The Accuracy Comparison of Scoring Systems in the Outcome Prediction of Acute Organophosphate Poisoning

Abstract

Background: Organophosphates (OP) with high morbidity and mortality are one of the most common causes of poisoning especially in developing countries. Early diagnosis and appropriate treatment is often life saving as mortality rate of OP poisoning is still high. The objective of this study is to compare the accuracy of scoring systems (the sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE II) score and glasgow coma scale (GCS)) in the prediction of mortality of acute organophosphate poisoning. Methodology: A retrospective and prospective study was done on 200 patients with acute OP poisoning admitted to the Poison Control Center (PCC), hospitals of Ain Shams University in the period between 1/1/2016 and 31/12/2016. Information was collected from the sheets and computerized data base of the patients. SOFA score, APACHE II score and GCS were calculated to each patient admitted. The results were revised, coded and organized for statistical analysis. Results: The study results revealed 180 (90%) patients recovered and 20 (10%) patients died. The area under the curve of receiver operator characteristic (ROC) of SOFA score was 0.995, for APACHE II score was 0.986 and compared to GCS was 0.977 with significantly higher SOFA and APACHE II scores in the died patients than in the recovered patients (P <0.001). As regards GCS there was statistically significant difference between recovered and died patients (P <0.001). Conclusion: It could be concluded that SOFA score, APACHE II score and GCS systems can be used to predict mortality of acute organophosphate poisoning with preference to SOFA score which had the highest accuracy and predictive ability. From the previous results, our study recommends that application of SOFA score, APACHEII score and GCS are good predictors of high mortality in OP intoxicated patients which helps in proper allocation of resources particularly for intensive care unit patients.

Latent class trajectories of biochemical parameters and their relationship with risk of mortality in ICU among acute organophosphorus poisoning patients

“…This study has examined more accessible, relatively inexpensive biochemical parameters and shown more clinical utility and are much more convenient than expensive laboratory-based markers and may be considered for use in clinical settings for future OP poisoning patients admitted for intensive care. Commonly used scoring systems heavily depends on clinical and laboratory investigational information 5 , 17 , 18 , 41 – 45 , and rely on single measurements usually at the time of admission of patient. LLPA used in this study is a person-centered approach where latent classes identify trajectories of patients based on repeated measures of very routine clinical parameters 29 .…”

Latent Class Trajectories of Biochemical Parameters and Their Relationship With Risk of Mortality Among Acute Organophosphorus Poisoning Patients

“…Commonly used scoring systems heavily depends on clinical and laboratory investigational information [5,17,18,[41][42][43][44][45], and rely on single measurements usually at the time of admission of patient. LLPA used in this study is a person-centered approach where latent classes identify trajectories of patients based on repeated measures of very routine clinical parameters [29].…”

“…In our country, it is di cult to judge the amount as patients ingest different brands, which lack the description of concentration of the poisonous substance [6,12]. In clinical settings, the prognosis of these patients is mainly assessed by a variety of different methods including but not limited to vital status, poisoning scoring systems, and laboratory investigations [5,[13][14][15][16][17][18][19][20][21][22]. Biochemical analysis of blood plays an important role in the diagnosis of intoxicated patients since drugs with biochemical substances produce biochemical changes.…”

Trajectories of vital status parameters and risk of mortality among acute organophosphorus poisoning patients – a latent class growth analysis

“…Commonly used scoring systems heavily depend on clinical and laboratory investigational information [4,[20][21][22][23][24][25][26] Furthermore, most scoring systems rely on single measurements, usually at the time of patient admission. The LCGA used in this study is a person-centred approach in which latent classes identify trajectories of patients based on repeated measures of very routine clinical parameters [54] .…”

“…Many scoring systems are currently being used to evaluate the severity of acute OP poisoning, such as the Acute Physiology and Chronic Health Evaluation (APACHE) II score [ 20 , 21 ], GCS, Peradeniya Organophosphorus Poisoning Scale (POPS) [ 22 ], Poisoning Severity Score (PSS) [ 23 , 24 ], Sequential Organ Failure Assessment (SOFA) [ 25 ], Simplified Acute Physiology Score II (SAPS II) [ 26 ], and Practical Predicting Scoring System [ 4 ]. These scoring systems are complex and rely on subjective assessment of clinical information and laboratory investigations, which are difficult to acquire or accurately describe.…”