Development of a risk prediction nomogram for disposition of acute toxic exposure patients to intensive care unit

Abstract

Early risk stratification of acutely poisoned patients is essential to identify patients at high risk of intensive care unit (ICU) admission. We aimed to develop a prognostic model and risk‐stratification nomogram based on the readily accessible clinical and laboratory predictors on admission for the probability of ICU admission in acutely poisoned patients. This retrospective cohort study included adult patients with acute toxic exposure to a drug or a chemical substance. Patients' demographic, toxicologic, clinical and laboratory data were collected. Among the 1260 eligible patients, 180 (14.3%) were admitted to the ICU. We developed a generalized prognostic model for predicting ICU admission in patients with acute poisoning. The predictors included the Glasgow coma scale, oxygen saturation, diastolic blood pressure, respiratory rate and blood bicarbonate concentration. The model displayed excellent discrimination and calibration (optimistic‐adjusted area under the curve = 0.924 and optimistic‐adjusted Hosmer and Lemeshow test = 0.922, respectively) when internally validated. Additionally, we developed prognostic models that determine ICU admission in patients with specific poisonings. Furthermore, we constructed risk‐stratification nomograms that rank the probability of ICU admission in these patients. The developed risk‐stratification nomograms help decision‐making regarding ICU admission in acute poisonings. Future external validation in independent cohorts is necessary before clinical application.

Characteristics of suicidal poisoned patients admitted to tertiary care center during COVID-19 pandemic

“…Consistent with previous studies [ 12 , 39 ], phosphide pesticides were the most frequent cause of suicidal poisoning in our sample. It could be explained by their wide availability owing to uncontrolled sales in our agricultural locality, making them the method of choice for committing suicide [ 40 ].…”

“…Subsequently, Methling and colleagues [38] recommended monitoring patients with antidepressant and antipsychotic drug therapy for suicidal tendencies to protect them from committing suicide. Consistent with previous studies [12,39], phosphide pesticides were the most frequent cause of suicidal poisoning in our sample. It could be explained by their wide availability owing to uncontrolled sales in our agricultural locality, making them the method of choice for committing suicide [40].…”

Development and validation of a risk prediction nomogram for disposition of acute clozapine intoxicated patients to intensive care unit

“…They offer highly discriminatory condition-related risk assessment, which facilitates patient triaging and may also minimize unnecessary tests and expenses. 17,35 To the best of our knowledge, limited studies developed new risk prediction nomograms to predict different adverse outcomes in acute poisoning. Moreover, most of these studies were done on a wide range of poisoned agents, or non-pharmacological agents, and not drug specified, notably clozapine (Supplementary 1).…”

“…According to TUPCC protocols and guidelines, the decision of ICU admission is issued for patients meeting one or more of the following criteria: significant respiratory embarrassment and need for mechanical ventilation, and high flow O 2 , need for vasopressors for hemodynamic instability, renal replacement therapy, and presentation with intractable seizures not responding to the usual antiepileptics. 17…”

“…They simplify statistical predictive scores into a single numerical approximation for patients' conditions, indicating the probability of an event, such as the need for ICU admission or death. 17,18 Despite the widespread use of clozapine and the diverse associated adverse effects, up to our knowledge, no previous studies established risk prediction nomograms for patients admitted with acute clozapine intoxication. Therefore, the current study aims to investigate the factors associated with the risk of ICU admission among patients of acute clozapine intoxication and to establish and validate an early on admission nomogram, using the patient objective data to assess the probability of ICU admission.…”