Predictors of mortality in emergency centre patients with acute pesticide poisoning in Uganda.

Abstract

Although the global suicide deaths due to intentional pesticide poisoning disproportionately occur in low income countries (LIC) and lower to middle income Countries (LMIC), there is a scarcity of reports on emergency centre (EC) mortality and its predictors in these settings. Our goal was to determine the case fatality rate of Acute Pesticide Poisoning (APP) presenting to Mbarara Regional Referral Hospital (MRRH) EC and find out whether initial triage category predicted mortality in these patients. This was a prospective observational longitudinal study. Patients presenting with APP were enrolled using data collection forms. Data collected included initial triage category, vital signs, demographics, initial assessment, and management. They were followed up for 1 week. Out of 66 patients admitted with suspected pesticide poisoning, 61 had complete follow up during the study period. However, only 58 patients had the pesticide ingested confirmed. These were predominantly males 48 (73%) and farmers 28(42%) with a median age of 23 years (IQR 18-31). Majority of patients 58 (88%) were suicide attempts and had ingested mostly organophosphates 23 (35%), amitraz 11(17%), zinc phosphide 7(10%), and aluminium phosphide 4(6%). The median time from ingestion to presentation was 4hours (IQR 2.5-8). More than half 41(62%) of the patients were in the red triage category (ESI-1). The overall case fatality rate of APP was 18%. Majority of patients who died were in the red triage category but the initial triage category was not significantly associated with mortality (p=0.381). Male gender (p=0.018), time of admission (p= 0.037), and triage vitals including hypothermia (p=0.020), hypoxia (p= 0.004), hypotension (p= 0.031), and tachypnea (p= 0.031) were significantly associated with mortality. Although initial triage category was a poor predictor, triage vital signs, gender, and time of admission were significantly associated with mortality in patients with APP.