318 Comparision of the Initial Glasgow Coma Scale and Serum Cholinesterase Level to the ICU Stay in Acute Organophosporus Poisoning Presenting to a Tertiary Care Hospital in Madurai, India

Abstract

Intentional ingestion of organophosphorous (OP) is a common type of poisoning in central and southern parts of India. Subjective evaluation of clinical status by individual clinicians may differ in measurement of illness severity. It is essential to establish an effective management strategy for such cases of poisoning. A simple standardized system based on presenting Glasgow Coma Scale is likely to be most useful in low income countries (limited resources) where the majority of OP poisoning occurs. The objective of the study is to compare the initial Glasgow coma scale and Serum Cholinesterase level to the ICU stay in Acute Organophosporus poisoning presenting to a tertiary care hospital in Madurai, India. This is a prospective observational study from March 2015 till December 2016 where a specific set of data were collected from the study population. A total of 154 patients were enrolled, of which 33 were excluded as per exclusion criteria, which included mixed ingestions except alcohol, age less than 18, discharge against medical advise, and consumption to door time more than 24 hours. Data abstraction was done for initial GCS, serum cholinesterase level, and interventions in ED. The duration of ICU stay and outcome was followed until discharge. Further Pearson correlation was used to compare, if the GCS at initial presentation to ED had a correlation with the length-of-stay in the ICU. Intentional ingestion of organophosphorous compounds (OPCs) was more common in patients who were single, unemployed, and had alcohol abuse. Among the incidence of GCS from the total number of 121 patients, 71 patients had a GCS of more than ten, 28 patients within the range of 6-10, and 22 under five. The Glascow Coma Scale and ICU stay was compared and the mean average was plotted. Then a, Pearson correlation was calculated and there was a negative corelation of -0.64 (ie, if GCS decreased the ICU stay increased and vice versa). 0.64 value is of good corelation, which is significant. The initial cholinesterase levels when compared to ICU stay also showed a negative corelation but with a low significant value of -0.34. Among the complications Intermediate syndrome and secondary infections were common in presentation, and some OPCs had specific complications. Early assessment of patient through Glascow Coma Scale in organophosphorus poisoning is helpful in prognosticating and allows intensive monitoring and further critical care. Initial values of serum cholinesterase was not significant in deciding the severity of poisoning. In limited resource setting, presenting GCS has better prognosticating effect than serum cholinesterase level.