Prediction of Mortality in a Patient With Acute Poisoning

Abstract

Objective: This study aimed to develop a scoring system for predicting the in-hospital mortality of acute poisoning patients at the emergency department (ED). Methods: This was a retrospective analysis of the Injury Surveillance Cohort generated by the Korea Center for Disease Control and Prevention (KCDC) from 2011–2018. We developed the new-Poisoning Mortality Scoring system (new-PMS) to generate a prediction model using the derivation group (2011–2017 KCDC cohort). Points were computed for each category of each variable. The sum of these points was the new-PMS. The validation group (2018 KCDC cohort) was subjected to external temporal validation. The performance of new-PMS in predicting mortality was evaluated using receiver operating characteristic (ROC) curves for both groups. For simple interpretation in clinical settings, risk groups were categorized as very low, low, intermediate, and high according to the new-PMS; we suggested the mortality curve according to new-PMS. Results: Of 57326 poisoning cases, 42568 were selected. Of these, 34352 (80.7%) and 8216 (19.3%) were enrolled in the derivation and validation groups, respectively. New-PMS was the sum of points for each category of 10 predictors. The range of new-PMS was -20 to 3420 points. The area under the ROC curve of new-PMS was 0.942 (95% CI: 0.934–0.949) and 0.946 (95% CI: 0.930–0.963) for the derivation and validation groups, respectively. The mean predicted mortality and the observed mortalities of the high-risk group (new-PMS ≥1048) were 9.7% (95% CI: 9.3 – 10.0) and 10.0% for the derivation group and 8.4% (95% CI: 7.7 – 9.1) and 7.4% for the validation groups, respectively. Conclusions: New-PMS showed good performance in predicting in-hospital mortality for both groups. As mortality sharply increased with the high risk-group of the new-PMS, early hemodynamic stabilization of acute poisoning patients at the ED may improve their clinical outcomes. New-PMS contributes to clinical decision-making for acute poisoning patients in clinical settings.

A Proposal for a Novel Scoring System for Triage of Acutely Poisoned Patients at Tanta University Poisoning Treating Center, Egypt

“…Borron [30] showed that high anion gap is the most significant risk factor for death, regardless of the accompanying acid-base balance status in patients with acute intoxication. Additionally, Han et al [31] found in their Korean study on 42568 cases that SBP, heart rate, respiratory rate, body temperature and mental status were significant parameters in predicting mortality in acute poisoning. Moreover, Zaghary et al [25] noted that SBP and DBP were the most significant factors in the prediction of mortality, while pulse, temperature and respiratory rate showed non-significant differences between survivors and non-survivors.…”