Organophosphate Poisoned Patients Research Articles

Organothiophosphate Induced Acute and Reversible Parkinsonism: Case Report and Literature Review

Introduction: Organophosphate compound poisoning is one of the most common causes for admission to the Medical Intensive Care Unit. Parkinsonism is a primary neurotoxic manifestation of organophosphate intoxication. In this case report, we present the case of a 26 year old man who had the experience of organothiophosphate poisoning. Case presentation: A 26 year old man was admitted with tremors in upper and lower limbs together with the rigidity of all 4 limbs as well as difficulty in swallowing and in daily activities like walking, rising from chair, and turning on bed. He had consumed organophosphorus compound quinalphos, 15 days before. The basal ganglia changes were documented radiologically by Magnetic Resonance Imaging (MRI). Gradual recovery was observed by treatment with dopaminergic agents and central anticholinergics over few weeks. Only 0.5% of organophosphate poisoning patients develop neurotoxic manifestations in the form of extrapyramidal syndromes such as Parkinsonism. Discussion: The occurrence of Parkinsonism as a complication of organophosphate poisoning raises safety concerns, especially in developing countries. Yet, this study is the first case report on Organothiophospahate induced Parkinsonism. Conclusion: Clinicians should be aware of the possibility of extrapyramidal manifestations following organophosphate poisoning and the patients should be asked for regular follow-ups as the symptoms may appear even 1 month after the poisoning.

Factors associated with time to successful weaning in mechanically ventilated organophosphate poisoned patients

We designed this study to identify the factors associated with time to successful weaning in mechanically ventilated organophosphate (OP)-poisoned patients as the primary outcomes while duration of mechanical ventilation (MV) support, intensive care unit (ICU), and hospital length of stay (LOS) and in-hospital mortality as the secondary outcomes. We conducted a retrospective study of mechanically ventilated OP-poisoned patients admitted to the ICU of Poison Control Center of Ain Shams, Cairo, Egypt, starting from January 2019 to December 2019. Weaning was considered successful if the patient succeeded in the first spontaneous breathing trial of weaning and did not need reinstitution of MV. We used Cox proportional hazards regression models to identify factors associated with time to successful weaning in the studied patients. A total of 55 patients were enrolled in the study. Thirty-eight patients were weaned successfully. Lower initial red cell distribution width (RDW) levels [adjusted hazard ratio (HR), 0.299, 95% confidence interval (CI) (0.184–0.486)] and lower initial doses of atropine [adjusted HR, 0.97, 95% CI (0.935–0.999)] were independently associated with shorter time to achieve successful weaning. Successfully weaned patients had significantly longer hospital LOS (p = 0.019) and no reported in-hospital mortality (p < 0.001) compared with patients who failed to wean. We concluded that initial RDW and initial doses of atropine were found to be the strongest factors associated with time to successful weaning in mechanically ventilated OP-poisoned patients. RDW and atropine can be used as simple risk assessment tools in OP poisoning.

Mortality among organophosphate poisoning patients presenting with low Glasgow coma scale score at A Tertiary Care Hospital.

This study is designed to assess the mortality in OPP patients with low GCS scores. Study Design: Cross Sectional study. Setting: Jinnah Postgraduate Medical Center. Period: From 1st February 2018 to 31st August 2018. Material &amp; Methods: Included patients with low GCS, both genders and age of 18-60 years diagnosed with OPP. Their GCS was calculated and the outcome was determined in terms of mortality. Results: Out of 70 patients, the mean age was 35.2+16.5 years with the majority (62.9%) &lt;30 years. 62.9% of these were males. Most (57.1%) of them presented after ingestion of &lt;15mL of OP, 60% had the poisoning for &gt;60 minutes, and the majority (74.3%) had taken it orally. When the GCS was computed, 81.40% had that of &gt;5, while the mean came out to be 6.64 ±1.43. The mortality rate here was 17.10%. Conclusion: GCS toll can be a helpful and practical tool in assessing the mortality among the patients of OPP. However, because of the limited literature on the subject further studies are recommended to improve its validity.

PNS38 PREDICTION OF TOTAL HOSPITALIZATION COSTS ASSOCIATED WITH COMPLICATIONS IN ORGANOPHOSPHATE POISONING

Organophosphate poisoning is a major public health problem in rural and low socio-economic populations in India. The economic burden of this poisoning is high due to the manifestation of associated complications and its high treatment costs. This study attempts to predict the total hospitalization costs associated with the various significant complications in organophosphate poisoning. A retrospective cross-sectional study was conducted in a Tertiary care hospital in India after procuring the ethical approval. Data of patients diagnosed with organophosphate poisoning (ICD–T60) during January 2012- July 2018 were collected from the Medical and Finance Record Department and analyzed using R package and SPSS. A Regression tree was generated to identify the predominant complications that affected the cost. Generalized Linear Model was further used in predicting the mean total cost in the presence of those complications and their association with the cost. The original data was split into 70:30 ratio where 70% of the data was used for model building and 30% for its validation. A total of 638 organophosphate poisoned patients were included in the study. Majority of the patients were farmers [n=152 (23.8%)] with maximum suicidal rate [n=147 (24.1%)]. The total cost for treating 638 patients was 43501732.07 INR (median=45422.5 INR). According to the Regression tree, patients undergoing tracheostomy paid the highest amount (170000 INR) followed by seizures (150000 INR). Generalized Linear Model predicted that the majority of the patients were within 20000-50000 INR of actual cost reported (52.5% of the population falling under 20000 INR and 81.8% under 50000 INR). All significant complications except cardiac arrest (B= -0.252), had a positive association with the cost. The complications associated with organophosphate poisoning significantly increased treatment costs. This model will help the clinicians in estimating the total costs associated with complications in organophosphate poisoning.

Recovery Pattern and Barriers to Mobilization during Acute Rehabilitation Phase in Organophosphate Poisoning Patients

Organophosphate pesticide poisoning is a common clinical problem in developing countries, bringing with it significant morbidity and mortality. There is limited evidence on the mobility status in patients who survive acute intoxication by organophosphates. The purpose of this study is to assess the mobility patterns and barriers to mobilization in organophosphate poisoning survivors in the intensive care unit. This cross-sectional study looked at 37 patients with acute intoxication from organophosphate compounds. Patients with Acute Physiology and Chronic Health Evaluation scores of less than 93 and Richmond Agitation and Sedation scores between −2 and +2 were included. Potential mobility barriers, bed mobility, functional strength, transfers, and endurance were assessed using the Perme Intensive Care Unit Mobility score on alternative days for the first ten days of intensive care unit admission. Perme scores (2.50–6.0, p ≤ 0.01) improved significantly with improvement in the subcomponents of bed mobility score (1.83 ± 0.35 to 7.23 ± 3.84), transfers (0.37 ± 0.02 to 4.78 ± 3.84), and gait (1.83 ± 0.35 to 5.23 ± 1.27) from day 2 through day 10 of hospital admission. The endotracheal tube and continuous infusion were identified as major barriers to mobilization (66.6%) using Perme scores. Perme scores improved gradually in organophosphate poisoning patients in the intensive care unit. Identification of mobility barriers may help in the modification of rehabilitation goals.

Outcome of Self- and Planned Extubation in Organophosphate-Poisoned Patients

Respiratory failure is the most common cause of morbidity and mortality in organophosphate (OP)-intoxicated patients. We aimed to assess and compare the need for re-intubation and outcome between patients with self-extubation (SE) and planned extubation (PE).

Efficacy and outcomes of lipid resuscitation on organophosphate poisoning patients: A systematic review and meta-analysis

ObjectiveOrganophosphate (OP) pesticides are still widely available in developing countries, leading to numerous accidental or suicidal poisonings every year. Lipid emulsion treatments are commonly used in resuscitating OP poisoning patients but few studies regarding their use have been reported. Our meta-analysis aimed to analyze the efficacy and outcomes of lipid resuscitation on OP poisoning patients. MethodsA systematic search for associated studies was conducted in Pubmed, EMBASE, MEDLINE, the Cochrane Library and the Chinese National Knowledge Infrastructure. Collected data was pooled using Revman v5.3. Outcomes included prognosis (cured vs. mortality rates), hepatic function (serum ALT, AST, Total Bilirubin (TBIL) level), serum acetylcholinesterase (AchE) level and respiratory function (rate of respiratory muscular paralysis). ResultsSeven randomized controlled studies consisting of 630 patients meeting inclusion criteria were identified. Lipid emulsion helped to improve the cure rate [OR = 2.54, 95% CI (1.33, 4.86), p = 0.005] and lower the mortality rate [OR = 0.31, 95% CI (0.13, 0.74), p = 0.009]. Serum ALT, AST and TBIL in patients undergoing lipid resuscitation were lower than those in the control groups [ALT, SMD = −1.52, 95% CI (−2.64, 0.40), p = 0.008; AST, SMD = −1.66, 95% CI (−3.15, 0.16), p = 0.03; TBIL, SMD = −1.26, 95% CI (−2.32, 0.20), p = 0.02]. Serum AchE level were increased in patients treated with lipid emulsion [SMD = 2.15, 95% CI (1.60, 2.71), p < 0.00001]. Rate of respiratory muscular paralysis was lower in patients undergoing lipid resuscitation than those in the control groups [OR = 0.19, 95% CI (0.05, 0.71), p = 0.01]. ConclusionBased on our meta-analysis of included RCT reports, lipid resuscitation seems likely to help improve prognosis and liver function of OP poisoning patients. However, larger multi-center RCTs are still recommended.

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

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.

Implementing Best Practice in Critically Ill Organophosphate Poisoned Patient Through Simulation-Based Learning Program

Purpose: Despite the clinical and socio-economic impact of acute poisoned patients, many of the treatments are not standardized in Korea. Moreover, no formal training that is specifically focused on clinical toxicology exists. Rather, training and education are conducted case by case in various institutions. This study was conducted to develop a standardized simulation-based clinical toxicology training curriculum for healthcare providers. This program will focus on specific assessment and treatment of critical toxicology patients, specifically those who have been poisoned with organophosphate. Methods: The study was performed using a pre- and post-design to determine the effects of implementation of this program. The study was conducted at eight different urban teaching hospitals in a simulated room in the clinical area. The study was targeted to 19 groups composed of emergency residents and nurses. Simulation-based learning was conducted for each group. Results: All 19 groups achieved the minimum passing score of 75%. Implementation of the program led to improved performance rates for overall management and cooperative moods competency (p&lt;0.01). Inter-rater agreement between the two evaluators was excellent. In general, the participants thought the program was realistic and were able to recognize and improve the competencies needed to care for organophosphate poisoned patients. Conclusion: Simulation-based learning is an effective educational strategy that can be applied to improving and understanding proper care for rare but critical patients. This program was effective at improving team performance and cooperative moods when managing an organophosphate poisoned patient in the Emergency Department.

The effectiveness of patient-tailored treatment for acute organophosphate poisoning

BackgroundTo determine a new pralidoxime (PAM) treatment guideline based on the severity of acute organophosphate intoxication patients, APACHE II score, and dynamic changes in serum butyrylcholinesterase (BuChE) activity. MethodsThis is a randomization trial. All patients received supportive care measurements and atropinization. Each enrolled patient was treated with 2 gm PAM intravenously as the loading dose. The control group was treated according to the WHO's recommended PAM regimen, and the experimental group was treated according to their APACHE II scores and dynamic changes in BuChE activity. If a patient's APACHE II score was ≧26 or there was no elevation in BuChE activity at the 12th hour when compared to the 6th, doses of 1 g/h PAM (i.e., doubled WHO's recommended PAM regimen) were given. The levels of the serum BuChE and red blood cells acetylcholinesterase and the serum PAM levels were also measured. ResultsForty-six organophosphate poisoning patients were enrolled in this study. There were 24 patients in the control group and 22 patients in the experimental group. The hazard ratio of death in the control group to that of the experimental group was 111.51 (95% CI: 1.17–1.613.45; p = 0.04). The RBC acetylcholinesterase level was elevated in the experimental group but was not in the control group. The experimental group did not exhibit a higher PAM blood level than did the control group. ConclusionThe use of PAM can be guided by patient severity. Thus, may help to improve the outcomes of organophosphate poisoning patients.

Risk of Parkinson disease after organophosphate or carbamate poisoning.

Parkinson disease (PD) is a common neurodegenerative disease. The aim of this study was to evaluate the risk of PD in patients with organophosphate (OP) or carbamate (CM) poisoning by using the Taiwan National Health Insurance Research Database. We conducted a retrospective study involving a cohort of 45594 patients (9128 patients with a history of OP or CM poisoning and 36466 control patients) who were selected from the Taiwan National Health Insurance Research Database. The patients were observed for a maximum of 12years to determine the rates of new-onset PD, and a Poisson regression model was used to identify the predictors of PD. The cumulative incidence of PD between the two cohorts was plotted through Kaplan-Meier analysis. During the study period, the incidence rate ratio (IRR) of PD in the OP or CM poisoning patients was 1.36-fold [95% confidence interval (CI)=1.26-1.47] higher than that in the control patients in the multivariable model. The absolute incidence of PD was the highest for the group aged ≥75years in both cohorts (77.4 vs 43.7 per 10000 person-years). However, the age-specific relative risk was higher for the group aged <50years (adjusted IRR=3.88; 95% CI=3.44-4.39). Our results suggest that the likelihood of developing PD is greater in patients with OP or CM poisoning than in those without poisoning. OP or CM poisoning may be an independent risk factor for PD.

Effectiveness of High Dose Pralidoxime for Treatment of Organophosphate Poisoning

Background: For effective treatment of organophosphate (OP) poisoning, development of a standardized protocol with flexible dose regimen for atropine and pralidoxime is an essential step. In this study, we aimed to assess the protocol devised in our setting; Bach Mai Hospital Poison Treatment Center, for treatment of OP poisoning that included a higher dose regimen of pralidoxime (2PAM). Methods: A protocol for treatment of OP poisoning was developed during 1995 to 1996, which included an atropinization scoring scale and a modification of 2PAM dose regimen. In this study, OP poisoned patients who were treated during 1997 to 2002 with the new protocol (study group or cases) were compared with historical control group which included OP poisoned patients treated between 1993 and 1994 prior to establishment of the new protocol. Results: One-hundred and eight cases and 54 controls were included. The cases and controls were not significantly different according to age, gender and plasma cholinesterase activity on admission from each other. There was no significant difference of mean duration of 2PAM therapy between the two groups. The controls received mean total 2PAM dose of 7.2±4.1 g, while the patients in the study group received 20.0±12.7 g which was 2.77 times higher than the dose for control group (P<0.001). Patients in the study group received significantly lower doses of atropine (100.2±119.1 vs. 231.8±225.5, P<0.001). Patients in the study group required a shorter duration of hospital stay compared to controls (6.2±4.8 vs. 8.2±5.8, P=0.035). In addition, morality rate decreased significantly (P=0.004) from 13% to 1.9% by application of the new protocol. Conclusion: The new protocol was more effective for patients with OP toxicity as it reduced the morbidities and mortality. A flexible regimen of 2PAM therapy for OP poisoning is recommended to be implemented.

Cardiovascular Effects of Acute Organophosphate Poisoning

Background:Cardiovascular effects of acute organophosphate (OP) poisoning are common. This study was aimed to assess the cardiovascular effects of OP poisoned patients in Nepal. Methods:This was a prospective hospital-based cross-sectional study of 115 acute OP poisoned patients presenting in emergency department of a tertiary care teaching hospital of central Nepal during November 2008 to October 2011. Cardiovascular manifestations were assessed by physical examination and electrocardiogram (ECG). All data including demographic features, clinical findings and outcomes were entered into a pre-structured proforma. Results:A total of 115 OP poisoned patients were studied. Mean age of the patients was 29.8±13.9 years. Fifty-seven patients (49.6%) developed cardiac effects that all had sinus tachycardia. Sinus bradycardia was observed in 3 patients (2.61%). Hypertension was detected in 23 patients (20%) and pulmonary edema developed in 24 patients (20.9%). The most common ECG abnormalities recorded were prolonged QTc in 21 patients (18.26%) and ventricular extrasystole in 14 patients (12.2%). Five patients developed polymorphic ventricular tachycardia (VT) and 3 patients developed ventricular fibrillation (VF) which could not be reverted back despite adequate treatments and led to death (mortality rate: 6.9%). Conclusion:Cardiac effects of OP poisoning can be life-threatening. Prompt diagnosis, early supportive and definitive therapies with atropine and oximes along with vigilant monitoring of the patients for prominent cardiac effects such as QT prolongation, VT or VF during hospital stay can definitely save lives of the victims.

REDUCED LEVELS OF SERUM POTASSIUM AND PLASMA CHOLINESTERASE IN ACUTE ORGANOPHOSPHATE POISONING: POSSIBLE PREDICTIVE MARKERS

Background: It is becoming apparent that although inhibition of cholinesterase plays a key role in organophosphate (OP) toxicity, other factors are also important. One of the contributing factors for severity of OP poisoning is electrolyte imbalances such as hypokalemia. This study was aimed at evaluating the value of hypokalemia in association with plasma cholinesterase (PChE) levels in predicting morbidity and mortality of acute OP poisoning. Methods: In this cross sectional study patients with definitive diagnosis of OP poisoning were enrolled. Pre-interventional clinical features were observed and noted with severity assessment as per Proudfoot classification, along with measurement of serum potassium ion ([K+]) concentration and PChE level. Results: Fifty OP poisoned patients (33 men, 17 women) were enrolled with median age of 27.1 years. The most common clinical manifestation was congested conjunctiva (82%) followed by miosis (78%) and bronchorrhea (78%). A total of 21 cases presented with one or more severe clinical features according to Proudfoot classification. Among them, 61.9% of cases (13 out of 21) developed hypokalemia. Muscle weakness or fasciculation developed with mean serum [K+] of 3.31 ± 0.11. Ventilatory support was required at the mean serum [K+] of 3.27 ± 0.10 mmol/L. Fatality was noted when the mean serum [K+] reduced to 2.90 ± 0.06 mmol/L. Correlation of the clinical effects and serum [K+] was significant (P 75%). Death was mostly observed among patients who had respiratory distress associated with hypokalemia and grossly reduced PChE. Conclusion: For severe clinical features of OP poisoning, serum [K+] and PChE level are greatly reduced. Hence, these biochemical findings can be proposed as OP poisoning predictive markers. Clinicians and medical toxicologists should consider hypokalemia associated with reduced PChE level as alarming signs of poor prognosis in OP poisoned patients.

Body mass index as a prognostic factor in organophosphate-poisoned patients

Organophosphate poisoning is a serious clinical entity and considerable morbidity and mortality. Several factors have been identified to predict outcomes of organophosphate poisoning. Organophosphates are lipophilic and therefore predicted to have a large volume of distribution and to rapidly distribute into tissue and fat. Thus, toxic effects of organophosphate would be expected to last longer in obese patients. We investigated the relationship between obesity and clinical course in 112 acute organophosphate-poisoned patients from an initial medical record review of 234 patients. One hundred twenty-two patients were excluded: 6 were children, 14 had an uncertain history of exposure and of uncertain agent, 10 were transferred to another hospital, 67 were discharged from the emergency department because their toxicity was mild, 21 had carbamate poisoning, and 4 did not have height or weight checked. Clinical features, body mass index, Glasgow Coma Scale, laboratory findings, serum cholinesterase activity, electrocardiogram finding, management, and outcomes were examined. The lipid solubility of the implicated organophosphate was characterized by its octanol/water coefficient. Forty of 112 patients were obese. Obese patients who were poisoned by high lipophilicity organophosphate compounds had a need for longer use of mechanical ventilation, intensive care unit care, and total length of admission. Body mass index can provide a guide to physicians in predicting clinical course and management in organophosphate-poisoned patients.

Chlorpyrifos is associated with slower serum cholinesterase recovery in acute organophosphate-poisoned patients

Purpose. Organophosphate poisoning (OPP) accounts for 200,000 deaths annually in developing countries. Serum cholinesterase (SChE) is of diagnostic value in patients with OPP and is checked repeatedly during the course of treatment. This study aimed to investigate the recovery pattern in patients with OPP using linear mixed models. Methods. Using a retrospective cohort study design, we included 212 adult OPP patients who had visited the emergency department (ED) in a tertiary medical center between 2000 and 2010. One hundred and thirty-one patients were available for analysis, as 81 patients did not meet the criteria and were excluded. Information regarding basic personal characteristics, initial vital signs and severity scores, laboratory data, type and amount of organophosphate ingested, treatment, and serial SChE values was collected. A random coefficient model with a random intercept and a random slope of time were added to address the dynamic relationships of SChE with time and other associated factors. Results. The initial SChE activity and recovery rates varied among patients with OPP. The type of organophosphate, the first SChE activity, and the initial APACHE II score were significantly related to the SChE recovery trend. Chlorpyrifos and methamidophos had significantly slower and faster SChE recovery rates, respectively, than other organophosphates. Sex, dose of Pralidoxim (2-PAM), and delay in obtaining medical assistance did not significantly affect SChE recovery. Conclusions. This study demonstrated the pattern and associated correlates of SChE activity recovery in patients with acute OPP. Chlorpyrifos appeared to have a slower SChE activity recovery rate than other organophosphates.

Performance Assessment of the SOFA, APACHE II Scoring System, and SAPS II in Intensive Care Unit Organophosphate Poisoned Patients

This study assessed the ability of the Sequential Organ Failure Assessment (SOFA) and Acute Physiology, Chronic Health Evaluation (APACHE) II scoring systems, as well as the Simplified Acute Physiology Score (SAPS) II method to predict group mortality in intensive care unit (ICU) patients who were poisoned with organophosphate. The medical records of 149 organophosphate poisoned patients admitted to the ICU from September 2006 to December 2012 were retrospectively examined. The SOFA, APACHE II, and SAPS II were calculated based on initial laboratory data in the Emergency Department, and during the first 24 hr of ICU admission. The probability of death was calculated for each patient based on the SOFA score, APACHE II score, and SAPS II equations. The ability to predict group mortality by the SOFA score, APACHE II score, and SAPS II method was assessed using two by two decision matrices and receiver operating characteristic (ROC) curve analysis. A total of 131 patients (mean age, 61 yr) were enrolled. The sensitivities, specificities, and accuracies were 86.2%, 82.4%, and 83.2% for the SOFA score, respectively; 65.5%, 68.6%, and 67.9% for the APACHE II scoring system, respectively; and 86.2%, 77.5%, and 79.4% for the SAPS II, respectively. The areas under the curve in the ROC curve analysis for the SOFA score, APACHE II scoring system, and SAPS II were 0.896, 0.716, and 0.852, respectively. In conclusion, the SOFA, APACHE II, and SAPS II have different capability to discriminate and estimate early in-hospital mortality of organophosphate poisoned patients. The SOFA score is more useful in predicting mortality, and easier and simpler than the APACHE II and SAPS II.

Clinical Significance of National Patients Sample Analysis: Factors Affecting Mortality and Length of Stay of Organophosphate and Carbamate Poisoned Patients

ObjectivesThis study considered whether there could be a change of mortality and length of stay as a result of inter-hospital transfer, clinical department, and size of hospital for patients with organophosphates and carbamates poisoning via National Patients Sample data of the year 2009, which was obtained from Health Insurance Review and Assessment Services (HIRA). The utility and representativeness of the HIRA data as the source of prognosis analysis in poisoned patients were also evaluated.MethodsOrganophosphate and carbamate poisoned patients' mortality and length of stay were analyzed in relation to the initial and final treating hospitals and departments, as well as the presence of inter-hospital transfers.ResultsAmong a total of 146 cases, there were 17 mortality cases, and the mean age was 56.8 ± 19.2 years. The median length of stay was 6 days. There was no inter-hospital or inter-departmental difference in length of stay. However, it significantly increased when inter-hospital transfer occurred (transferred 11 days vs. non-transferred 6 days; p = 0.037). Overall mortality rate was 11.6%. The mortality rate significantly increased when inter-hospital transfer occurred (transferred 23.5% vs. non-transferred 7.0%; p = 0.047), but there was no statistical difference in mortality on inter-hospital and inter-department comparison at the initial treating facility. However, at the final treating facility, there was a significant difference between tertiary and general hospitals (5.1% for tertiary hospitals and 17.3% for general hospitals; p = 0.024), although there was no significant inter-departmental difference.ConclusionsWe demonstrated that hospital, clinical department, length of stay, and mortality could be analyzed using insurance claim data of a specific disease group. Our results also indicated that length of stay and mortality according to inter-hospital transfer could be analyzed, which was previously unknown.

The difference in C-reactive protein value between initial and 24 hours follow-up (D-CRP) data as a predictor of mortality in organophosphate poisoned patients

Background. Organophosphate poisoning is a worldwide concern and there have been many reports about factors involved in the severity and prognosis of toxicity. The aim of this study was to evaluate the relationship between the serum C-reactive protein activity and clinical outcome in acute organophosphate-poisoned patients. Methods. This was a retrospective cohort study conducted from January 2007 to February 2012. Using a multivariate logistic analysis, data on the total population was retrospectively analyzed for association with mortality. The difference in C-reactive protein value between initial and follow-up after 24 hours (D-CRP) was compared in survivors and non-survivors. The D-CRP, APACHE (Acute Physiology and Chronic Health Evaluation) II scoring system and SOFA (Sequential Organ Failure Assessment) score were compared by analyzing receiver operating characteristic (ROC) curves. Results. Among the 96 subjects, 74 survived and 22 died. In the total population, age, BUN, creatinine, APACHE II and SOFA score, MAP, GCS, hematocrit, respiratory rate, albumin, cholinesterase, and the difference in C-reactive protein value between initial and follow-up after 24 hours (D-CRP) were found to be associated with mortality. The fatality rate of organophosphate poisoning was 22.9% and the D-CRP was found to be associated with a significantly higher risk of death in a multiple logistic regression (Odds ratio = 1.178, 95% CI = 1.049–1.322, p = 0.006). Conclusion. The initial serum C-reactive protein and acetylcholinesterase were not found to be associated with the severity of acute organophosphate poisoning. However, the difference in C-reactive protein value between initial and follow-up after 24 hours (D-CRP) was associated with mortality in the total population of patients with acute organophosphate poisoning.

Temperature changes among organophosphate poisoned patients, Tehran- Iran

BackgroundAcute poisoning with organophosphorus compounds (OPs) is a major global clinical problem in the developing countries. There have been many animal studies and few human surveys on the effects of organophosphorus pesticide (OP) poisoning on thermoregulation. The aim of this prospective study was to document the pattern of tympanic temperature changes among OP poisoned patients throughout the length of their hospital stay.Methods60 patients with diagnose of organophosphate poisoning were included in this study. Questioner was filled out by trained nurses including demographic, clinical and paraclinical data. Tympanic temperature and Pulse rate data of the cases were collected on five- occasions after admission.ResultsThere were 41 (68.3%) male and 19 (31.7%) female, with a mean age of 34.4 ±19.4 years (range 13–89 years). Forty five patients had intentional poisoning for suicidal attempt. At the time of entry, the mean tympanic temperature, pulse rate, respiratory rate and blood pressure (systolic and diastolic) of the OP poisoned patients were respectively 37.1+/−0.6°C (36.0- 39.5), 91+/−18 (55–145), 18+/−5.6 (8–44), 116+/−20 mm Hg (70–170) and 75+/−11.6 mm Hg (40–110). 41.7% of the cases had serum butyryl cholinesterase activities (BChE) ≥ 50% normal (≥1600 mU/ml). Our patients had normal temperature at the time entry (mean = 37.1). Tympanic temperature decreasing below 36°C was not detected among the patients during the study period. A rise in mean tympanic temperature was found after atropine administration.ConclusionOur study showed hypothermia was not considerable factor among organophosphate poisoned patients, although more studies with similar situations in tropical countries are needed.