Evaluation of various scoring systems as predictors of the need for intensive care unit admission and other adverse outcomes among patients with acute clozapine poisoning

Abstract

Acute clozapine poisoning (ACP) is frequently reported worldwide. We evaluated the efficacy of the Poison Severity Score (PSS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Rapid Emergency Medicine Score (REMS), and Modified Early Warning Score (MEWS) as predictors for intensive care unit (ICU) admission, mechanical ventilation (MV), mortality, and length of hospital stay in patients with ACP. A retrospective cohort study was conducted using records of patients diagnosed with ACP from January 2017 to June 2022 and admitted to an Egyptian poison control center. Analyzing 156 records showed that all assessed scores were significant predictors of the studied outcomes. The PSS and APACHE II score showed the highest area under the curve (AUC) as ICU admission predictors with insignificant variations. The APACHE II score showed the best discriminatory power in predicting MV and mortality. Nevertheless, MEWS exhibited the highest odds ratio (OR) as an ICU predictor (OR = 2.39, and 95% confidence interval = 1.86–3.27) and as a mortality predictor (OR = 1.98, and 95% confidence interval = 1.16–4.41). REMS and MEWS were better predictors of length of hospital stay compared with the APACHE II score. The simpler, lab-independent nature and the comparable discrimination but higher odds ratio of MEWS compared with APACHE II score justify MEWS’ superior utility as an outcome predictor in ACP. We recommend using either the APACHE II score or MEWS, depending on the availability of laboratory investigations, resources, and the case’s urgency. Otherwise, the MEWS is a substantially feasible, economical, and bedside alternative outcome predictor in ACP.

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

“…Additionally, the PASS assessing agitations in disturbed consciousness patients with the agitation was significantly valid in predicting the need for ETI and MV with good prediction power (AUC = 0.893), 90.32% sensitivity, and 73.68% specificity at a cutoff of ≤14. 53 – 55…”

“…Additionally, the PASS assessing agitations in disturbed consciousness patients with the agitation was significantly valid in predicting the need for ETI and MV with good prediction power (AUC = 0.893), 90.32% sensitivity, and 73.68% specificity at a cutoff of ≤14. [53][54][55] The PASS score has advantages over the conventional scores, making it more suitable for predicting the need for ETI and MV as it assesses the breathing pattern, which is essential for predicting the need for assisted ventilation in disturbed-conscious patients. Additionally, the respiratory component of FOUR enables clinicians to assess the breathing patterns of apneic and irregular breathing patients.…”