Practical aspects of using different scoring scale for determining the severity and prognosis of drug poisoning in adults

Abstract

ABSTRACT. In the clinical observation of patients with poisoning in the intensive care unit, various static and dynamic indicators of the severity of the condition and its prognosis are used. Such indicators are the basis of scoring scales; however, the sensitivity of the scales can vary significantly depending on many factors. Aim. Generalization of modern approaches to the use of standardized point scales for assessing the physiological state of a person on the example of international scales: PSS, SAPS II, APACHE IV and analysis of the effectiveness of their use in the diagnosis and treatment of acute poisoning. Materials and Мethods. The publications of scientific databases Elsevier, PubMed, ToxNet on the topic of the study were analyzed. A retrospective evaluation of the medical data of 2,740 patients with narcotic poisoning (opioid syndrome) who were treated during 2011-2020 at the Kyiv Toxicology Center was carried out. The data of deceased patients - 98 people - were separately evaluated. The sensitivity and specificity of the APACHE IV, SAPS II, PSS scales for assessing the severity of the opioid syndrome and predicting death were evaluated. Results. It was established that the severity indicator of the condition in patients with opioid syndrome according to the PSS scale had a moderate negative correlation (r = 0.016, p < 0.001) with the data according to the APACHE IV scale, but the assessment according to the SAPS II scale had a statistically significant positive correlation (r = 0.231, p = 0.002) with data on the PSS scale. A statistically significant positive correlation was established between the predictive index of the occurrence of death according to the APACHE IV scale and its actual occurrence (r = 0.548, p < 0.001); according to the SAPS II scale, the similar indicator did not have statistical reliability, but approached the confidence interval (r = 0.475, р = 0.051); no statistically significant relationship was obtained between the assessment of the fatal state on the PSS scale and the actual occurrence of death (r = 0.117, p = 0.078). Conclusions. Today, the PSS remains the best way to compare the severity of poisoning by different toxic agents, in different groups of patients with reference to a geographical location or a specific country. However, the assessment of patients with opioid syndrome revealed significant differences in the severity of poisoning and the prognosis of death, which were calculated using different scales. Keywords: poisoning, poisoning severity scale, PSS, SAPS II, APACHE IV.