Poisoning severity score, APACHE II and GCS: Effective clinical indices for estimating severity and predicting outcome of acute organophosphorus and carbamate poisoning

K.G. Sam, K. Kondabolu, D. Pati, A. Kamath, G. Pradeep Kumar, P.G.M. Rao

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Self-poisoning with organophosphorus (OP) compounds is a major cause of morbidity and mortality across South Asian countries. To develop uniform and effective management guidelines, the severity of acute OP poisoning should be assessed through scientific methods and a clinical database should be maintained. A prospective descriptive survey was carried out to assess the utility of severity scales in predicting the outcome of 71 organophosphate (OP) and carbamate poisoning patients admitted during a one year period at the Kasturba Hospital, Manipal, India. The Glasgow coma scale (GCS) scores, acute physiology and chronic health evaluation II (APACHE II) scores, predicted mortality rate (PMR) and Poisoning severity score (PSS) were estimated within 24 h of admission. Significant correlation (P <0.05) between PSS and GCS and APACHE II and PMR scores were observed with the PSS scores predicting mortality significantly (P ≤ 0.001). A total of 84.5% patients improved after treatment while 8.5% of the patients were discharged with severe morbidity. The mortality rate was 7.0%. Suicidal poisoning was observed to be the major cause (80.2%), while other reasons attributed were occupational (9.1%), accidental (6.6%), homicidal (1.6%) and unknown (2.5%) reasons. This study highlights the application of clinical indices like GCS, APACHE, PMR and severity scores in predicting mortality and may be considered for planning standard treatment guidelines. © 2008 Elsevier Ltd and Faculty of Forensic and Legal Medicine.
Original languageEnglish
Pages (from-to)239-247
Number of pages9
JournalJournal of Forensic and Legal Medicine
Volume16
Issue number5
DOIs
Publication statusPublished - 2009

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Organophosphate Poisoning
Glasgow Coma Scale
APACHE
Carbamates
physiology
Poisoning
mortality
Mortality
health
evaluation
Forensic Medicine
morbidity
Guidelines
Organophosphorus Compounds
Morbidity
cause
India
Databases
medicine
Therapeutics

Cite this

@article{769ad547fc044365affba67919af541c,
title = "Poisoning severity score, APACHE II and GCS: Effective clinical indices for estimating severity and predicting outcome of acute organophosphorus and carbamate poisoning",
abstract = "Self-poisoning with organophosphorus (OP) compounds is a major cause of morbidity and mortality across South Asian countries. To develop uniform and effective management guidelines, the severity of acute OP poisoning should be assessed through scientific methods and a clinical database should be maintained. A prospective descriptive survey was carried out to assess the utility of severity scales in predicting the outcome of 71 organophosphate (OP) and carbamate poisoning patients admitted during a one year period at the Kasturba Hospital, Manipal, India. The Glasgow coma scale (GCS) scores, acute physiology and chronic health evaluation II (APACHE II) scores, predicted mortality rate (PMR) and Poisoning severity score (PSS) were estimated within 24 h of admission. Significant correlation (P <0.05) between PSS and GCS and APACHE II and PMR scores were observed with the PSS scores predicting mortality significantly (P ≤ 0.001). A total of 84.5{\%} patients improved after treatment while 8.5{\%} of the patients were discharged with severe morbidity. The mortality rate was 7.0{\%}. Suicidal poisoning was observed to be the major cause (80.2{\%}), while other reasons attributed were occupational (9.1{\%}), accidental (6.6{\%}), homicidal (1.6{\%}) and unknown (2.5{\%}) reasons. This study highlights the application of clinical indices like GCS, APACHE, PMR and severity scores in predicting mortality and may be considered for planning standard treatment guidelines. {\circledC} 2008 Elsevier Ltd and Faculty of Forensic and Legal Medicine.",
author = "K.G. Sam and K. Kondabolu and D. Pati and A. Kamath and {Pradeep Kumar}, G. and P.G.M. Rao",
note = "Cited By :28 Export Date: 10 November 2017 Correspondence Address: Sam, K.G.; Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal, Karnataka, India; email: kishoregnanasam@gmail.com Chemicals/CAS: Butyrylcholinesterase, 3.1.1.-; Carbamates; Organophosphorus Compounds; Pesticides References: Eddleston, M., Patterns and problems of deliberate self-poisoning in the developing world (2000) Quart J Med, 93, pp. 715-731; Pawar, K.S., Bhoite, R.R., Pillay, C.P., Chavan, S.C., Malshikare, D.S., Garad, S.G., Continuous pralidoxime infusion versus repeated bolus injection to treat organophosphorus pesticide poisoning: a randomised controlled trial (2006) Lancet, 368, pp. 2136-2141; Gunnell, D., Eddleston, M., Phillips, M.R., Konradsen, F., The global distribution of fatal pesticide self-poisoning: systematic review (2007) BMC Public Health, 7, p. 357; Srinivas, R.C.H., Venkateswarlu, V., Surrender, T., Eddleston, M., Buckley, Pesticide poisoning in south India: opportunities for prevention and improved medical management (2005) Trop Med Int Health, 10 (6), pp. 581-588; Eddleston, M., Konradsen, F., Time for a re-assessment of the incidence of intentional and unintentional injury in India and south east Asia (2007) Int J Epidemiol, 36 (1), pp. 208-211; Khan, S., Hemalatha, R., Jeyaseelan, L., Oommen, A., Zachariah, A., Neuroparalysis and oxime efficacy in organophosphate poisoning: a study of butyrylcholinesterase (2001) Human Exp Toxicol, 20, pp. 169-174; Persson, H., Case data severity grading (1998) Toxicol Lett, 95 (1 S), p. 29; Davies, J.O.J., Eddleston, M., Buckley, N.A., Predicting outcome in acute organophosphorus poisoning with a poison severity score or the Glasgow coma scale (2008) QJM, 101 (5), pp. 371-379; Goel, A., Joseph, S., Dutta, T.K., Organophosphate poisoning: predicting the need for ventilatory support (1998) J Assoc Physicians India, 46, pp. 786-790; Grmec, S., Mally, S., Klemen, P., Glasgow coma scale score and QTc interval in the prognosis of organophosphate poisoning (2004) Acad Emerg Med, 11 (9), pp. 925-930; Sungurtekin, H., Gurses, E., Balei, C., Evaluation of several clinical scoring tools in organophosphate poisoned patients (2006) Clin Toxicol, 44, pp. 121-126; Knaus, W.A., Draper, E.A., Wagner, D.P., Zimmerman, J.E., Apache II: a severity of disease classification system (1985) Crit Care Med, 13, pp. 818-829; Persson, H.E., Sjoberg, G.K., Haines, J.A., Pronczuk, J.G., Poisoning severity score: grading of acute poisoning (1998) Clin Toxicol, 36, pp. 205-213; Cherian, M.A., Roshini, C., Peter, J.V., Cherian, A.M., Oximes in organophosphorus poisoning (2005) Indian J Crit Care Med, 9 (3), pp. 155-163; Eddleston, M., Gunnell, D., Karunaratne, A., De Silva, D., Sheriff, M.H.R., Buckley, N.A., Epidemiology of intentional self-poisoning in rural Sri Lanka (2005) Brit J Psychiatr, 187, pp. 583-584; Sam, K.G., Andrade, H.A., Lisa, P., Abhishek, P., Shashi, J.S., Rao, P.G.M., Effectiveness of an educational program to promote pesticide safety among pesticide handlers of South India (2008) Int Arch Occup Environ Health, 81 (6), pp. 787-795; Agarwal, S.B., Bhatnagar, V.K., Agarwal, A., Agarwal, U., Venkaiah, K., Nigam, S.K., Impairment in clinical indices in acute organophosphate insecticide poisoning patients in India (2007) Int J Toxicol, 4 (1). , http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijto/vol4n1/poison.xml, <http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijto/vol4n1/poison.xml> [accessed November 2007]; Bobba, R., Venkataraman, B.V., Pais, P., Joseph, T., Correlation between the severity of symptoms in organophos phorus poisoning and cholinesterase activity (RBC and plasma) in humans (1996) Indian J Physiol Pharmacol, 40 (3), pp. 249-252; George, B.K., Pavlos, K., George, T., Aristidis, T.M., Review of clinical and toxicological features of acute pesticide poisonings in Crete (Greece) during the period 1991-2001 (2004) Med Sci Monitor - Int Med J Exp Clin Res, 10 (11), pp. 622-627; Konradsen, F., Van der Hoek, W., Peiris, P., Self-inflicted poisonings in Sri Lanka. Reaching for the bottle of pesticide - a cry for help (2006) Soc Sci Med, 62, pp. 1710-1719; Heard, K., Bebarta, V.S., Reliability of the Glasgow coma scale for the emergency department evaluation of poisoned patients (2004) Human Exp Toxicol, 23, pp. 197-200; Starmark, J.E., Heath, A., Severity grading in self-poisoning (1988) Human Toxicol, 7, pp. 551-555; Kelly, C.A., Upex, A., Bateman, N.D., Comparison of consciousness level assessment in the poisoned patient using the alert/verbal/painful/unresponsive scale and the Glasgow coma scale (2004) Ann Emerg Med, 44, pp. 108-113; Chan, B., Gaudary, P., Grattan-Smith, T.M., McNeil, R., The use of Glasgow coma scale in poisoning (1993) J Emerg Med, 11, pp. 579-582; Adnet, F., Borrow, S.W., Finot, M.A., Lapandry, C., Baud, F.J., Intubation difficulty in poisoned patients: association with initial Glasgow coma scale score (1998) Acad Emerg Med, 5, pp. 123-127; Emerman, C.L., Connors, A.F., Burma, G.M., Level of consciousness as a predictor of complications following tricyclic overdose (1987) Ann Emerg Med, 16, pp. 326-330; Sungurtekin, H., Gurses, E., Balci, C., Evaluation of several clinical scoring tools in organophosphate poisoned patients (2006) Clin Toxicol, 44, pp. 121-126; Eizadi-Mood, N., Saghaei, M., Jabalameli, M., Predicting outcomes in organophosphate poisoning based on APACHE II and modified APACHE II scores (2007) Human Exp Toxicol, 26, pp. 573-578; Pach, J., Persson, H., Sancewicz-Pach, K., Groszek, B., Comparison between the poisoning severity score and specific grading scales used at the Department of Clinical Toxicology in Krakow (1999) Przegl Lek, 56 (6), pp. 401-408",
year = "2009",
doi = "10.1016/j.jflm.2008.12.004",
language = "English",
volume = "16",
pages = "239--247",
journal = "Journal of Forensic and Legal Medicine",
issn = "1752-928X",
publisher = "Churchill Livingstone",
number = "5",

}

Poisoning severity score, APACHE II and GCS: Effective clinical indices for estimating severity and predicting outcome of acute organophosphorus and carbamate poisoning. / Sam, K.G.; Kondabolu, K.; Pati, D.; Kamath, A.; Pradeep Kumar, G.; Rao, P.G.M.

In: Journal of Forensic and Legal Medicine, Vol. 16, No. 5, 2009, p. 239-247.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Poisoning severity score, APACHE II and GCS: Effective clinical indices for estimating severity and predicting outcome of acute organophosphorus and carbamate poisoning

AU - Sam, K.G.

AU - Kondabolu, K.

AU - Pati, D.

AU - Kamath, A.

AU - Pradeep Kumar, G.

AU - Rao, P.G.M.

N1 - Cited By :28 Export Date: 10 November 2017 Correspondence Address: Sam, K.G.; Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal, Karnataka, India; email: kishoregnanasam@gmail.com Chemicals/CAS: Butyrylcholinesterase, 3.1.1.-; Carbamates; Organophosphorus Compounds; Pesticides References: Eddleston, M., Patterns and problems of deliberate self-poisoning in the developing world (2000) Quart J Med, 93, pp. 715-731; Pawar, K.S., Bhoite, R.R., Pillay, C.P., Chavan, S.C., Malshikare, D.S., Garad, S.G., Continuous pralidoxime infusion versus repeated bolus injection to treat organophosphorus pesticide poisoning: a randomised controlled trial (2006) Lancet, 368, pp. 2136-2141; Gunnell, D., Eddleston, M., Phillips, M.R., Konradsen, F., The global distribution of fatal pesticide self-poisoning: systematic review (2007) BMC Public Health, 7, p. 357; Srinivas, R.C.H., Venkateswarlu, V., Surrender, T., Eddleston, M., Buckley, Pesticide poisoning in south India: opportunities for prevention and improved medical management (2005) Trop Med Int Health, 10 (6), pp. 581-588; Eddleston, M., Konradsen, F., Time for a re-assessment of the incidence of intentional and unintentional injury in India and south east Asia (2007) Int J Epidemiol, 36 (1), pp. 208-211; Khan, S., Hemalatha, R., Jeyaseelan, L., Oommen, A., Zachariah, A., Neuroparalysis and oxime efficacy in organophosphate poisoning: a study of butyrylcholinesterase (2001) Human Exp Toxicol, 20, pp. 169-174; Persson, H., Case data severity grading (1998) Toxicol Lett, 95 (1 S), p. 29; Davies, J.O.J., Eddleston, M., Buckley, N.A., Predicting outcome in acute organophosphorus poisoning with a poison severity score or the Glasgow coma scale (2008) QJM, 101 (5), pp. 371-379; Goel, A., Joseph, S., Dutta, T.K., Organophosphate poisoning: predicting the need for ventilatory support (1998) J Assoc Physicians India, 46, pp. 786-790; Grmec, S., Mally, S., Klemen, P., Glasgow coma scale score and QTc interval in the prognosis of organophosphate poisoning (2004) Acad Emerg Med, 11 (9), pp. 925-930; Sungurtekin, H., Gurses, E., Balei, C., Evaluation of several clinical scoring tools in organophosphate poisoned patients (2006) Clin Toxicol, 44, pp. 121-126; Knaus, W.A., Draper, E.A., Wagner, D.P., Zimmerman, J.E., Apache II: a severity of disease classification system (1985) Crit Care Med, 13, pp. 818-829; Persson, H.E., Sjoberg, G.K., Haines, J.A., Pronczuk, J.G., Poisoning severity score: grading of acute poisoning (1998) Clin Toxicol, 36, pp. 205-213; Cherian, M.A., Roshini, C., Peter, J.V., Cherian, A.M., Oximes in organophosphorus poisoning (2005) Indian J Crit Care Med, 9 (3), pp. 155-163; Eddleston, M., Gunnell, D., Karunaratne, A., De Silva, D., Sheriff, M.H.R., Buckley, N.A., Epidemiology of intentional self-poisoning in rural Sri Lanka (2005) Brit J Psychiatr, 187, pp. 583-584; Sam, K.G., Andrade, H.A., Lisa, P., Abhishek, P., Shashi, J.S., Rao, P.G.M., Effectiveness of an educational program to promote pesticide safety among pesticide handlers of South India (2008) Int Arch Occup Environ Health, 81 (6), pp. 787-795; Agarwal, S.B., Bhatnagar, V.K., Agarwal, A., Agarwal, U., Venkaiah, K., Nigam, S.K., Impairment in clinical indices in acute organophosphate insecticide poisoning patients in India (2007) Int J Toxicol, 4 (1). , http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijto/vol4n1/poison.xml, <http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijto/vol4n1/poison.xml> [accessed November 2007]; Bobba, R., Venkataraman, B.V., Pais, P., Joseph, T., Correlation between the severity of symptoms in organophos phorus poisoning and cholinesterase activity (RBC and plasma) in humans (1996) Indian J Physiol Pharmacol, 40 (3), pp. 249-252; George, B.K., Pavlos, K., George, T., Aristidis, T.M., Review of clinical and toxicological features of acute pesticide poisonings in Crete (Greece) during the period 1991-2001 (2004) Med Sci Monitor - Int Med J Exp Clin Res, 10 (11), pp. 622-627; Konradsen, F., Van der Hoek, W., Peiris, P., Self-inflicted poisonings in Sri Lanka. Reaching for the bottle of pesticide - a cry for help (2006) Soc Sci Med, 62, pp. 1710-1719; Heard, K., Bebarta, V.S., Reliability of the Glasgow coma scale for the emergency department evaluation of poisoned patients (2004) Human Exp Toxicol, 23, pp. 197-200; Starmark, J.E., Heath, A., Severity grading in self-poisoning (1988) Human Toxicol, 7, pp. 551-555; Kelly, C.A., Upex, A., Bateman, N.D., Comparison of consciousness level assessment in the poisoned patient using the alert/verbal/painful/unresponsive scale and the Glasgow coma scale (2004) Ann Emerg Med, 44, pp. 108-113; Chan, B., Gaudary, P., Grattan-Smith, T.M., McNeil, R., The use of Glasgow coma scale in poisoning (1993) J Emerg Med, 11, pp. 579-582; Adnet, F., Borrow, S.W., Finot, M.A., Lapandry, C., Baud, F.J., Intubation difficulty in poisoned patients: association with initial Glasgow coma scale score (1998) Acad Emerg Med, 5, pp. 123-127; Emerman, C.L., Connors, A.F., Burma, G.M., Level of consciousness as a predictor of complications following tricyclic overdose (1987) Ann Emerg Med, 16, pp. 326-330; Sungurtekin, H., Gurses, E., Balci, C., Evaluation of several clinical scoring tools in organophosphate poisoned patients (2006) Clin Toxicol, 44, pp. 121-126; Eizadi-Mood, N., Saghaei, M., Jabalameli, M., Predicting outcomes in organophosphate poisoning based on APACHE II and modified APACHE II scores (2007) Human Exp Toxicol, 26, pp. 573-578; Pach, J., Persson, H., Sancewicz-Pach, K., Groszek, B., Comparison between the poisoning severity score and specific grading scales used at the Department of Clinical Toxicology in Krakow (1999) Przegl Lek, 56 (6), pp. 401-408

PY - 2009

Y1 - 2009

N2 - Self-poisoning with organophosphorus (OP) compounds is a major cause of morbidity and mortality across South Asian countries. To develop uniform and effective management guidelines, the severity of acute OP poisoning should be assessed through scientific methods and a clinical database should be maintained. A prospective descriptive survey was carried out to assess the utility of severity scales in predicting the outcome of 71 organophosphate (OP) and carbamate poisoning patients admitted during a one year period at the Kasturba Hospital, Manipal, India. The Glasgow coma scale (GCS) scores, acute physiology and chronic health evaluation II (APACHE II) scores, predicted mortality rate (PMR) and Poisoning severity score (PSS) were estimated within 24 h of admission. Significant correlation (P <0.05) between PSS and GCS and APACHE II and PMR scores were observed with the PSS scores predicting mortality significantly (P ≤ 0.001). A total of 84.5% patients improved after treatment while 8.5% of the patients were discharged with severe morbidity. The mortality rate was 7.0%. Suicidal poisoning was observed to be the major cause (80.2%), while other reasons attributed were occupational (9.1%), accidental (6.6%), homicidal (1.6%) and unknown (2.5%) reasons. This study highlights the application of clinical indices like GCS, APACHE, PMR and severity scores in predicting mortality and may be considered for planning standard treatment guidelines. © 2008 Elsevier Ltd and Faculty of Forensic and Legal Medicine.

AB - Self-poisoning with organophosphorus (OP) compounds is a major cause of morbidity and mortality across South Asian countries. To develop uniform and effective management guidelines, the severity of acute OP poisoning should be assessed through scientific methods and a clinical database should be maintained. A prospective descriptive survey was carried out to assess the utility of severity scales in predicting the outcome of 71 organophosphate (OP) and carbamate poisoning patients admitted during a one year period at the Kasturba Hospital, Manipal, India. The Glasgow coma scale (GCS) scores, acute physiology and chronic health evaluation II (APACHE II) scores, predicted mortality rate (PMR) and Poisoning severity score (PSS) were estimated within 24 h of admission. Significant correlation (P <0.05) between PSS and GCS and APACHE II and PMR scores were observed with the PSS scores predicting mortality significantly (P ≤ 0.001). A total of 84.5% patients improved after treatment while 8.5% of the patients were discharged with severe morbidity. The mortality rate was 7.0%. Suicidal poisoning was observed to be the major cause (80.2%), while other reasons attributed were occupational (9.1%), accidental (6.6%), homicidal (1.6%) and unknown (2.5%) reasons. This study highlights the application of clinical indices like GCS, APACHE, PMR and severity scores in predicting mortality and may be considered for planning standard treatment guidelines. © 2008 Elsevier Ltd and Faculty of Forensic and Legal Medicine.

U2 - 10.1016/j.jflm.2008.12.004

DO - 10.1016/j.jflm.2008.12.004

M3 - Article

VL - 16

SP - 239

EP - 247

JO - Journal of Forensic and Legal Medicine

JF - Journal of Forensic and Legal Medicine

SN - 1752-928X

IS - 5

ER -