E-Posters

introduction / background

Requirement of intensive care unit (ICU) admission results from direct or indirect effects of poisons. Early ICU admission is essential to reduce morbidity and mortality. Various scoring systems were required in clinical practice to reduce admission rates with subsequent reduction in hospitalization costs. Acute physiology and chronic health evaluation II score is the most frequently used scoring system in ICU admissions. It includes many clinical and laboratory variables. Moreover, early warning score is a simple physiological bedside scoring system suitable for emergency. Additionally, poison severity score is a grading scheme for poison severity. Many studies compared efficacy of scoring systems in prediction of the need of ICU admission. However, only few studies evaluated these systems in acute poisoned patients. The aim of this study was to evaluate the utility of different scoring systems APACHE II score, EWS and PSS in prediction of ICU admission in acute poisoned patients in Tanta University poison control center.

Objectives

The aim of this study was to evaluate the utility of different scoring systems Acute Physiology and Chronic Health Evaluation II score (APACHE II), Early Warning Score (EWS) and Poison Severity Score (PSS) in prediction of intensive care unit admission in acute poisoned patients in Tanta poison control center

Materials & Methods

All acute poisoned patients who admitted to Tanta PCC had been included. Diagnosis was based on history, clinical manifestations and laboratory investigations if available. Patients with chronic or combined poisoning, missed clinical data, referred patients with previous medical intervention and with an accompanying condition were excluded. All included patients were subjected to history including age and history of any chronic disease, clinical examination consisting of vital signs measurement and systemic examination had been performed. Laboratory investigations were measured including arterial blood gases, electrolytes, renal function tests and complete blood count. Patients were classified either required or not require ICU admission

Results

Aluminum phosphide and organophosphate were the most frequently 2 poisons that required ICU admission. Aluminum phosphide and organophosphate poisoned patients who required had significantly higher scores than patients who didn’t require ICU admission. Median APACHE II score, EWS and PSS were 11, 5 and 3 respectively in aluminum phosphide poisoned patients who required ICU admission. However, they were 3, 2 and 1 respectively in those who didnʼt require. Poison severity score had the best AUC with sensitivity (96.3%), specificity (98.06%) at cutoff point more than 1. Pairwise comparison of ROC curves revealed significant difference as PSS had significantly higher AUC than other scores. Median APACHE II score, EWS and PSS were 22, 5 and 3 respectively in organophosphate poisoned patients who required compared to 4, 2 and 1 respectively in those who didnʼt require ICU admission. Poison severity score had the best AUC with sensitivity (78,95%), specificity (96.95%) at cutoff point more than 2. Pairwise comparison of ROC curves revealed no significant difference between studied scores.

Conculsion

Poison severity score in aluminum phosphide poisoned patients had the best predictive value for ICU admission. Therefore, elevated PSS more than one is good predictor for need of ICU admission. However, EWS higher than two is better in prediction of need of ICU admission in organophosphate poisoning due to its applicability in emergency.

References

• Haniffa R., Isaam I., De Silva A. P., Dondorp A. M. & De Keizer N. F. 2018. Performance of Critical Care Prognostic Scoring Systems in Low and Middle-Income Countries. • Brandenburg R., Brinkman S., De Keizer N. F., Kesecioglu J., Meulenbelt J. & De Lange D. W. 2017. The Need for ICU Admission in Intoxicated Patients. • Lindqvist E., Edman G., Hollenberg J., Nordberg P. & Forsberg S. 2019. Long-Term Mortality and Cause of Death for Patients Treated in Intensive Care Units Due to Poisoning.

acknowledgement / Contact

© 2021. Tanta University. All right reserved.