Assessment of the efficacy of four scoring systems in prediction of acute organophosphorous poisoning outcome

Abstract

Background Organophosphorous (OP) compounds are one of the major classes of pesticides. In developing countries, acute OP poisoning is a significant health problem due to its high mortality rate. Aim This study aimed to compare the efficacy of four scoring systems: Acute Physiology and Chronic Health Evaluation II (APACHE II), Poison Severity Score (PSS), Rapid Emergency Medicine Score (REMS), and Sequential Organ Failure Assessment (SOFA) score for outcome prediction in acute OP-poisoned cases. Patients and methods This cohort study included 100 cases with acute OP poisoning admitted to Tanta University Poison Control Center from the August 1, 2019 to the end of July 2020. The sociodemographic data, clinical examination, and laboratory investigations were recorded. From the collected data, the four scores were calculated for every patient. Results The present study demonstrated that survivors were 92% and nonsurvivors were 8%. About 14% of patients needed intubation, mechanical ventilation, and ICU admission. Regarding prediction of mortality, nonsurvivors had significant higher values of the studied scores than survivors, except for PSS. Furthermore, receiver-operating characteristic curve analysis showed that REMS had the best area under the curve followed by APACHE II score and then SOFA score. Concerning prediction of the need of intubation, mechanical ventilation, and ICU admission, the study recorded statistically significant differences between the two groups regarding all studied scores and REMS had the best area under the curve followed by APACHE II score, SOFA score, and then PSS. Conclusion REMS was the best score for prediction of acute OP poisoning outcome.

Development and validation of a novel poisoning agitation-sedation score for predicting the need for endotracheal intubation and mechanical ventilation in acutely poisoned patients with disturbed consciousness

“…Few studies compared scoring systems for predicting the need for ETI and MV in acutely poisoned patients with drug overdose, pesticides, tricyclic antidepressants (TCAs), carbon monoxide (CO), and clozapine. 23–52 However, previously compared scores cannot be applied to all poisoned patients with disturbed consciousness. Additionally, they cannot assess the risk of agitated patients needing ETI and MV.…”