PIH5 - The Efficacy of Oximes in Acute Human Organophosphorus Poisoning; An Updated Meta-Analysis

Abstract

The present study iims to meta-analyze clinical trials evaluating the efficacy of oximes on organophosphorus (OP) poisoning treatment. PubMed, Scopus, Google Scholar, and clinicaltials. gov were searched for studies investigating the effects of oximes in the treatment of OP poisoning. Mortality, intermediate syndrome, intensive care unit (ICU) admission rate, hospital stay duration, and intubation rate were the key outcomes of interest. Data were searched in the time period of 1966 through December 2013. Thirteen studies (eleven clinical trials and two historical cohorts) that met our criteria were included in the analysis. Pooling of data showed that relative risk (RR) of need for intubation in OP poisoning for eight included trials comparing oximes with placebo was 1.27 with 95% CI= 0.73 to 2.23 (P= 0.4). RR of only one observational study was 1.57 (95% CI= 0.79 to 3.2, P>0.05). The summary of RR for mortality rate in 9 studies was 0.38 (95% CI= 0.65 to 2.97, P= 0.41) and for one observational study was 1.33 (95% CI= 0.54 to 3.29, P>0.05). The RR for ICU admission rate in OP poisoning for three trials comparing oximes to placebo was2.12 with 95% CI= 0.89 to 5.03 (P= 0.09). For only one observational study, RR was 0.81 (95% CI= 0.49 to 1.25, P>0.05). For intermediate syndrome, while the RR of only trial comparing oximes with placebo was 1.89 (95% CI= 1.27 to 2.91, P<0.05), for only one observational study, it was 1.43 (95% CI= 0.7 to 2.96, P>0.05). For hospital stay duration, the RR of four studies was 0.75 with 95% CI = -0.51 to 1.99. According to these data, oximes beneficence in OP poisoning is unclear and there is possible increase in incidence of intermediate syndrome.