Prediction of Outcome of Acutely Intoxicated Patients Admitted To Intensive Care Unit in Mansoura-Dakhlia Governorate-Egypt

Abstract

Acute poisoning is a frequent cause of admission to emergency departments and intensive care units, as it is considered as an important medical emergency requiring early diagnosis and rapid initiation of therapy. The aim of the present study was to assess characteristics, and outcomes of acutely intoxicated patients who were admitted to ICU. Also, design a scoring system regarding priority for ICU admission. The present study was carried out on 40 patients who were admitted to intensive care unit of El Mansoura General Hospitals-Egypt during a period of 6 months. Personal, toxicological, and medical histories, clinical examination and routine investigations were recorded for each patient. At discharge; all patients were reassessed for determination of patients' outcome. The patients were mostly females, single; student aged less than 30 years and from rural areas. The majority of the patients (72.5%) were recovered, 22.5% were died and 5% were referred to hyperbaric oxygen therapy units after carbon monoxide intoxication. Many patients were presented by constricted pupil (45%), respiratory depression (42.5%), altered mental status (42.5%), tachycardia (47.5%), and nausea & vomiting (75%). The highest numbers of cases were poisoned by medicinal drugs (40%) followed by agricultural chemicals (35%). Statistically significant difference between occupation, toxicological amount & frequency, pulse rate, Glasgow coma score, PH & PCO2 and type of poison (zinc phosphide) and patient outcomes was observed. Although many of the patients' characteristics were significantly associated with patient outcome yet none of them was considered significant predictors for death. So, the suggested scoring system depended mainly on clinical data and simple rapid investigation that may be helpful for rapid assessment of the patients after further validation. We recommend the presence of a channel of communication between the general care centers and the poison control centers for consultation about the protocol of treatment of poisoned patients. Nationwide, a mechanism of communication between the poison centers must be done to benefit from the different expertise and to make a uniform protocol for treatment of poisoned cases to decrease the mortality rate and the burden on hospitals resources.

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

“…El‐Sarnagawy and Hafez 53 also identified GCS of ≤8 on admission as the most sensitive (100%) predictor for mechanical ventilation in drug‐overdosed patients. Moreover, many studies demonstrated the prognostic value of the GCS, heart rate, SBP, and respiratory rate in predicting outcomes of the ICU admitted poisoned patients 16,29,54 …”

Five year (2013-2017) trends in poisoning among patients of the Buea Regional Hospital, South-West Region (Cameroon)

“…The age group 16-30 years old was most affected. Similar studies have confirmed the vulnerability of young people to poisons (Achour et al, 2011;Arulmurugan et al, 2017;Chen et al, 2010;Gupta et al, 1998;Oreby et al, 2016). Nevertheless, in a study carried out between 1999 and 2008 in Taiwan, aged males above 65 years old were the most affected group with medicinal drug poisoning (Chien et al, 2011).…”

“…Dog bite and food poisoning were at the top position, followed by alcohol. In similar studies, common poisoning agents were agricultural inputs, alcohol and drugs (Chen et al, 2010;Oreby et al, 2016;Saravi, 2013). Alcohol abuse is a common issue in the modern society.…”

“…This retrospective study aimed at assessing five-year trends in poisoning at the Buea Regional Hospital. A total of 335 cases were recorded during the study period: nowadays, poisoning is one of the main causes of hospital referring (Eslami et al, 2014), affecting people worldwide in all social levels and age groups (Oreby et al, 2016).…”

A Proposal for a Novel Scoring System for Triage of Acutely Poisoned Patients at Tanta University Poisoning Treating Center, Egypt

“…Zaghary et al [25] showed that the mean value of heart rate in non-survived poisoned cases was 96.0 ± 26 beats/minute and also observed absence of significant difference between survivors and non-survivors. Contrary to this, Yu et al [5] and Oreby et al [26] noted statistically significant differences between survivors and non-survivors regarding the heart rate.…”