Predictors of Clinical Decision Rule in Hydrocarbon Intoxicated Cases Admitted to Poison Control Center Ain Shams University Hospitals during 2015-2016

Abstract

Hydrocarbon toxicity is a common cause of death among cases admitted to poison control centers due to its dangerous complications. The Aim of this study is to derive a clinical decision rule and to identify predictors of outcome after hydrocarbon poisoning. Methods: The prospective study included 674 cases admitted to the PCC ASU hospitals during the years 2015 – 2016. All cases subjected to full history ,clinical data and detection of acid base status by measuring ABG. Emergency interferences were evaluated. Results:563 cases were due to kerosene poisoning,111 cases were due to benzene poisoning .There was significant difference between the two types of hydrocarbon poisoning regarding admission,while there was no significant difference regarding death, mechanical ventilation and CNS abnormalities. 98.5% of cases lived,1.5% died. 33.5%of cases were in the age group >1 - ≤2 years, 17.7% >18 - ≤40years, all dead cases were children and 40% of deaths were in the age group (>2 - ≤3years).Most of cases were males(65%) without significant difference between both genders. 71.2% were accidental, 28.5%were suicidal and 0.3% were criminal mode of toxicity. 77.6% used oral route, 15% were dermal and 7.4% were by injection. 88.6% of cases needed observasion in the ER for 1week. 12 cases needed endotracheal intubation and mechanical ventilation, 5 cases were shocked and needed dopamine as vasopressor, 31 cases received corticosteroid, 45 cases received bronchodilator by nebulizer and all cases received O2 therapy and antibiotics. Of symptomatic survived cases, 66% , 70%,67%,46%,9% and 1.5% had hyperthermia, tachycardia ,respiratory distress, acidosis, CNS abnormalities and hypotension respectively. All dead cases had hyperthermia, tachycardia, respiratory distress, acidosis and 50% had hypotension and 60% had CNS abnormalities.Lastly, Mchanical ventilation was used in 3% of symptomatic survived group and 100% of the dead group. The group of deaths showed significant predominance of hyperthermia, tachycardia, hypotension, respiratory distress, CNS abnormalities, acidosis and need of mechanical ventilation when compared with the survivors group. The Logistic regression analysis revealed that hypotension, CNS abnormalities, acidosis and need of mechanical ventilation all are predictors of in-hospital mortality Conclusion: Hydrocarbon poisoning is common oral accidental toxicity among children in the age group >1 - ≤2 years .Predictors of fatal outcome are: children especially the age group >2 - ≤3 years, hypotension, CNS abnormalities, acidosis, respiratory distress, hyperthermia and tachycardia. Recommendations: Any case presented with the previously mentioned predictors should be considered as a high risk group for proper management and in order to decrease risk of fatalities. Preventive measures should be done as awareness of parents about hydrocarbon toxicity, proper packing and storage of such dangerous materials.