Development and validation of new poisoning mortality score system for patients with acute poisoning at the emergency department

Abstract

Background A prediction model of mortality for patients with acute poisoning has to consider both poisoning-related characteristics and patients’ physiological conditions; moreover, it must be applicable to patients of all ages. This study aimed to develop a scoring system for predicting in-hospital mortality of patients with acute poisoning 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) during 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 categories 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 area under the receiver operating characteristic curve (AUROC) for both the groups. Results Of 57,326 poisoning cases, 42,568 were selected. Of these, 34,352 (80.7%) and 8216 (19.3%) were enrolled in the derivation and validation groups, respectively. The new-PMS was the sum of the points for each category of 10 predictors. The possible range of the new-PMS was 0–137 points. Hosmer–Lemeshow goodness-of-fit test showed adequate calibration for the new-PMS with p values of 0.093 and 0.768 in the derivation and validation groups, respectively. AUROCs of the new-PMS were 0.941 (95% CI 0.934–0.949, p < 0.001) and 0.946 (95% CI 0.929–0.964, p < 0.001) in the derivation and validation groups, respectively. The sensitivity, specificity, and accuracy of the new-PMS (cutoff value: 49 points) were 86.4%, 87.2%, and 87.2% and 85.9%, 89.5%, and 89.4% in the derivation and validation groups, respectively. Conclusions We developed a new-PMS system based on demographic, poisoning-related variables, and vital signs observed among patients at the ED. The new-PMS showed good performance for predicting in-hospital mortality in both the derivation and validation groups. The probability of death increased according to the increase in the new-PMS. The new-PMS accurately predicted the probability of death for patients with acute poisoning. This could contribute to clinical decision making for patients with acute poisoning at the ED.

Evaluation of Various Scoring Systems in Prediction of Acute Carbon Monoxide Poisoning Outcome

“…Toxicology researches lack a well-accepted method for assessing severity of CO poisoning in emergency department (Roca-Barceló et al 2020& Han et al, 2021. The current study is unique to investigate REMS, MEWS & SCS as a predictor of the need for ventilation and mortality in acute CO poisoned patients in Egypt.…”

Combining Phenylalanine and Leucine Levels Predicts 30-Day Mortality in Critically Ill Patients Better than Traditional Risk Factors with Multicenter Validation

“…Different categories of each amino acid were defined based on normal ranges and risk ranges published in our previous studies, Youden’s index, and appropriate gradients. The regression coefficient for each category was converted into points by dividing it by the smallest regression coefficient in the model [ 19 , 20 ]. The PLA score was the sum of the points for each category.…”

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

“…20 – 23 As a result, the traditional prognostic scores are frequently inaccurate for determining prognosis in acutely poisoned patients with an unexpected course that is dependent on numerous variables. 18,24…”

“…[20][21][22][23] As a result, the traditional prognostic scores are frequently inaccurate for determining prognosis in acutely poisoned patients with an unexpected course that is dependent on numerous variables. 18,24 From this perspective, we aimed to develop and validate a novel Poisoning Agitation-Sedation Score (PASS) for predicting the need for endotracheal intubation (ETI) and mechanical ventilation (MV) in acutely poisoned patients with DCL.…”