title: The role of chest and abdominal computed tomography in assessing the severity of acute corrosive ingestion.
abstract: BACKGROUND
  Corrosive substance ingestion is a toxicological emergency with relatively high mortality requiring rational surgical decisions.
  
  
  OBJECTIVE
  Evaluate the role of chest and abdominal computed tomography (CT) in assessing the severity of acute corrosive ingestion.
  
  
  METHODS
  A retrospective study of adults admitted due to corrosive ingestion, who underwent gastrointestinal endoscopy and CT within 48 h of admission. Endoscopy findings were graded as 0, 1, 2a, 2b, 3a, and 3b (Zargar's criteria), CT findings were graded as 0, 1, 2, and 3. For each patient endoscopy and CT grades were compared, and sensitivity and specificity for predicting mortality or emergency laparotomy were calculated.
  
  
  RESULTS
  Twenty-three patients were included, aged 18-87 years; seven underwent emergency laparotomy, five died. Endoscopy grading was higher than CT grading in 14 patients (66%). The sensitivities of endoscopy grades 2b and 3 to predict mortality and emergency laparotomy were 1 and 0.8, respectively; the specificities were 0.38 and 0.37, respectively. The sensitivities of CT grade 3 to predict mortality and emergency laparotomy were 0.4 and 0.28, respectively; the specificities were 0.94 and 0.93, respectively. Three patients had pulmonary infiltrates on CT but not on chest X-ray. DISCUSSION. CT tends to underestimate the severity of corrosive ingestion compared with endoscopy. It has lower sensitivity and higher specificity than endoscopy in predicting major outcome. CT can provide important information on lung injury, and when endoscopy cannot be completed.
  
  
  CONCLUSIONS
  CT should not be the only basis for surgical decisions during the initial phase of acute corrosive ingestions.
authors.affiliation: Israel Poison Information Center, Rambam Health Care Campus, The Rappaport Faculty of Medicine, Technion-Israel Institute of Technology , Haifa , Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Lurie
authors.forename: M
authors.initials: M
authors.lastname: Slotky
authors.forename: D
authors.initials: D
authors.lastname: Fischer
authors.forename: R
authors.initials: R
authors.lastname: Shreter
authors.forename: Y
authors.initials: Y
authors.lastname: Bentur
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002424:Caustics / Q000008:administration & dosage / Q000633:toxicity*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D041981:Gastrointestinal Tract / Q000000981:diagnostic imaging / Q000187:drug effects*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011860:Radiography, Abdominal; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D062606:Tertiary Care Centers; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D002424:Caustics