Abstract
A quantifiable, quick, inexpensive and reproducible predictor is needed to decide if caustic substance ingestion results in burn regardless of the symptoms. A multicenter cohort study was conducted to investigate the predictive value of red cell distribution width (RDW) in detecting the esophageal burns. The data of 174 patients were retrospectively analyzed. Eleven patients were excluded due to inability to define the substance ingested. Complete blood count (CBC) was taken at admission, and an esophagogastroduodenoscopy was performed within the first 12–24 h in all patients, regardless of their symptoms. The age and gender of the patients, the types of substances ingested, the parameters in the CBC and the severity of the esophageal injury were correlated. Esophageal burns were diagnosed in 38 of 163 patients (23.3%). The risk of esophageal burn with RDW values below 12.20 was significantly lower. Multivariate analysis showed that RDW was the most significant predictor of esophageal burn (p = 0.000, odds ratio (OR) 7.74 (95% confidence interval (CI), 3.02–19.9)). Receiver operating characteristic (ROC) curve analysis demonstrated 84.2% sensitivity at a cut-off value of 12.20 for RDW. The results showed that CBC parameters could avoid unnecessary esophagogastroduodenoscopy. The RDW values regardless of the symptomatology is a good predictor of esophageal burns, and an RDW value over 12.20 shows the increased risk of esophageal burn.
Highlights
Caustic substance ingestion (CSI) used to be a big problem in developed countries, it is still a life-threatening problem worldwide, mostly in developing countries
The esophageal burn was diagnosed in 38 cases (23.3%), 2 of which were graded as severe
Values expressed as means ± standard deviations, *, wbc: white blood cell, plt: platelet, hgb: hemoglobin, mcv: mean corpuscular volume, rdw: red cell distribution width, mpw: mean platelet volume, pdw: platelet distribution width, lym: lymphocyte, mono: monocyte, neut: neutrophil, eos: eosinophil, baso: basophil
Summary
Caustic substance ingestion (CSI) used to be a big problem in developed countries, it is still a life-threatening problem worldwide, mostly in developing countries. Female to male ratio is 2/3 in CSI [2] Esophagogastroduodenoscopy (EGD) is the gold standard for the diagnosis. Many patients are faced every day in the emergency departments, studies published in the literature conflict with each other in the diagnosis [1,3,4]. Per the hazard caused by CSI is enormous, the ratio of unnecessary EGDs is between. 60% and 82% in the literature [2,4]. This high number of false negative results is due to discordance of the signs and symptoms of the presence of burn. A quantifiable, quick, inexpensive and reproducible predictor is needed to decide if the CSI resulted in burn or not
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