A study to assess the utility of poison severity score, pseudocholinesterase levels and Glasgow coma scale in predicting severity and clinical outcome of organophosphorus poisoning

Abstract

Background: Suicides due to organophosphate self-poisoning is a major cause of concern world over. Organophosphate compounds (OP) possess a major cause of suicide in India.  There is a greater need for tools to predict severity of OP poisoning. We in this study try to assess the utility of the Glasgow coma scale (GCS), pseudocholinesterase levels and the poisoning severity score (PSS) in estimating severity and clinical prognosis of OP poisoning in patients of south India.Methods: A prospective study was conducted over 2 years in department of medicine, KIMS hospital and research centre, patients who were >18 years of age were included. OP poisoning was determined by either history of consumption or clinical features. Pseudocholinesterase levels at admission, PPS and GCS scores were assessed at admission and at 24 hours. Clinical, demographical, and certain laboratory investigation were recorded. Patients were followed till the patient stayed in intensive care unit.Results: In present study 100 patients were enrolled. Significant association was observed between GCS (p<0.001), PSS (p<0.001) and outcome of OP poisoning. Unexpectedly no significant association was observed with pseudocholinesterase level (p=0.118). A total of 83% patients were improved after treatment and mortality rate observed was 17%. Out of these 83% severe complications were observed in 14% of the patients.Conclusions: The findings of this study highlight the usefulness of GCS and PSS systems for predicting severity of OP poisoning. Identification of severity at an early stage followed by prompt treatment can prevent deaths. Our study did not find any association between pseudocholinesterase levels at admission and severity of OP poisoning.