Performance of clinical scoring systems in acute organophosphate poisoning

Peter, John Victor; Thomas, Lovely; Moran, John L.; Abhilash, Kundavaram Paul Prabhakar; Jasmine, Sudha; Iyyadurai, Ramya

doi:10.3109/15563650.2013.841181

Cited by 37 publications

(35 citation statements)

References 19 publications

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“…APACHE-II, SAPS-II, GCS, and PSS (poisoning severity score) were all studied. APACHE-II, GCS, and PSS scoring systems were found to be correlated to mortality rates 11,12. We found that patients with low GCS were hospitalized longer (p<0.001, r=-0.723).…”

Section: Discussionmentioning

confidence: 64%

Prognostic factors determining morbidity and mortality in organophosphate poisoning

Açıkalın¹,

Dişel²,

Matyar³

et al. 2017

Pak J Med Sci

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Objective:Our aim in this retrospective study was to determine the factors affecting poor prognosis and mortality of organophosphate (OP) poisoning by reviewing patient data. We also reviewed present knowledge to make conclusions on certain longstanding debates in light of the literature.Methods:In this retrospective descriptive study, patients who were admitted to and hospitalized in the emergency department (ED) or intensive care unit (ICU) of a university hospital with the diagnosis of OP poisoning between December 2010 and December 2015 were evaluated. All the data were obtained from electronic and manual patient files. A total of 80 patients were included in the study.Results:The mean age of the study patients was 32.4±15.0 (13-94). Forty-nine (61.2%) patients were female. Twenty-two (27.5%) patients were seriously poisoned and needed mechanical ventilation (MV) support. Low pseudocholinesterase (PChE), high creatinine (Cr), low Glasgow Coma Scale (GCS) scores and long hospitalization durations were all found to be poor prognostics in MV patients. Low PChE and high Cr levels were found to be independent predictors of the hospitalization duration and high Cr was found to be an independent predictor of the intubation duration of MV patients in regression analyses. Ten (45.5%) of the MV patients were unresponsive to medical treatment and Therapeutic plasma exchange (TPE) was performed. Seven patients were discharged healthy. Three patients with low PChE levels and comorbidities died.Conclusions:Prolongation of respiratory depression necessitating MV support, comorbidities, long hospital stay, elevated creatinine, low GCS scores and low PcHE levels without regeneration in the first 48 hours of admission are all found to be poor prognostic factors for organophosphate (OP) poisoning.

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Section: Discussionmentioning

confidence: 64%

Prognostic factors determining morbidity and mortality in organophosphate poisoning

Açıkalın¹,

Dişel²,

Matyar³

et al. 2017

Pak J Med Sci

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“…[1] In a retrospective study of 396 patients by Peter et al . [10] the performance of the APACHE II score, the SAPS II, MPM II and the poisoning severity score (PSS) was evaluated; they found that even in the setting of poisoning, the generic scoring systems APACHE-II and SAPS-II outperform the PSS. However, the APACHE II score is neither very sensitive nor specific in terms of mortality prediction.…”

Section: Types Of Icu Scoring Systemsmentioning

confidence: 99%

Scoring systems in the intensive care unit: A compendium

Rapsang¹,

Shyam²

2014

Indian Journal of Critical Care Medicine

188

136

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Severity scales are important adjuncts of treatment in the intensive care unit (ICU) in order to predict patient outcome, comparing quality-of-care and stratification for clinical trials. Even though disease severity scores are not the key elements of treatment, they are however, an essential part of improvement in clinical decisions and in identifying patients with unexpected outcomes. Prediction models do face many challenges, but, proper application of these models helps in decision making at the right time and in decreasing hospital cost. In fact, they have become a necessary tool to describe ICU populations and to explain differences in mortality. However, it is also important to note that the choice of the severity score scale, index, or model should accurately match the event, setting or application; as mis-application, of such systems can lead to wastage of time, increased cost, unwarranted extrapolations and poor science. This article provides a brief overview of ICU severity scales (along with their predicted death/survival rate calculations) developed over the last 3 decades including several of them which has been revised accordingly.

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“…The inter‐rater reliability of the PSS was established in the seminal, multicenter study of 14 poisoning centers that independently rated the PSS in 371 cases (Persson et al, ). Therefore, although gathering additional inter‐rater reliability data in the current sample would have strengthened the study, our focus was on testing the validity (not reliability) of the measure, an approach that has been typical of subsequent PSS validation research (Akdur et al, ; Churi et al, ; Peter et al, ; Sam et al, ). Finally, we did not compare the performance of the PSS with alternative, validated measures of acute medical morbidity such as the Glasgow Coma Scale (Teasdale & Jennett, ) that have been included in some prior PSS validation studies (Akdur et al, ; Churi et al, ; Sam et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, because it takes into consideration all major organ systems in scoring, it is capable of assessing a broad range of poisoning effects, making it optimal for widespread use including in medico-legal cases. Following its introduction and initial testing, evidence for the validity of the PSS has been based on studies of calls to Poison Centers (Bentur, Raikhlin-Eisenkraft, & Lavee, 2004;Casey, Dexter, Michell, & Vale, 1998;Wong, Taylor, Ashby, & Robinson, 2010) and poisoning patients presenting to hospital (Peter et al, 2013;Sabzghabaee et al, 2011;Thanacoody et al, 2016). This research has shown that the PSS predicts clinical outcomes including mortality (Peter et al, 2013;Sabzghabaee et al, 2011;Thanacoody et al, 2016) and that it is correlated with other validated measures of acute medical morbidity (Akdur et al, 2010;Churi, Ramesh, Bhakta, & Chris, 2012;Peter et al, 2013;Sam et al, 2009).…”

mentioning

confidence: 99%

“…Following its introduction and initial testing, evidence for the validity of the PSS has been based on studies of calls to Poison Centers (Bentur, Raikhlin-Eisenkraft, & Lavee, 2004;Casey, Dexter, Michell, & Vale, 1998;Wong, Taylor, Ashby, & Robinson, 2010) and poisoning patients presenting to hospital (Peter et al, 2013;Sabzghabaee et al, 2011;Thanacoody et al, 2016). This research has shown that the PSS predicts clinical outcomes including mortality (Peter et al, 2013;Sabzghabaee et al, 2011;Thanacoody et al, 2016) and that it is correlated with other validated measures of acute medical morbidity (Akdur et al, 2010;Churi, Ramesh, Bhakta, & Chris, 2012;Peter et al, 2013;Sam et al, 2009). A major limitation of this evidence is that it is based primarily on studies of single drug exposures including organophosphate (Akdur et al, 2010;Peter et al, 2013;Sam et al, 2009), carbon monoxide (Cevik et al, 2006), and methanol or ethylene glycol (Thanacoody et al, 2016).…”

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confidence: 99%

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Validation of the Poisoning Severity Score (PSS) in suicidal behavior by self‐poisoning

Conner

Wiegand

Gorodetsky

et al. 2019

Behavioral Sci & The Law

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Intentional self‐poisoning is the leading method of suicidal behavior leading to medical attention worldwide. The medical severity of self‐poisoning events has major treatment, prognostic, and medico‐legal implications, yet measures of severity are limited. The Poisoning Severity Score (PSS) is a widely used scale but validation data are limited, particularly in the study of suicidal behavior per se. The sample was a consecutive series of intentional self‐poisoning patients aged 13 to 65 treated at a large university medical center (n = 673). PSS scores, with a range 0 (none) to 4 (death), were calculated along with other structured clinical data and analyzed in a series of linear regressions adjusted for age and sex. Higher PSS scores were consistently associated with greater medical morbidity and more intensive acute medical treatments, and nearly all effect sizes were large. Results support the validity of the PSS in hospital‐treated self‐poisoning patients.

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Performance of clinical scoring systems in acute organophosphate poisoning

Abstract: In acute OP poisoning, the generic scoring systems APACHE-II and SAPS-II outperform the PSS. These tools may be used to predict the mortality rate in OP poisoning.

Cited by 37 publications

References 19 publications

Prognostic factors determining morbidity and mortality in organophosphate poisoning

Prognostic factors determining morbidity and mortality in organophosphate poisoning

Scoring systems in the intensive care unit: A compendium

Validation of the Poisoning Severity Score (PSS) in suicidal behavior by self‐poisoning

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