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Journal Article

Citation

Martín-Rodríguez F, López-Izquierdo R, Castro-Villamor MA, Martín-Conty JL, Herrero-Antón RM, Del Pozo-Vegas C, Guillén-Gil D, Dueñas-Laita A. Aust. Crit. Care 2020; ePub(ePub): ePub.

Copyright

(Copyright © 2020, Confederation of Australian Critical Care Nurses, Publisher Elsevier Publishing)

DOI

10.1016/j.aucc.2020.07.004

PMID

33067102

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.


Language: en

Keywords

Poisoning; Emergency medical services; Prehospital; Clinical decision-making; Lactate; Serious adverse events

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