Q J Med 2003; 96: 635-642
© 2003 Association of Physicians
The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity
From the 1School of Medical Practice and Population Health, 2Discipline of Clinical Pharmacology, and 4School of Population Health Sciences, University of Newcastle, and 3Department of Clinical Toxicology and Pharmacology, Newcastle Mater Misericordiae Hospital, Newcastle, NSW, Australia
Received 28 February 2003 and in revised form 29 May 2003
Background: There are difficulties with the diagnosis of serotonin toxicity, particularly with the use of Sternbach’s criteria.
Aim: To improve the criteria for diagnosing clinically significant serotonin toxicity.
Design: Retrospective analysis of prospectively collected data
Methods: We studied all patients admitted to the Hunter Area Toxicology Service (HATS) following an overdose of a serotonergic drug from January 1987 to November 2002 (n = 2222). Main outcomes were: diagnosis of serotonin toxicity by a clinical toxicologist, fulfilment of Sternbach’s criteria and treatment with a serotonin receptor (5-HT2A) antagonist. A learning dataset of 473 selective serotonin reuptake inhibitor (SSRI)-alone overdoses was used to determine individual clinical features predictive of serotonin toxicity by univariate analysis. Decision rules using CART analysis were developed, and tested on the dataset of all serotonergic overdose admissions.
Results: Numerous clinical features were associated with serotonin toxicity, but only clonus (inducible, spontaneous or ocular), agitation, diaphoresis, tremor and hyperreflexia were needed for accurate prediction of serotonin toxicity as diagnosed by a clinical toxicologist. Although the learning dataset did not include patients with life-threatening serotonin toxicity, hypertonicity and maximum temperature > 38°C were universal in such patients; these features were therefore added. Using these seven clinical features, decision rules (the Hunter Serotonin Toxicity Criteria) were developed. These new criteria were simpler, more sensitive (84% vs. 75%) and more specific (97% vs. 96%) than Sternbach’s criteria.
Discussion: These redefined criteria for serotonin toxicity should be more sensitive to serotonin toxicity and less likely to yield false positives.
Address correspondence to Dr G.K. Isbister, Discipline of Clinical Pharmacology, Level 5, Clinical Sciences Building, Newcastle Mater Misericordiae Hospital, Waratah NSW 2298, Australia. e-mail: gsbite{at}bigpond.com
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  S.-L. Guo, T.-J. Wu, C.-C. Liu, C.-C. Ng, C.-C. Chien, and H.-L. Sun Meperidine-induced serotonin syndrome in a susceptible patient Br. J. Anaesth., September 1, 2009; 103(3): 369 - 370. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Ahuja and A. J. Cole Hyperthermia syndromes in psychiatry Adv. Psychiatr. Treat., May 1, 2009; 15(3): 181 - 191. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. W. Evans and O. P. Soldin More on Serotonin Syndrome Associated with Triptan Monotherapy N. Engl. J. Med., August 21, 2008; 359(8): 870 - 871. [Full Text] [PDF]
|
|
|
|
 |
|
 G. Shanmugam, B. Kent, T. Alsaiwadi, and R. Baskett Serotonin syndrome following cardiac surgery Interactive CardioVascular and Thoracic Surgery, August 1, 2008; 7(4): 656 - 657. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Frank Recognition and treatment of serotonin syndrome Can Fam Physician, July 1, 2008; 54(7): 988 - 992. [Full Text] [PDF]
|
|
|
|
 |
|
 B. TOUSI Movement disorder emergencies in the elderly: Recognizing and treating an often-iatrogenic problem Cleveland Clinic Journal of Medicine, June 1, 2008; 75(6): 449 - 457. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. J. Looper Potential Medical and Surgical Complications of Serotonergic Antidepressant Medications Psychosomatics, February 1, 2007; 48(1): 1 - 9. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. W. Boyer and M. Shannon The Serotonin Syndrome N. Engl. J. Med., March 17, 2005; 352(11): 1112 - 1120. [Full Text] [PDF]
|
|
|
|
 |
|
 P. K. Gillman Comment on: Serotonin syndrome due to co-administration of linezolid and venlafaxine J. Antimicrob. Chemother., October 1, 2004; 54(4): 844 - 845. [Full Text] [PDF]
|
|