A Proposal for a Novel Scoring System for Triage of Acutely Poisoned Patients at Tanta University Poisoning Treating Center, Egypt

Abstract

Background: Poisoning is defined as exposure of an individual to a potentiality harmful substance either by inhalation, skin contact, ingestion, or injection. Aim of the Work: This study aimed to develop and validate a novel scoring system using vital signs, arterial blood gases (ABG) and consciousness level as a tool of triage for evaluation and outcome prediction of acutely poisoned patients. Methods: The current prospective cohort study was conducted on patients with acute poisoning who were admitted at Tanta University Poisoning Treating Center (TUPTC) throughout a period of start of April 2020 to the end of June 2021. For each patient, age, sex, and toxicological characteristics were obtained. Clinical examination and routine laboratory investigations were also done. Results: Significant differences were observed between survivors and non-survivors in the derivation group (444 patients) regarding systolic blood pressure, diastolic blood pressure, respiratory rate, temperature, blood pH, PaCO2, serum HCO3, and O2 saturation. Using univariate and multivariate regression analysis SBP, serum HCO3, and O2 saturation were valid to construct the prediction score at cut off ≤100 mmHg, ≤16.6 mEq/L, and ≤93% respectively. Variables were given points and the score has range from 0 (the best score) to 3 (the worst score). The discrimination power in the derivation group at cut-off point >1 was excellent (AUC: 0.925) with 91.3% sensitivity and 94.9% specificity. Additionally, the discrimination power in the validation group (140 patients) at cut-off point >1 was excellent (AUC: 0.965) with 87.5% sensitivity and 93.8% specificity. Conclusion: This proposed score could be considered a simple and excellent tool for triage to identify acutely poisoned patients who are at risk of mortality. In addition, it is validated and so it could be used in other populations.