Evaluation of Various Scoring Systems in Prediction of Acute Aluminum Phosphide (ALP) Poisoning Outcome

Abstract

Introduction: Aluminum phosphide (Alp) poisoning is a major health problem developing countries because of the high rates of morbidity and mortality even in well-equipped and experienced hospitals.. The aim of this study: Was to evaluate various scoring system (Acute Physiology and Chronic Health Evaluation (APACHE) score, Rapid Emergency Medicine Score (REMS), The Sequential Organ Failure Assessment (SOFA) score) at admission for outcome prediction in acute aluminum phosphide poisoned patients. Patients and methods: The present study is a cohort study that was carried out on acute Alp poisoned patients at Poison Control Unit, Tanta University Emergency Hospital. It was composed of two periods; one year retrospective (from April 2015 to March 2016) and six months prospective (from April 2016 to September 2016).All admitted patients over 16 years with acute aluminum phosphide poisoning were included in this study. Patients were grouped according to their outcome into survivors and non survivors. From the collected data, APACHE II, SOFA and REMS scores were calculated for every patient. Results: The present study was carried out on admitted fifty acute Alp poisoned patients. Out of them, survivors represented 44% and 56% were non-survivors. The majority of patients were in the age group 16-20 years, females, student, from rural areas (90%) and most of patients had ingested phosphides intentionally in a median dosage of one tablet. Hypotension, tachypnea, metabolic acidosis, hyperglycemia and higher serum creatinine levels and alanine transaminase (ALT) at admission, were risk factors of mortality from Alp. Non survivors had significantly higher APACHE II, SOFA and REMS score values than survivors. SOFA score had the best AUC (0.989) followed by APACHE II score then REMS score (0.987 and 0.970 respectively). However, no significant differences between AUC values of compared scores could be demonstrated. Conclusion: The clinical scores (APACHE II, SOFA and REMS) were similar and effective tools for determination of the severity of acute Alp poisoning. However, REMS proved to be more applicable than other scores owing to its simplicity, less time-consuming and effectiveness in emergency situations. Therefore, REMS score is suggested to be used in the emergency situations to predict outcome in Alp poisoned patients.

Potential Clinical and Laboratory Prognostic Factors for Prediction of Need for ICU admission in Acute Aluminum Phosphide Poisoning

“…Similarly, Shadnia et al (2010) found that respiratory rate ranged from 0 to 55 cycles/min in acute aluminum phosphide poisoned patients who were admitted to ICU. Tachypnea could be a sign of metabolic acidosis which was the most common type of acid base disturbance in the current study (Abd Elghany et al, 2018).…”

“…As regard outcome of acute aluminum phosphide poisoned cases, all cases that needed ICU were in need for vasopressors and 91.1% of them died. This could be explained by the highly cardiotoxic property of aluminum phosphide without specific antidote (Abd Elghany et al, 2018). Moreover, aluminum phosphide leads to refractory hypotension which doesn't respond to crystalloid administration and the second step in management is administration of vasopressors (Farahani et al, 2016).…”

Comparing the Effectiveness of Three Scoring Systems in Outcome Prediction of Acute Tricyclic Antidepressants Poisoning Cases

“…This short delay time could be explained by the presence of TUPCC in the center of Delta region with readily available transportations. Furthermore, a large number of the cases who attempt suicide are just trying to gain sympathy and draw attention of their beloved ones and not aiming to end their lives, therefore, they seek medical advice rapidly (Abd Elghany et al, 2018).…”

Assessment of Intravenous Lipid Emulsion as an Adjuvant Therapy in Acute Aluminum Phosphide Poisoning: A randomized Controlled Trial

“…Intensive care admission for the need of mechanical ventilation is frequently required in ALP poisoning due to hypoxia, adult respiratory distress syndrome, and disturbed conscious level (Abd Elghany et al 2018;Louriz et al 2009;Mehrpour et al 2008). Definitely, the favorable effects of ILE in this regard minimize costs, efforts, and the complications related to ventilation.…”