Severity and carbamazepine level at time of initial poison center contact correlate with outcome in carbamazepine poisoning.

We reviewed data from carbamazepine poisonings reported to the Kentucky Regional Poison Center from January 1986 through March 1992 to identify information available at the time of poison center contact which correlates to outcome. The Spearman rank correlation test was used to describe the relationship between two ordinal variables and interval-level variables. The Kruskal-Wallis test was used to determine the relationship between categorical and ordinal variables. Two way analysis of variance was used to test the effect of routine carbamazepine use on final severity and carbamazepine level of 345 reports involving carbamazepine poisoning; 263 (76%) involved only carbamazepine ingestion and formed the database. One hundred eighty four (70%) carbamazepine ingestions occurred in victims < or = 17 years old, 79 (30%) occurred in adults. Severity assigned at the time of initial poison center contact was significantly correlated with outcome severity for children and adults (r > or = 0.9, p < 0.00001). The amount reported ingested influenced the correlation between initial and final severity; whereas, time elapsed between ingestion and poison center contact did not alter the correlation between initial and final severity. The reason for ingestion was significantly correlated with outcome (p < 0.00001). A significant correlation between outcome and peak carbamazepine level for each age group was observed (pediatric r = 0.5, p < 0.00001, and adult r = 0.4, p = 0.008). Carbamazepine levels > 85 mumol/L (> 20 mcg/mL) were associated with more severe toxicity.

Predictors of outcome in acute meningococcal infection in children.

OBJECTIVES: To develop a rapid and sensitive method for identification of patients at risk for organ system failure and death due to acute meningococcal infection, and to evaluate the reliability of the Pediatric Risk of Mortality score in predicting mortality rates from acute meningococcal infection. DESIGN: A prospective study which followed a retrospective analysis. SETTING: The Emergency Department and pediatric intensive care unit (ICU) of a university-affiliated children's hospital. PATIENTS: The hospital records of 86 pediatric patients with acute meningococcal infection during a 5-yr period (group 1) were reviewed. Twenty-two ICU patients (group 2) were then prospectively evaluated, and the occurrence rate of organ system failure was compared with that rate predicted by the model developed from the analysis of group 1. INTERVENTIONS: The occurrence of prognostic factors was compared with the development of organ system failure and death by Fisher's exact test and logistic regression analysis for patients in group 1. The mortality rates for groups 1 and 2 were compared with those rates that were predicted by the use of the Pediatric Risk of Mortality score. MAIN RESULTS: Eighteen of 86 patients in group 1 developed organ system failure, and seven (8.1%) patients died. Logistic regression analysis found that the combination of circulatory insufficiency, peripheral WBC counts of < 10,000 cells/mm3, and coagulopathy best predicted organ system failure. Ten of 22 patients in group 2 developed organ system failure, and two died. All patients with organ system failure exhibited > or = 1 of three identified prognostic factors. The probability of organ system failure occurring was > .5 for nine of ten patients with organ system failure. A total of nine patients in groups 1 and 2 developed multiple organ system failure, and all nine patients died. Based on Pediatric Risk of Mortality scoring, the mortality risk for nonsurvivors ranged from 27% to 94%, compared with 1% to 48% for survivors. The overall mortality rate was consistent with that rate predicted by the Pediatric Risk of Mortality scoring system. CONCLUSIONS: Patients with acute meningococcal infection who exhibit signs of circulatory insufficiency, a peripheral WBC count of < 10,000 cells/mm3, or a coagulopathy have a high probability of developing organ system failure. Death is highly probable when multiple organ system failure develops, and the overall mortality rate is accurately predicted by the Pediatric Risk of Mortality score.

Homelessness and the mentally ill offender.

This paper presents the results of a retrospective analysis of the discharge summaries of 69 mentally ill offenders. The subjects were patients in a New York State Psychiatric Hospital for a two-year period between January 1988 and December 1989 who were referred by the courts under New York State Criminal Procedure Law (CPL). The subjects were further compared as to homelessness at the time of the instant offense to study the association of this variable and criminal behavior among the mentally ill. Statistical analyses demonstrated significant relationships between variables of homelessness, prior offense history, and substance abuse.