Mortality In Poisoned Patients Research Articles

The impact and risk factors of recreational drug poisoning in patients admitted to the emergency room of Bab El Oued

Recreational drug refers to the use of drugs that are not intended for medical reasons but for its psychoactive nature and leisure. In the Middle East and worldwide, drug abuse is a growing problem for authorities Materials and methods: We carried out a descriptive and analytic cohort study. We included all cases aged over 16 years presented to the emergency department (SU) of the Lamine Debaghine-Bab El Oued University hospital, between November 2020 to October 2021 presenting acute toxicity due to self-reported recreational drug use or exhibiting symptoms/signs consistent with acute toxicity. Furthermore, we carried out a multivariate analysis by logistic regression to eliminate all confounding factors around the risk of morbidity and mortality of poisoned patients. Results: The mean age was 18-year-old. they are mostly due to prescription medicine.50.7% of the cases are dual consumptions of leisure drugs. 51% stayed more than 13h. Starting from the initial model (Table 01), the explanatory variables which remained significant in the final model illustrated as follows: Signs of cardiac collapse or decompensation significantly increased the risk of hospitalization and intensive care unit admission. They multiplied the risk by 2.5: ORa= 2.5 (1.1 – 5.81) CI 95% Discussion: We highlighted that drug abuse started at a really young age in our population. we noticed a preponderance of dual and medicinal drugs, a longer duration of hospitalization and a significantly increased risk of cardiac events Conclusion: We could relate the pretty young age and duration of stay to the lake of awareness, social level and the accessibility to prescription medicine for a leisure purpose

Evaluation of the new poisoning mortality score in comparison with PSS and SOFA scoring systems to predict mortality in poisoned patients admitted to the intensive care unit.

Mortality prediction in acute poisoning patients aids in prompt and effective treatment. This study aimed to evaluate the effectiveness of the new Poisoning Mortality Score (PMS) in comparison with the Poison Severity Score (PSS) and Sequential Organ Failure Assessment (SOFA) scoring systems in poisoned patients admitted to the intensive care unit (ICU). The medical records of 523 poisoned patients admitted to the ICU of the Poison Control Centre from September 2021 to June 2022 were examined retrospectively. The PMS, PSS, and SOFA scores were calculated based on the worst values of the first 24 h of admission. A total of 100 patients were enrolled in the study, and the in-hospital mortality rate was 28%. The best cut-off points for predicting mortality for PMS, PSS, and SOFA scores were > 53, > 2, and > 6, with sensitivities of 67.9%, 85.7%, and 82.4% and specificities of 73.6%, 84.7%, and 83.3% respectively. In a pairwise comparison of the AUCs for PMS, PSS, and SOFA scores, SOFA displayed significantly greater accuracy than PSS and PMS. The PMS, PSS, and SOFA scoring systems were significant predictors of mortality in ICU-admitted poisoned patients, however, the SOFA score showed the best performance (OR = 1.77, and 95% CI = 1.42-2.54) with significant P-value (0.002) as a predictor of mortality and highest AUC(0.904).

Prognostic indicators in critically ill poisoned patients: development of a risk-prediction nomogram.

The prognosis of acutely poisoned patients is a significant concern for clinical toxicologists. In this study, we sought to determine the clinical and laboratory findings that can contribute to predicting the medical outcomes of poisoned patients admitted to intensive care units (ICUs). This retrospective study was performed from January 2009 to January 2016 in the ICU of Vali-e-Asr Hospital in Birjand, Iran. We included all patients with the diagnosis of acute poisoning admitted to the ICU. Demographic data, laboratory results, the Sequential Organ Failure Assessment (SOFA), and acute physiology score + age points + chronic health points (APACHE) II, and the Simplified Acute Physiology Score (SAPS) II, and outcome were collected. Univariate analysis (Mann-Whitney or t-test), multiple logistic regression, receiver operating characteristics (ROC) curve analysis, and Pearson's correlation test were performed using SPSS, STATA/SE 13.0, and Nomolog software programs. The multiple logistic regression analysis revealed that five factors were significant for predicting mortality including age (OR 95% CI: 1.1[1.05-1.12], p<0.001), Glasgow Coma Score (GCS) (OR 95% CI: 0.71[0.6-0.84], p<0.001), white blood cell (WBC) count (OR 95% CI: 1.1[1.01-1.12], p=0.04), serum sodium (Na) (OR 95% CI: 1.08[1.01-1.15], p=0.02), and creatinine levels (Cr) (OR 95% CI: 1.86 [1.23-2.81], p=0.003). We generated a five-variable risk-prediction nomogram which could both predict mortality risk and identify high-risk patients. Age, GCS, WBC, serum creatinine, and sodium levels are the best prognostic factors for mortality in poisoned patients admitted to the ICU. The APACHE II score can discriminate between non-survivors and survivors. The nomogram developed in the current study can provide a more precise, quick, and simple analysis of risks, thereby enabling the users to predict mortality and identify high-risk patients.

Prognostic indicators in critically ill poisoned patients: development of a risk-prediction nomogram.

Objectives The prognosis of acutely poisoned patients is a significant concern for clinical toxicologists. In this study, we sought to determine the clinical and laboratory findings that can contribute to predicting the medical outcomes of poisoned patients admitted to intensive care units (ICUs). Methods This retrospective study was performed from January 2009 to January 2016 in the ICU of Vali-e-Asr Hospital in Birjand, Iran. We included all patients with the diagnosis of acute poisoning admitted to the ICU. Demographic data, laboratory results, the Sequential Organ Failure Assessment (SOFA), and acute physiology score + age points + chronic health points (APACHE) II, and the Simplified Acute Physiology Score (SAPS) II, and outcome were collected. Univariate analysis (Mann-Whitney or t-test), multiple logistic regression, receiver operating characteristics (ROC) curve analysis, and Pearson's correlation test were performed using SPSS, STATA/SE 13.0, and Nomolog software programs. Results The multiple logistic regression analysis revealed that five factors were significant for predicting mortality including age (OR 95% CI: 1.1[1.05-1.12], p<0.001), Glasgow Coma Score (GCS) (OR 95% CI: 0.71[0.6-0.84], p<0.001), white blood cell (WBC) count (OR 95% CI: 1.1[1.01-1.12], p=0.04), serum sodium (Na) (OR 95% CI: 1.08[1.01-1.15], p=0.02), and creatinine levels (Cr) (OR 95% CI: 1.86 [1.23-2.81], p=0.003). We generated a five-variable risk-prediction nomogram which could both predict mortality risk and identify high-risk patients. Conclusions Age, GCS, WBC, serum creatinine, and sodium levels are the best prognostic factors for mortality in poisoned patients admitted to the ICU. The APACHE II score can discriminate between non-survivors and survivors. The nomogram developed in the current study can provide a more precise, quick, and simple analysis of risks, thereby enabling the users to predict mortality and identify high-risk patients.

Outcome Prediction in Acutely Intoxicated Patients Admitted to Intensive Care Unit

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.

The Availability of Antidotes in Public Hospitals in Kuwait: A Cross Sectional Survey

Objective: Inadequate availability of essential antidotes is reported in many countries. Information on the availability of antidotes in Kuwait is not available. The aim is to determine whether there are adequate stocks of antidotes in public hospitals in Kuwait and to identify the presence of guidelines for antidote stocking and sharing and to determine the presence of emergency medicine pharmacists in the emergency departments. Methods: A cross-sectional study was carried out using a questionnaire distributed to chief pharmacists of six public hospitals in Kuwait. The questionnaire enquired on the availability of 29 antidotes. Results: All the chief pharmacists responded to the survey. The antidotes that were not available in any of the hospitals were botulinum antitoxin, calcium gluconate gel, dicobaltedetate, fomepizole, sodium calcium edetate, sodium thiosulphate, succimer and unithiol. There was substantial variation in the availability of antidotes, especially for cyanide poisoning, ranging from no hospitals for sodium thiosulphate to one hospital each for sodium nitrite and hydroxocobalamin. Only two hospitals had stocks of the polyvalent snake antivenom. Only three hospitals had sharing agreements. Kuwait does not have guidelines for stocking antidotes. None of the hospitals had emergency medicine pharmacists. Conclusion: The six general hospitals in Kuwait have inadequate availability of certain antidotes. Urgent measures, by creating a national guideline for antidote stocking and enforcing antidote hazard vulnerability assessment and establishing a poison control centre, are needed to reduce morbidity and mortality of poisoned patients in Kuwait.

Editorial: [Hot Topic: Antidotes and Rescue Therapies

Editorial: [Hot Topic: Antidotes and Rescue Therapies

Acute poisonings treated in hospitals in Oslo: a one-year prospective study (II): clinical outcome.

The changing pattern of acute poisoning may affect complications and outcome in these patients. An update study on acute poisonings was therefore performed and compared to similar data from 1980. A prospective cross-sectional multi-center study of all adult patients (> or = 16 years) hospitalized in Oslo with a main diagnosis of acute poisoning, irrespective of intention, over a one-year period. Of 947 admissions, 222 (23%) were comatose. Complications were observed in 173 (18%), slightly reduced from 1980 (22%). Ten (1.1%) died and six (0.6%) got permanent sequelae, of which seven and five were drug- or alcohol-related, respectively. Seventy-five percent received treatment besides observation; 39% received antidotes, increased from 21% in 1980, most frequently flumazenil (23%) and naloxone (14%). In-hospital mortality in poisoned patients remained low, few patients entailed complications, and most patients survived without permanent sequelae. Drug- and alcohol-abuse related poisonings were most severe.

Acute poisonings treated in hospitals in Oslo: A one-year prospective study (II): Clinical outcome

Objectives. The changing pattern of acute poisoning may affect complications and outcome in these patients. An update study on acute poisonings was therefore performed and compared to similar data from 1980. Design. A prospective cross-sectional multi-center study of all adult patients (≥ 16 years) hospitalized in Oslo with a main diagnosis of acute poisoning, irrespective of intention, over a one-year period. Results. Of 947 admissions, 222 (23%) were comatose. Complications were observed in 173 (18%), slightly reduced from 1980 (22%). Ten (1.1%) died and six (0.6%) got permanent sequelae, of which seven and five were drug- or alcohol-related, respectively. Seventy-five percent received treatment besides observation; 39% received antidotes, increased from 21% in 1980, most frequently flumazenil (23%) and naloxone (14%). Conclusions. In-hospital mortality in poisoned patients remained low, few patients entailed complications, and most patients survived without permanent sequelae. Drug- and alcohol-abuse related poisonings were most severe.