ABSTRACT
PURPOSE: This study examined the Poisoning Severity Score (PSS) from acute poisoning patients, to determine the relationships among the PSS, PSSsum, the primary outcome (prolonged stay at the ER over 24 hours, general ward and ICU admission and the application of intubation and mechanical ventilator, and the administration of inotropes). METHODS: A retrospective study was conducted through the EMR for 15 months. The PSS grade was classified according to the evidence of symptoms and signs. The differences in the primary outcomes between the PSS of when a single organ was damaged, and the PSS, PSSsum combined with the grade of when multiple organs were damaged, were studied. The cutoff value was calculated using the receiving operating characteristics (ROC) curve. RESULTS: Of the 284 patients; 85 (29.9%) were men with a mean age of 48.8 years, and their average arrival time to the ER was 4.4±6.7 hours. The most frequently used drug was hypnotics. The number of patients with PSS grade 0, 1, 2, 3, and 4 was 17, 129, 122, 24, and one, respectively. No ICU admissions, application of intubation and mechanical ventilators, administration of inotropes were observed among the patients with PSS grades 0 and 1 but only on patients with PSS grades 2 to 4. At PSS, when separating the patients according to the number of damaged organs, 17 had no symptoms, 133 had one organ damaged, 75 had two organs damaged, 36 had three organs damaged, and 23 had four organs damaged. Significant differences were observed between increasing number of damaged organs and the primary outcome. CONCLUSION: Among the acute poisoning patients, the PSS was higher in severity when the grade was higher. The number of damaged organs and the primary outcome showed meaningful statistical differences. This study confirmed that when the patients' PSS>2 and PSSsum>5, the frequency of ICU admission was higher, and they were considered to be severe with an increased prescription risk of application of intubation and mechanical ventilator, and the administration of inotropes.
Subject(s)
Humans , Male , Hypnotics and Sedatives , Intubation , Patients' Rooms , Poisoning , Prescriptions , Prognosis , Retrospective Studies , Ventilators, MechanicalABSTRACT
Objective To study the applied value of modified poisoning severity score (PSS) for early prognostic evaluation in acute paraquat poisoning.Methods Thirty-seven patients with acute paraquat poisoning from June 2013 to June 2016 were enrolled.The PSS score,the modified PSS score,the acute physiology and the chronic health status Ⅱ score (APACHE Ⅱ) of the patients were calculated.The relationship between modified PSS and APACHE Ⅱ was analyzed.Also the factors that affect outcome were analyzed by logistic regression analysis.The work characteristic curve (ROC curve) of the PSS,the modified PSS and the APECH Ⅱ were drawn and compared.Results There was a positive correlation between the risk of death and admission time,poisonous dose,the concentration of urine paraquat,and white blood cell count (P＜0.05).There was a significant correlation between the modified PSS and the APACHE Ⅱ (P＜0.0001).The immediate PSS score,the modified PSS score,and the APACHE Ⅱ score were significant for the prognosis of patients with acute paraquat poisoning.The area under the curve (AUC) was in turn 0.774,0.788,0.799.Among them,the best bound of the modified PSS score was 6.5 (when the score is greater than 6.5,the risk of death is higher).Further comparison of the area under the three curves showed that there was no significant difference in the area under the ROC curve between the three scores in predicting the prognosis of death [P=0.7633(PSS-DPSS),P=0.7791 (PSS-APACHE Ⅱ),P=0.8918(DPSS-APACHE Ⅱ)].Conclusion Modified PSS is helpful in early predicting the prognosis of acute paraquat poisoning.