Outcome Prediction in Acutely Intoxicated Patients Admitted to Intensive Care Unit

Abstract

Background: Acute poisoning represents a significant proportion of intensive care unit admissions. Even though the overall mortality may be low, they may consume considerable intensive care unit (ICU) resources. Early diagnosis and rapid initiation of appropriate therapy in emergency department and ICU are critical for decreasing hospital morbidity and mortality in poisoned patients. The objective of this study is to determine predictors of outcome of acutely intoxicated patients in intensive care unit which may improve the course of management and decide the pathway of care. Methodology: This is an observational cross sectional retrospective study of 321 acutely intoxicated patients admitted to intensive care unit of Poison Control Center (PCC) in hospitals of Ain Shams University. Information was collected from the sheets and computerized data base of the patients after obtaining the permission of the director of PCC and the regional ethics committee. The results were revised, coded and organized for statistical analysis. Results: The total number of acutely intoxicated patients admitted to ICU of PCC in hospitals of Ain Shams University in the selected period of study was 321 patients. There were 265 patients (82.6%) survived with no complications, 30 patients (9.4%) survived but developed complications and 26 patients (8%) died. The study showed statistically significant difference between uncomplicated, complicated and dead cases as regards mode of toxicity, causative Agent, heart rate, systolic blood pressure, respiratory rate, skin discoloration, Glasgow coma scale (GCS), blood pH, emesis or lavage, activated charcoal, dialysis, endotracheal intubation, mechanical ventilation and dopamine therapy. Conclusion: It could be detected by statistical analysis that causative agent, heart rate, systolic blood pressure, respiratory rate, blood pH, mechanical ventilation and dopamine therapy were significant outcome predictors of acutely poisoned patients in intensive care unit. From the previous results, our study recommends that these predictors of outcome should be assessed routinely and as early as possible to evaluate the severity, improve the course of management and deciding the pathway of care.