Validity of Vital Signs, Coma Scales and Modified APACHE Score in Prediction of Prognosis and Outcome of Acutely Poisoned Patients

Abstract

Introduction: Acute toxicity management is a major medical problem in the whole world as poisoning is one of the most common causes for coming to hospital emergency departments. Early diagnosis and treatment in emergency department and ICU are critical for the poisoned patient to reduce hospital morbidity and mortality. Objective: Evaluation of the validity of coma scaling systems as Glasgow coma scale (GCS), Reed scale, poisoning severity score (PSS), modified acute physiology and chronic health evaluation (APACHE) score (MAS) and vital signs as predictors of clinical course and outcome of acutely poisoned patients. Patients and Methods: This retrospective study was carried out on 100 acutely intoxicated patients. They were selected from patients attended Sohag University Hospitals with age more than 18 years old who were in need for intermediate or intensive care unit. The study was conducted during the period from March 2018 to the end of February 2021. Results: this study revealed that 62% of the patients were in the age group 18-30 years old and 63% were females. The majority of them intoxicated by oral route (91%) and most of them were suicidal (68%). For the outcome, 75% of patients had been survived and 25% of patients died. PSS, Reed, MAS and GCS as coma scaling scores at admission showed significant difference between survivors and non-survivors of these patients. Systole and diastole as parameters of vital signs also showed significant difference between survivors and non-survivors. While, pulse, temperature and respiratory rate showed non-significant difference between survivors and non-survivors. Conclusion:The study concluded that PSS, Reed scale, MAS, GCS, diastole and systole respectively are valid prognostic tools for the outcome in acutely poisoned patients.

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

“…This could be explained by hemodynamic instability, cardiogenic or vascular shock that may occur in most of the non-survivors. Similar findings were reported by Zaghary et al [25] who noted a significant difference between survivors and nonsurvivors regarding SBP and DBP. While Yu et al [5] noted that DBP showed a significant difference between survivors and non-survivors while SBP didn't show any significant difference.…”

“…In the same line, Aydin and Cetinkaya [27] noted that the mean value of respiratory rate in nonsurvivors (23.8 ± 11.1 breaths/minute) was significantly higher compared to survivors (20.5±3.5 breaths/minute). In contrast, Zaghary et al [25] did not observe any significant difference between survivors and non-survivors regarding respiratory rate.…”

“…In the current study, the median value of the heart rate in non-survivors was 80 beats/minute and there was no significant difference between survivors and non-survivors. Zaghary et al [25] showed that the mean value of heart rate in non-survived poisoned cases was 96.0 ± 26 beats/minute and also observed absence of significant difference between survivors and non-survivors. Contrary to this, Yu et al [5] and Oreby et al [26] noted statistically significant differences between survivors and non-survivors regarding the heart rate.…”

“…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.…”

“…The sensitivity of these scores was 70.6, 90.2 and 2% respectively and the specificity was 94.4, 44.4 and 100% respectively. Moreover, Zaghary et al [25] compared the effectiveness of four different scores (PSS, Reed, modified APACHE II and GCS) in prediction of mortality in patients with acute poisoning. They showed that PSS was the best predictor (AUC of 0.92 at a cut off >2), followed by Reed scale (AUC= 0.866 at a cut off >1), then the modified APACHE II (AUC= 0.848 at a cut off >9).…”