Predictive Value of Triage Vital Signs and Conscious Level for Outcome Evaluation in Acutely Organophosphate Poisoned Patients

Mona Moussa,Nayel Zaki,Soheir Mohamed,Maha Hilal,Marwa Elnabi

doi:10.21608/ajfm.2018.15875

Abstract

Triage in Emergency departments requires emergency doctors to make rapid decisions based on their knowledge and experiences. Triage of patients is critical to patient safety, yet no clear information exists by the utility of initial vital signs and conscious levelin identifying critically ill acutely organophosphate (OP) poisoned patients. The objective of this study is to determine the relationship between triage vital signs and conscious level in predicting outcome of acutely organophosphate poisoned patients.A retrospective and prospective study was carried out on 200 patients of acute OP poisoning admitted to the Poison Control Center (PCC), Ain Shams University Hospitals. Information including vital signs and Glasgow coma scale (GCS) on admission after obtaining the permission of the director of PCC and the regional ethics committee was collected from the sheets and computerized data base of the patients, an informed written consent has been obtained from each patient or from his/her caregiver for inclusion in the prospective part of the study. The results were revised, coded and organized for statistical analysis. The study results revealed 180 (90%) patients discharged and 20 (10%) patients died. The study also showed that 8% of patients had fever, 9.5% had tachycardia, 1.5% had bradycardia, 5% had hypotension, 2% had hypertension, 2.5% had tachypnea and 3.5% showed bradypnea. Also 89% of patients had GCS > 8, while 11% of patients had GCS ≤ 8. The study showed statistically significant difference between discharged and died patients as regards heart rate, blood pressure, respiratory rate, body temperature and GCS. It could be concluded that heart rate, respiratory rate and coma scale can serve as easily measurable tools for outcome prediction in acutely OP poisoned patients. From the previous results, our study recommends to use these parameters to help emergency physicians to quickly detect poisoned patients with poor outcomes.

Highlights

Organophosphates (OP) are used as insecticides in agricultural and domestic settings throughout the world (Eddleston et al, 2008).Poisoning with OP compounds is responsible for great morbidity and mortality in developing countries. (Sivangnanam, 2002).Insufficient control on the importation, production, storage and unsafe use of OP pesticides are the common reasons of poisoning (Suleman et al, 2006)
Triage of patients is critical to patient safety, yet no clear information exists by the utility of initial vital signs and conscious level in identifying critically ill acutely organophosphate (OP) poisoned patients
A retrospective and prospective study was carried out on 200 patients of acute OP poisoning admitted to the Poison Control Center (PCC), Ain Shams University Hospitals

Summary

Introduction

Organophosphates (OP) are used as insecticides in agricultural and domestic settings throughout the world (Eddleston et al, 2008).Poisoning with OP compounds is responsible for great morbidity and mortality in developing countries. (Sivangnanam, 2002).Insufficient control on the importation, production, storage and unsafe use of OP pesticides are the common reasons of poisoning (Suleman et al, 2006). Organophosphates (OP) are used as insecticides in agricultural and domestic settings throughout the world (Eddleston et al, 2008). Poisoning with OP compounds is responsible for great morbidity and mortality in developing countries. Insufficient control on the importation, production, storage and unsafe use of OP pesticides are the common reasons of poisoning (Suleman et al, 2006). The mortality rate of OP in developing countries is high and is often related to delay in diagnosis or improper management (Eizadi-Mood et al, 2007). OP poisoning remains an important cause of morbidity and mortality, but no definite parameters have been identified as predictors of outcome. Prediction of morbidity at presentation might help in decision making in places of limited resources like rural settings in developing countries (Muley et al, 2014)

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