for evaluating a patient who has ingested a caustic substance. This can help to identify a patient who may require more aggressive management. The authors are from the Universitat de Valencia and Hospital de la Marina Baixa de la Villa Joiosa in Spain.
Patient selection: caustic ingestion
Parameters:
(1) substance ingested
(2) blood neutrophil count in the differential count in percent
(3) serum bicarbonate in mmol/L (to detect metabolic acidosis)
(4) endoscopic lesion (Zargar grade IIb or III)
Parameter
Finding
Points
substance ingested
acidic
1
other
0
percent neutrophils
< 75%
0
>= 75%
2
serum bicarbonate
> 22 mmol/L
0
<= 22 mmol/L
2
endoscopic lesion in esophagus
no
0
yes
1
endoscopic lesion in stomach
no
0
yes
2
If endoscopy was contraindicated, then both endoscopic findings are assumed to be present.
