A predictive model for serious adverse events in adults with acute poisoning in prehospital and hospital care. Issue 3 (May 2021)

• Record Type: Journal Article
• Authors: Martín-Rodríguez, Francisco; López-Izquierdo, Raúl; Castro-Villamor, Miguel A.; Martín-Conty, José L.; Herrero-Antón, Rosa M.; del Pozo-Vegas, Carlos; Guillén-Gil, David; Dueñas-Laita, Antonio
• Is Part Of: Australian critical care. Volume 34:Issue 3(2021)
• Page Start: 209
• Page End: 216
• Publication Date: 2021-05
• Subjects: Lactate -- Clinical decision-making -- Emergency medical services -- Poisoning -- Prehospital -- Serious adverse events; Intensive care nursing -- Periodicals; Intensive care nursing -- Australia -- Periodicals; Electronic journals; 616.028
• DOI: 10.1016/j.aucc.2020.07.004
• Languages: English
• ISSNs: 1036-7314

Abstract

Abstract: Objective: The objective of this study was to design a risk model with variables determined before hospital arrival to predict the risk of serious adverse events in patients with acute poisoning. Methods: A preliminary prospective, multicentre cohort study of adults with prehospital diagnosis of acute intoxication was conducted. The study was carried out in the Public Health System of the Community of Castilla-Leon (Spain), including seven advanced life support units and five hospitals, between April 1, 2018, and June 30, 2019. People aged >18 years with a main prehospital diagnosis of acute poisoning admitted to a referral hospital on advanced life support were included. The main outcome measure was prehospital and hospital serious adverse events in patients with acute poisoning. Results: We included 221 patients, with a median age of 47 years (interquartile range: 33–61). The most frequent cause of poisoning was psychopharmaceuticals (111 cases, 49.8%): 38 (17.2%) patients had a serious adverse event, with a hospital mortality of 4.1% (nine cases) in the 30 days after the index event. The final model included age ≥65 years (odds ratio [OR]: 9.59, 95% confidence interval [CI]: 3.48–26.45; p < 0.001), oxygen saturation/fraction of inspired oxygen index ≤300 (OR: 15.03, 95% CI: 5.74–39.33; p < 0.001), and point-of-care lactate ≥4 mmol/L (OR: 7.68, 95% CI: 2.88–20.45; p < 0.001). The poisoning Early Warning Score was constructed from these three variables, and 1 point was assigned to each variable. The area under the curve of the score was 0.896 (95% CI: 0.82–0.96; p < 0.001). Conclusions: The poisoning Early Warning Score may help in decision-making and promote early identification of high-risk patients with acute poisoning in the prehospital context.