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Abstract：
OBJECTIVE: Esophagogastroduodenoscopy is considered the gold standard in assessing the severity of injury to the gastrointestinal tract following corrosive ingestion. Zargar\'s endoscopic grading of injury helps in prognostication as well as guiding management. Since the major burden of cases lies in resource-limited settings, the availability of endoscopic evaluation is a limiting factor. Hence, it is prudent to develop bedside tools that can be used as screening tools to identify patients at high risk of mortality and complications so that timely referrals and judicious utilization of resources can be made. Literature in this regard is limited and published studies have shown that clinical features fail to predict the severity of injury. We aimed our study to find the role of Drooling, Reluctance, Oropharynx, Others, and Leukocytosis (DROOL) score as a predictor of mortality and complications following acute corrosive ingestion.
METHODS: This was a diagnostic accuracy study conducted in the emergency department (ED) of a tertiary care hospital in North India. We screened all cases of acute corrosive ingestion presented to our ED. We collected the data on demographic profile, clinical features, investigations, endoscopy findings, treatment, and DROOL score. We followed patients for up to 12 weeks for outcomes including mortality and complications.
RESULTS: We studied 79 patients of acute corrosive ingestion. The median age was 26 years with a female predominance. Nausea, vomiting, and pain abdomen were the common symptoms. The median DROOL score was 4. The majority of our patients had normal to Zargar grade 1 injury to the stomach and esophagus. Out of 79 patients, 27 patients developed some complications. The overall mortality up to 12 weeks was 10%. The receiver operating characteristics (ROC) analysis was performed, and the area under the ROC (AUROC) curve of Zargar classification in predicting overall complications was 0.909 (96% confidence interval [CI]: 0.842-0.975) and it was 0.775 (95% CI: 0.553-1.000) in predicting mortality. The AUROC of DROOL score in predicting overall complications was 0.932 (95% CI: 0.877-0.987) and the AUROC of DROOL score in predicting mortality was 0.864 (95% CI: 0.758-0.970). The ROC analysis showed that a DROOL score ≤4 has a sensitivity of 96.2% and a specificity of 77.8% in predicting overall complications. Similarly, DROOL score ≤5 has a sensitivity of 81.7% and a specificity of 62.5% in predicting the development of mortality. Delong test showed that there was no statistically significant difference in Zargar versus DROOL score in terms of prediction of mortality and overall complications (P > 0.05).
CONCLUSIONS: DROOL score is comparable to Zargar score in identifying patients at high risk of mortality and complications. Hence, DROOL score can be used for risk stratification of patients presenting with corrosive ingestion.
METHODS: This was a diagnostic accuracy study conducted in the emergency department (ED) of a tertiary care hospital in North India. We screened all cases of acute corrosive ingestion presented to our ED. We collected the data on demographic profile, clinical features, investigations, endoscopy findings, treatment, and DROOL score. We followed patients for up to 12 weeks for outcomes including mortality and complications.
RESULTS: We studied 79 patients of acute corrosive ingestion. The median age was 26 years with a female predominance. Nausea, vomiting, and pain abdomen were the common symptoms. The median DROOL score was 4. The majority of our patients had normal to Zargar grade 1 injury to the stomach and esophagus. Out of 79 patients, 27 patients developed some complications. The overall mortality up to 12 weeks was 10%. The receiver operating characteristics (ROC) analysis was performed, and the area under the ROC (AUROC) curve of Zargar classification in predicting overall complications was 0.909 (96% confidence interval [CI]: 0.842-0.975) and it was 0.775 (95% CI: 0.553-1.000) in predicting mortality. The AUROC of DROOL score in predicting overall complications was 0.932 (95% CI: 0.877-0.987) and the AUROC of DROOL score in predicting mortality was 0.864 (95% CI: 0.758-0.970). The ROC analysis showed that a DROOL score ≤4 has a sensitivity of 96.2% and a specificity of 77.8% in predicting overall complications. Similarly, DROOL score ≤5 has a sensitivity of 81.7% and a specificity of 62.5% in predicting the development of mortality. Delong test showed that there was no statistically significant difference in Zargar versus DROOL score in terms of prediction of mortality and overall complications (P > 0.05).
CONCLUSIONS: DROOL score is comparable to Zargar score in identifying patients at high risk of mortality and complications. Hence, DROOL score can be used for risk stratification of patients presenting with corrosive ingestion.
摘要：
目的：食管胃十二指肠镜检查被认为是评估腐蚀性摄入后胃肠道损伤严重程度的金标准。Zargar的内镜损伤分级有助于预测和指导治疗。由于案件的主要负担在于资源有限的环境，内镜评估的可用性是一个限制因素.因此，明智的做法是开发可用作筛查工具的床边工具，以识别具有高死亡率和并发症风险的患者，以便及时转诊和合理利用资源。这方面的文献有限，已发表的研究表明，临床特征无法预测损伤的严重程度。我们的研究目的是找到流口水的作用，勉强，口咽喉,Others,白细胞增多症（DROOL）评分可作为急性腐蚀性摄入后死亡率和并发症的预测指标。
方法：这是一项在印度北部一家三级保健医院的急诊科（ED）进行的诊断准确性研究。我们筛查了所有出现在我们ED上的急性腐蚀性摄入病例。我们收集了人口统计数据，临床特征,调查,内窥镜检查结果，治疗,和DROOL得分。我们随访患者长达12周的结果，包括死亡率和并发症。
结果：我们研究了79例急性腐蚀性摄入患者。平均年龄为26岁，女性为主。恶心，呕吐,腹部疼痛是常见的症状。DROOL评分中位数为4。我们的大多数患者对胃和食道有正常的Zargar1级损伤。79名患者中,27例患者出现一些并发症。直到12周的总死亡率为10%。进行了接收器工作特性(ROC)分析，Zargar分类预测总体并发症的ROC曲线下面积(AUROC)为0.909(96%置信区间[CI]:0.842-0.975),预测死亡率为0.775(95%CI:0.553-1.000).DROOL评分预测总体并发症的AUROC为0.932(95%CI:0.877-0.987)，DROOL评分预测死亡率的AUROC为0.864(95%CI:0.758-0.970)。ROC分析显示，DROOL评分≤4对预测总体并发症的敏感性为96.2%，特异性为77.8%。同样，DROOL评分≤5在预测死亡率发展方面的敏感性为81.7％，特异性为62.5％。Delong检验显示Zargar与DROOL评分在预测死亡率和总体并发症方面差异无统计学意义(P>0.05)。
结论：DROOL评分与Zargar评分在确定具有高死亡率和并发症风险的患者方面相当。因此，DROOL评分可用于出现腐蚀性摄入的患者的风险分层。
方法：这是一项在印度北部一家三级保健医院的急诊科（ED）进行的诊断准确性研究。我们筛查了所有出现在我们ED上的急性腐蚀性摄入病例。我们收集了人口统计数据，临床特征,调查,内窥镜检查结果，治疗,和DROOL得分。我们随访患者长达12周的结果，包括死亡率和并发症。
结果：我们研究了79例急性腐蚀性摄入患者。平均年龄为26岁，女性为主。恶心，呕吐,腹部疼痛是常见的症状。DROOL评分中位数为4。我们的大多数患者对胃和食道有正常的Zargar1级损伤。79名患者中,27例患者出现一些并发症。直到12周的总死亡率为10%。进行了接收器工作特性(ROC)分析，Zargar分类预测总体并发症的ROC曲线下面积(AUROC)为0.909(96%置信区间[CI]:0.842-0.975),预测死亡率为0.775(95%CI:0.553-1.000).DROOL评分预测总体并发症的AUROC为0.932(95%CI:0.877-0.987)，DROOL评分预测死亡率的AUROC为0.864(95%CI:0.758-0.970)。ROC分析显示，DROOL评分≤4对预测总体并发症的敏感性为96.2%，特异性为77.8%。同样，DROOL评分≤5在预测死亡率发展方面的敏感性为81.7％，特异性为62.5％。Delong检验显示Zargar与DROOL评分在预测死亡率和总体并发症方面差异无统计学意义(P>0.05)。
结论：DROOL评分与Zargar评分在确定具有高死亡率和并发症风险的患者方面相当。因此，DROOL评分可用于出现腐蚀性摄入的患者的风险分层。
