Comparison between various scoring systems in predicting the need for intensive care unit admission of acute pesticide-poisoned patients

El-Sarnagawy, Ghada N; Abdelnoor, Amira A; Abuelfadl, Arwa; El-Mehallawi, Inas H.

doi:10.1007/s11356-021-17790-y

Cited by 18 publications

(5 citation statements)

References 56 publications

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“…40,41 Furthermore, aluminum phosphide is a commonly used pesticide in our locality due to the agricultural nature of the Gharbia governorate. 42 Regarding GCS assessment, the highest percentage of patients presented with moderate GCS (40.1% and 49%) in both the derivation and validation cohorts, respectively. However, Zaghary et al 43 reported that 9% of acutely poisoned patients admitted to Sohag University Hospitals belonged to the moderate group.…”

Section: Discussionmentioning

confidence: 91%

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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

Abd Elghany,

Lashin,

El-Sarnagawy

et al. 2023

Hum Exp Toxicol

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Background Accurate assessment of disturbed consciousness level (DCL) is crucial for predicting acutely poisoned patients’ outcomes. Aim Development of a novel Poisoning Agitation-Sedation Score (PASS) to predict the need for endotracheal intubation (ETI) and mechanical ventilation (MV) in acutely poisoned patients with DCL. Validation of the proposed score on a new set of acutely poisoned patients with DCL. Methods This study was conducted on 187 acutely poisoned patients with DCL admitted to hospital from June 2020 to November 2021 (Derivation cohort). Patients' demographics, toxicological data, neurological examination, calculation of the Glasgow Coma Scale (GCS), Full Outline of Unresponsiveness (FOUR) score, Richmond Agitation–Sedation Scale (RASS), and outcomes were gathered for developing a new score. The proposed score was externally validated on 100 acutely poisoned patients with DCL (Validation cohort). Results The PASS assessing sedation consists of FOUR (reflexes and respiration) and GCS (motor) and provides a significantly excellent predictive power (AUC = 0.975) at a cutoff ≤9 with 100% sensitivity and 92.11% specificity for predicting the need for ETI and MV in sedated patients. Additionally, adding RASS (agitation) to the previous model exhibits significantly good predictive power (AUC = 0.893), 90.32% sensitivity, and 73.68% specificity at a cutoff ≤14 for predicting the need for ETI and MV in disturbed consciousness patients with agitation. Conclusion The proposed PASS could be an excellent, valid and feasible tool to predict the need for ETI and MV in acutely poisoned disturbed consciousness patients with or without agitation.

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Section: Discussionmentioning

confidence: 91%

“…40,41 Furthermore, aluminum phosphide is a commonly used pesticide in our locality due to the agricultural nature of the Gharbia governorate. 42…”

Section: Discussionmentioning

confidence: 99%

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

Abd Elghany,

Lashin,

El-Sarnagawy

et al. 2023

Hum Exp Toxicol

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“…Consistent with previous studies [ 12 , 39 ], phosphide pesticides were the most frequent cause of suicidal poisoning in our sample. It could be explained by their wide availability owing to uncontrolled sales in our agricultural locality, making them the method of choice for committing suicide [ 40 ]. Conversely, pharmaceuticals are commonly used for suicidal poisoning in Europe and Iran [ 41 , 42 ].…”

Section: Discussionmentioning

confidence: 99%

Characteristics of suicidal poisoned patients admitted to tertiary care center during COVID-19 pandemic

El-Sarnagawy

Hafez

Amer

2022

Egypt J Neurol Psychiatry Neurosurg

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Background Suicidal poisoning is a major concern during the COVID-19 pandemic that has several physical and mental hazards. This study aimed to evaluate the characteristics of suicidal poisoned patients admitted to a tertiary poison control center during the pandemic lockdown and assess COVID-related knowledge and attitude among those patients to identify the high-risk group for suicide. This cross-sectional study was conducted on acutely poisoned patients admitted to Tanta University Poison Control Center from June to December 2020. Upon admission, socio-demographic data, causative poisoning agents, COVID-related knowledge and attitude, Hamilton Anxiety Rating Scale (HAM-A), and Hamilton Depression Rating Scale (HAM-D) were collected from all participants. Results A total of 254 poisoned patients were categorized into suicidal (85.04%) and accidental (14.96%) poisoning groups. The former was caused mainly by phosphides and was significantly associated with a history of using psychotropic medications and high HAM-A and HAM-D results. Logistic regression analysis showed that a history of psychiatric illness, low attitude scores, and high HAM-D scores were significant risk factors for suicidal poisoning. Conclusions Considerable number of suicidal poisoned patients had moderate-to-severe depressive symptoms, highlighting the importance of providing specialized psychiatric services in poisoning centers, particularly among vulnerable populations, to prevent the overwhelming repeated suicidal attempts.

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“…The prognosis of acute aluminum phosphide poisoning is usually based on clinical and laboratory features such as severe metabolic acidosis, refractory shock, cardiorespiratory failure requiring mechanical ventilation, or the presence of stupor or coma (low Glasgow Coma Scale [GCS]). [ 12 13 14 15 16 17 18 19 20 ] These toxidrome features are considered accurate and reproducible in predicting mortality. Furthermore, scoring tools based on these variables, such as the PGI score (representing low pH, low GCS score, and impaired or low systolic blood pressure), Acute Physiologic Assessment and Chronic Health Evaluation II score, or the Sequential Organ Failure Assessment score have demonstrated excellent predictive abilities.…”

Section: Introductionmentioning

confidence: 99%

Prognostic significance of poison-related factors and consumption patterns in acute aluminum phosphide poisoning

et al. 2023

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OBJECTIVES: The prognosis of acute aluminum phosphide poisoning is usually based on toxidrome features, with little focus on poison-related factors. We aimed to study the prognostic significance of poison-related factors, consumption patterns, and time delays to treatment. METHODS: We performed a prospective cohort study in an academic hospital in North India in patients aged ≥ 13 with aluminum phosphide poisoning from July 2019 to December 2020. During data collection, a particular emphasis was made on the poison formulation, the ingested dose, the reconstitution of poison, vomiting, and time intervals to initiate various treatments. The primary outcome was inhospital mortality. RESULTS: Fifty-eight patients were enrolled (median age, 32 years; 37 males). The mean dose of the ingested poison was 6.56 (±5.42) g. The predominant formulation of poison was pellet ( n = 41), followed by powder ( n = 16). Twenty patients performed reconstitution of poison before consumption, and 13 stirred the poison while reconstituting. All patients but three developed vomiting after consumption. Inhospital mortality ( n = 23, 39%) was significantly high with a higher ingested dose ( P < 0.001), nonstirred reconstitution before consumption ( P = 0.042), fewer vomiting episodes ( P = 0.010), a delay in detection of the victim by someone ( P = 0.001), and delayed initiation of intravenous fluids ( P = 0.043). The secondary outcomes (shock and requirement of vasopressor or ventilation) remained unaffected by the stirring in the reconstitution group. CONCLUSIONS: Poison-related factors and time intervals determine early risk stratification at admission in aluminum phosphide poisoning.

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Comparison between various scoring systems in predicting the need for intensive care unit admission of acute pesticide-poisoned patients

Cited by 18 publications

References 56 publications

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

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

Characteristics of suicidal poisoned patients admitted to tertiary care center during COVID-19 pandemic

Prognostic significance of poison-related factors and consumption patterns in acute aluminum phosphide poisoning

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