A predictive model for serious adverse events in adults with acute poisoning in prehospital and hospital care

• Published in: Australian critical care Vol. 34; no. 3; pp. 209 - 216
• Main 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
• Format: Journal Article
• Language: English
• Published: Australia Elsevier Ltd 01.05.2021
• Subjects: Adult; Aged; Clinical decision-making; Cohort Studies; Emergency Medical Services; Hospitals; Humans; Lactate; Middle Aged; Poisoning; Prehospital; Prospective Studies; Serious adverse events; Spain; Spain; Poisoning; Lactate; Clinical decision-making; Emergency medical services; Prehospital; Serious adverse events
• ISSN: 1036-7314; 1878-1721
• DOI: 10.1016/j.aucc.2020.07.004

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. 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. 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). 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.