Applicability of different scoring systems in outcome prediction of patients with mixed drug poisoning-induced coma

Abstract

Background:Mixed drugs poisoning (MDP) is common in the emergency departments. Because of the limited number of intensive care unit beds, recognition of risk factors to divide the patients into different survival groups is necessary. Poisoning due to ingestion of different medications may have additive or antagonistic effects on different parameters included in the scoring systems; therefore, the aim of the study was to compare applicability of the different scoring systems in outcomes prediction of patients admitted with MDP-induced coma.Methods:This prospective, observational study included 93 patients with MDP-induced coma. Clinical and laboratory data conforming to the Acute Physiology and Chronic Health Evaluation (APACHE II), Modified APACHE II Score (MAS), Mainz Emergency Evaluation Scores (MEES) and Glasgow Coma Scale (GCS) were recorded for all patients on admission (time0) and 24 h later (time24). The outcome was recorded in two categories: Survived with or without complication and non-survived. Discrimination was evaluated using receiver operating characteristic (ROC) curves and area under the ROC curve (AUC).Results:The mortality rate was 9.7%. Mean of each scoring system was statistically significant between time0 and time24 in the survivors. However, it was not significant in non-survivors. Discrimination was excellent for GCS24 (0.90±0.05), APACHE II24 (0.89±0.01), MAS24 (0.86±0.10), and APACHE II0 (0.83±0.11) AUC.Conclusion:The GCS24, APACHE II24, MAS24, and APACHE II0 scoring systems seem to predict the outcome in comatose patients due to MDP more accurately. GCS and MAS may have superiority over the others in being easy to perform and not requiring laboratory data.

Development and validation of a risk-prediction nomogram for in-hospital mortality in adults poisoned with drugs and nonpharmaceutical agents

“…The mortality rate in our cohort was comparable to that on reported in other prospective observational studies (9.7%) poisoning due to a combination of drugs, [39] and lower than pesticide-related fatalities (25.31%) reported in retrospective studies. [40] However, our mortality rate was higher than that reported in 2012 by the American Association of Poison Control Centers, concluding that only 1% of fatalities were exposure-related.…”

Acute Poisoning Induced Coma: Characteristics and Predictive Role of Early Creatine Phosphokinase on Its Outcome

“…There was significant relation between patient age and length of hospital stay with the mortality. This was in accordance with Eizadi-Mood et al, (2011) who reported that increasing age was associated with fatal outcome in drug-induced coma, while Bates, (2001) concluded that, the longer a patient remains in a coma the poorer the outcome.…”

“…This result was in accordance with Kheirabadi et al, (2015), also Duncan and Thakore, (2009) who suggested that it could be safe to observe poisoned patients with decreased consciousness, even if they have a GCS of 8 or less, in the emergency department. However, Eizadi-Mood et al, (2011) found that GCS has a useful role in outcome prediction of patients with drug overdose.…”

“…Patients in vegetative state or who remain comatose for 1 month following the acute event have little or no chance of recovery, and many of these patients will die (Heyerdahl et al, 2008). Glasgow Coma Scale (GCS) has been used for recovery evaluation of patients admitted to ICU following drug overdose, the need for intubation in patients and for predicting acute and delayed poisoning outcome (Eizadi-Mood et al, 2011).…”

Comparison of Full Outline of UnResponsiveness (FOUR) score and the conventional scores in predicting outcome in aneurysmal subarachnoid haemorrhage patients

“…GCS is used for assessing consciousness in all populations. [3] It has been a gold standard against which newer scales are compared. Over the years, its shortcomings like unreliability of verbal response in an intubated patient and absence of brainstem reflexes tests have come to focus.…”