QJM Advance Access published online on March 4, 2008
QJM, doi:10.1093/qjmed/hcn014
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Predicting outcome in acute organophosphorus poisoning with a poison severity score or the Glasgow coma scale
From the 1South Asian Clinical Toxicology Research Collaboration, 2Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, England, UK, 3Ox-Col Collaboration, Department of Clinical Medicine, University of Colombo, Sri Lanka and 4Department of Clinical Pharmacology and Toxicology, Canberra Clinical School, ACT, Australia
Address correspondence to J.O.J. Davies, Department of Haematology, Hammersmith Hospital, London. email: james.davies{at}doctors.net.uk
Received 22 October 2007 and in revised form 8 January 2008
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Abstract |
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Background: Organophosphorus (OP) pesticide poisoning kills around 200 000 people each year, principally due to self-poisoning in the Asia-Pacific region.
Aim: We wished to assess whether patients at high risk of death could be identified accurately using clinical parameters soon after hospital admission.
Design: We evaluated the usefulness of the International Program on Chemical Safety Poison Severity Score (IPCS PSS) and the Glasgow Coma Score (GCS) prospectively for predicting death in patients poisoned by OP pesticides.
Methods: Data were collected as part of a multicenter cohort study in Sri Lanka. Study doctors saw all patients on admission, collecting data on pulse, blood pressure, pupil size, need for intubation and GCS.
Results: Of the patients, 1365 with a history of acute OP poisoning were included. Receiver operating characteristic (ROC) curves were calculated for the IPCS PSS and GCS on admission. The IPCS PSS and GCS had similar ROC area under the curves (AUC) and best cut points as determined by Youden's index (AUC/sensitivity/specificity 0.81/0.78/0.79 for IPCS PSS 
grade 2 and 0.84/0.79/0.79 for GCS 
13). The predictive value varied with the pesticide ingested, being more accurate for dimethoate poisoning and less accurate for fenthion poisoning (GCS AUC 0.91 compared with 0.69).
Conclusions: GCS and the IPCS PSS were similarly effective at predicting outcome. Patients presenting with a GCS 13 need intensive monitoring and treatment. However, the identity of the organophosphate must be taken into account, since the half of all patients who died from fenthion poisoning only had mild symptoms at presentation.