Review for 10.1186/1471-230X-11-72 (2011)

Reviewer's report
Title:Caustic ingestion in adults: The role of age in predicting outcome
Version: 1Date:9 January 2011
Reviewer: Sandro Contini
Reviewer's report:
This paper concerns the influence of age on the outcome of patients complaining
caustic ingestion. The answer is rather obvious: aged patients have a poorer
clinical
outcome due to systemic complications, without any influence of the endoscopic
severity of injury on the survival. As the authors underline, systemic comorbidities
play certainly a role in increasing complications, mainly respiratory. Though the
authors take into consideration the reasons for ingestion (accidental or suicide), it
is not specified the clinical outcome after a suicide attempts. Severe mucosal
damage (grade 3), complications and death after ingestion are much commoner
after suicide ingestion than after accidental, where the main complication is
esophageal stricture, whose monitoring requires months, while the follow-up is
rather short in this paper. Therefore, it would be nice to have a more detailed
description of the outcome after grade 3 lesion, which should be more prone to
complications. Obviously in grade 1 and 2 complications are consequences of
already present comorbidities more than of the caustic injury itself. In spite of the
fact that the conclusions are clearly supported by the data, with a thorough
statistical analysis, the data reported do not seem to be clinically relevant and are
already known in clinical practice: aged patients, with comorbidities, usually have
complicated clinical performances.
More specifically,
• English style should be improved,
• In Background, the phrase "appropriate timing of EGD is still under debate[2-8]"
is not correct. As the authors point out later, there is a definite timing and risk in
performing endoscopic examination, well recognized in the literature
• In Background, the phrase “The increase in the proportion of elderly in the
population has become a major health problem in the 21st century. In Taiwan,
the percentage of the population over 65 years old has increased from
approximately 8.2% in 1998 to 10.4% in 2008.[11] From WHO data, in 2000,
there were 600 million people over the age of 60, and there will be 1.2 billion by
2025” s superfluous and should be eliminated.
• In Methods there is a poor description of the immediate management and
several statements could be questioned (why chest x ray only when aspiration
pneumonia was suspected? The results of antiacid therapy are not the same with
PPI, H2 antagonist and sucralfate gel, etc)
• The definitions of systemic and upper GI complications should be included in
Methods and not in the Results
• How is aspiration pneumonia defined? Respiratory complications may occur not
only for aspiration, especially in the elderly patients.
• The incidence of strictures reported is rather low, that means likely low
incidence of ingestion of highly corrosive substances. This arises two questions
o Is adequate the follow up for strictures?
o Are the complications consequences of comorbidities more than of the
ingestion itself?
o The delay of admission to hospital after ingestion, which can play a role in the
clinical outcome, is not taken into consideration.
• Page 11, 5th line from below: Kaplan-Meyer instead of Kaplan-Miere
• As the authors declare, “when the elderly suffer from caustic injury, the
respiratory system must be carefully supported with particular care to prevent
aspiration. If infection is suspected, empiric antibiotics must be given as soon as
possible.” In this setting, why not consider the use of antibiotic prophylaxis?
Moreover, what does it mean “as soon as possible”?
• Table 1 is superfluous
• Table 3: 63 patients were submitted to a surgical procedure (operation). What
kind of procedure has been performed?
Level of interest: An article of limited interest
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests