Significance of the Poisoning Severity Score as a Prognostic Factor in Poisoning

PURPOSE: The clinical factors that help to determine the management in the emergency department for acute poisoning are the type of toxic material and the amount, the cause of poisoning, and the toxidrome. Especially, when one cannot obtain much information about the type of toxic material and the amount from history taking, the most important factor in deciding whether a patient should be hospitalized or discharged is the toxidrome. The Poisoning Severity Score is a standardized system for scoring clinical signs and symptoms due to poisoning. This study was conducted to see if the Poisoning Severity Score on arrival at the emergency department might be used as a prognostic factor and, to see if there are any other factors that might be used to deciding on treatment plans and whether to hospitalize or discharge a patient. METHODS: Retrospective chart reviews of poisoned patients who had visited the Emergency Department of Ansan Hospital of Korea University were used in this study. Age, sex, the time taken to arrive at the emergency department after poisoning, the type of toxic material and the cause of poisoning, the mean arterial pressure, the pulse pressure, the respiratory rate, the body temperature, the initial Poisoning Severity Score, the AST, the serum creatinine level, the anion gap, and the base excess were checked. Also, the use of activated charcoal, gastric lavage, antidotes, hemodialysis/hemoperfusion, and mechanical ventilation, as well as the final Poisoning Severity Score and the clinical progress were checked. RESULTS: In cases of high initial poisoning, the final Poisoning Severity Score was, with statistical significance, much higher than it was in cases of low initial poisoning. Also, in cases of high final Poisoning Severity Scores, the mechanical ventilation rate and the death rate were higher than they were in cases of low final Poisoning Severity Scores, and this difference was statistically significant. In cases of high final Poisoning Severity Scores, mean age was older, and the intentional poisoning rate, the hemodialysis/ hemoperfusion rate, the base excess, and the initial Poisoning Severity Score were higher than in cases of low final Poisoning Severity Score. CONCLUSIONS: We have concluded that the initial Poisoning Severity Score can be a useful factor for giving a prognosis and for deciding on hospitalization and on a therapeutic plan. Also, we have concluded that multiple variables, such as the patient's age, the type of toxic material, the cause of poisoning, and the base excess are significant factors that can complement the initial Poisoning Severity Score in deciding on a hospitalization and therapeutic plan. Consequently, early evaluation of the type of toxic material and the cause of poisoning from history taking and early measurement of the initial Poisoning Severity Score and the variables mentioned above are of utmost importance in formulating a prognosis and deciding on the need for hospitalization.

Current Status of Violence in the Emergency Centers: Frequency and Management

PURPOSE: The aim of this study is to describe the current status of violence in emergency departments (ED) in Korea, especially in the aspect of frequency and management. METHOD: A cross-sectional survey of 60 academic emergency departments was performed. The questionnaires were posted to the chief resident physicians of emergency medicine. RESULTS: Thirty-three EDs (55%) responded to the survey questionnaire. The responders were experienced 18.4 verbal insults, 5.5 physical threats, 0.4 threats by weapon, 1.8 physical violences and 3.3 facility damages per 100,000 patients in a month. All kinds of violence occurred more frequently in the ED which annual census was less than 30,000. The current coping strategies for violence were video surveillance (93.9%), security personnel (75.8%), access control (36.4%), and educational programs (18.2%). The rate of threat by weapon and facility damage was significantly lower in the ED having security personnel. CONCLUSION: This study suggested that ED violence occurred frequently. The rate of violence of the ED having high annual census was more higher, because violence events may be suppressed by security personnel.