Emergency Management of Caustic Ingestion at high volume centres may improve survival: JAMA

Adults who consume caustic substances may die or suffer severe digestive consequences.Emergency management of caustic injuries in high-volume centers may improve survival rates, suggests a new study. In this study, referral to expert centers was associated with improved early survival after caustic therefore if feasible, low-volume hospitals should consider transferring patients to larger centers instead of attempting on-site management.This study was conducted by Alexandre Challine and team with the objective to examine the consequences of caustic ingestion in adults using a nationwide prospective database. The findings of this study were published in the Journal of American Medical Association on 8th December, 2021.Adult patients aged 16 to 96 admitted to the emergency department for caustic ingestion between January 2010 and December 2019 were identified in this study using the French Medical Information System Database, which includes all patients admitted in an emergency setting in French hospitals during this time period. This study's main exposure was esophageal caustic ingestion. The primary outcome measure was in-hospital patient outcomes after caustic ingestion. To assess independent predictors of in-hospital morbidity and mortality, a multivariate analysis was performed.Key findings of this study were: 3544 (0.016%) of the 22 657 226 patients admitted as emergency outpatients had ingested caustic agents and were included in this study. In this population, the median (IQR) age was 49 (34-63) years, and 1685 patients (48%) were female. During the primary hospital stay, 388 patients with caustic ingestion had digestive necrosis that required resection (11% ). In 3156 cases, nonsurgical treatment was used (89% ). A total of 1198 people (34%) had complications, and 294 (8%) died. The most common adverse event was pulmonary complications, which occurred in 869 patients (24%). Multivariate analysis revealed that old age, a high comorbidity score, suicidal ingestion, intensive care unit admission during management, emergency surgery for digestive necrosis, and treatment in low-volume centers were all predictors of mortality. Morbidity was predicted by old age, a higher comorbidity score, intensive care unit admission during management, and emergency surgery for digestive necrosis, according to a multivariate analysis.In conclusion, with the severity of caustic ingestion, in high-volume centers, emergency management of caustic injuries may improve survival rates. Reference: Challine A, Maggiori L, Katsahian S, et al. Outcomes Associated With Caustic Ingestion Among Adults in a National Prospective Database in France. JAMA Surg. Published online December 08, 2021. doi:10.1001/jamasurg.2021.6368