Comparison of the accuracy of two scoring systems in predicting the outcome of organophosphate intoxicated patients admitted to intensive care unit (ICU)

IntroductionOrganophosphates(OP) are one of the most common causes of poisoning, especially in developing countries, with high morbidity and mortality. As mortality rate of OP poisoning is still high, early diagnosis and appropriate treatment is often life saving. OP is the main cause of poisoning and death in the poison control centre (PCC), Ain Shams University (ASU) in Egypt.ObjectiveTo compare the accuracy of acute physiology and chronic health evaluation score (APACHE IV) and simplified acute physiology score (SAPS II) in the prediction of mortality of patients with organophosphate poisoning (OPP) who required admission to the Intensive Care Unit (ICU) of PCC of ASU between January 1st, 2009 and December 31st, 2009.MethodsA prospective study conducted by collecting data on consecutive patients with acute OPP admitted to the intensive care unit over 12 months. Data required to calculate the patients’ predicted mortality by (APACHE) IV and (SAPS) II scoring systems were collected.ResultsNinety patients were recruited in the study with acute OP toxicity. The observed mortality following acute OP toxicity was 13.3% (12 patients). The area under the receiver operator characteristic (ROC) curves of APACHE IV score was better than SAPS II score (0.921 ± 0.054 SE, 0.807 ± 0.078 SE, respectively). APACHE IV and SAPS II scores were significantly higher in the non-survival than in the survival group (P < 0.05).ConclusionAPACHE IV and SAPS II scores calculated within the first 24 h are good prognostic indicators among patients with acute OP toxicity that required ICU admission with preference to APACHE IV score. APACHE IV and SAPS II scores above 89, 44, respectively within the first 24 h are a predictor of poor outcome in patients with acute OP toxicity.RecommendationApplication of APACHE IV and SAPS II scores is a good predictor of high mortality in OP intoxicated patients which helps in proper allocation of resources.