급성 약물 중독 환자에서 Poisoning Severity Score (PSS)를 이용한중증도 분류와 중증도 분류에 있어 PSS 값과PSSsum 값의 Optimal Cutoff Value
Classify the Acute Drug Intoxication Patients with Poisoning Severity Score(PSS) and Calculate the Optimal Cutoff Value of PSS, PSSsum to Predict Poor Prognosis
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
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.
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.
참고문헌 (20)
- Persson HE, "Poisoning Severity Score. Grading of acute poisoning", Clin Toxicol, 36(3), pp.205~213 (1998)
- Casey PB, "The prospective value of the IPCS", EC, Clin Toxicol, pp.1998, 36(3)[DOI]
- Schwarz ES, "Should we be using the poisoning severity score?", J Med Toxicol, 13, pp.135~145 (2017)
- Cairns R, "The poisoning severity score: If did not exist, we wound have to invent it", J Med Toxicol, 13, pp.131~134 (2017)
- 김용환, "Performance Assessment of the SOFA, APACHE II Scoring System, and SAPS II in Intensive Care Unit Organophosphate Poisoned Patients", Journal of Korean Medical Science, 28(12), pp.1822~1826 (2013), 대한의학회
- Lee JH, "Effectiveness of the sequential organ failure assessment, acute physiology and chronic health evaluation II, and simplified acute physiology score II prognostic scoring system in paraquat-poisoned patients in the intensive care unit", Hum Exp Toxicol, 36(5), pp.431~437 (2017)
- Churi S, "Organophosphate poisoning: Prediction of severity and outcome by Glasgow Coma Scale, Poisoning Severity Score, Acute Physiology and Chronic Health Evaluation II score and Simplified Acute Physiology Score II", J Emerg Nurs, 38(5), pp.493~495 (2012)
- Yuan S, "The evaluation of acute physiology and chronic health evaluation II score, poisoning severity score, sequential organ failure assessment score combine with lactate to assess the prognosis of the patients with acute organophosphate pesticide poisoning", Medicine, 97, pp.21~24 (2018)
- Cheung R, "Prognostic utility of initial lactate in patients with acute drug overdose : A validation cohort", Ann Emerg Med, 72, pp.16~23 (2018)
- Manini AF, "Clinical risk factors for in hospital adverse cardiovascular events after acute drug overdose", Acad Emerg Med, 22(5), pp.499~507 (2015)
- Manini AF, "Validation of the prognostic utility of the electrocardiogram for acute drug overdose", J Am Heart Assoc, 6, pp.e004320~ (2017)
- Churi S, "Organophosphate poisoning: prediction of severity and outcome by Glasgow coma scale, poisoning severity score, acute physiology and chronic health evaluation II score and simplified acute physiology score II", J Emerg Nurs, 38(5), pp.493~495 (2012)
- Akdur O, "Poisoning severity score, Glasgow coma scale, corrected QT interval in acute organophosphate poisoning", Hum Exp Toxicol, 29(5), pp.419~425 (2010)
- Ebrahimi K, "Determining and comparing predictive and intensity value of severity score - sequential organ failure assessment score, acute physiology and chronic health evaluation 4, and poisoning severity score - in short term clinical outcome of patients with poisoning in an ICU", Indian J Crit Care Med, 16, pp.29~35 (2018)
- Davies JOJ, "Predicting outcome in acute organophosphorous poisoning with a poisoning severity score or the Glasgow coma scale", QJM, 101(5), pp.371~379 (2008)
- Mong R, "Use of a 23 hour emergency department observation unit for the management of patients with toxic exposures", Emerg Med J, 34, pp.755~760 (2017)
- Wong A Tayloer DM, "Changing epidemiology of intentional antidepressant drug overdose in Victoria, Australia", Australia NZ J Psych, 44, pp.759~764 (2010)
- Vukcevic NP, "Benzodiazepine poisoning in elderly", Vojnosanit Pregl, 73(3), pp.234~238 (2016)
- Hori S, "Clinical characteristics of patients who overdose on multiple psychotropic drugs in Tokyo", J Toxicol Sci, 41(6), pp.765~773 (2016)
- Douglas RJ, "No place for gastric lavage in the acute management of poisoning with a charcoal responsive substance", Intern Med J, 48(8), pp.1010~1011 (2018)