The Poisoning Severity Score, can it be used to assess the severity of an acute poisoning?
CCCF ePoster library. Lacroix G. 11/13/19; 283377; EP97
Geneviève Lacroix
Geneviève Lacroix
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Abstract
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ePoster
Topic: Retrospective or Prospective Cohort Study or Case Series

Lacroix, Geneviève 1; St-Onge, Maude Neveu, Xavier 3
1. Department of Family Medicine and Emergency medicine, Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Université Laval, Quebec, Canada
2. Department of Family Medicine and Emergency medicine, 
Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Université Laval, Quebec, Canada
3. Research center of CHU de Québec, Université Laval, Quebec, Canada


INTRODUCTION
The Poisoning Severity Score has been developed in the 1990s as a four-point severity-classification scale for grading the severity of poisoning regardless of the type of agents involved. It was initially designed in Europe to retrospectively assess the severity of poisonings reported to poison centers. Even if this score has been used as a prognostic tool in toxicologic studies, it has never been validated nor formally compared to other general prognostic scores in acute poisoning. The SOFA score, on the other hand, has been developed and validated as an organ dysfunction score in a mixed population of surgical and medical patients.
OBJECTIVES
The goals of this study were to test the validity of using the poisoning severity score to assess the severity of acute poisoning while testing its capacity of predicting the duration of mechanical ventilation and to compare its performance with that of the SOFA score.
METHOD
We did a retrospective assessment of poisoning cases reported to the Quebec Poison Control Centre between January 2013 and January 2016. We needed 440 cases to have a power of 80% and a p- value of 0,05 to assess the PSS's capacity of predicting the duration of mechanical ventilation, assuming that 24hr is a clinically significant difference. 463 cases of acute poisoning from this period were randomly selected from the Poison Centre database and information was recorded with an approved research data form. For each of these cases, the PSS and the SOFA score were calculated at the patient arrival and on repeated intervals until 72hrs after admission. The duration of mechanical ventilation as well as the intensive care unit and hospital length of stay (until transfer in psychiatry department) were recorded. The interrater reliability of the PSS and SOFA scoring in 75 cases was calculated between two independent reviewers.
RESULTS
The Poisoning Severity Score can predict the duration of mechanical ventilation in acute poisoning. In fact, there is a dose-response relationship between both. The initial value of the PSS and SOFA score can predict a duration of mechanical ventilation of more than 48hr with an area under the ROC curve of 0,82 and 0,88 respectively, without any statistical difference of performance between them. The capacity of the PSS and SOFA score at 12hr and 24hr after arrival to predict the duration of ventilation only improves over time as shown by the different areas under the ROC curve. On the same idea, the PSS and SOFA score have a good capacity to predict a length of stay of more than 48hr. However, the interrater reliability of the PSS is poor. The SOFA score performs better with an interrater reliability coefficient of 0,839 than the PSS with a coefficient of 0,409. No case of mortality was recorded.
CONCLUSION
This study demonstrates that both the Poisoning Severity Score and the SOFA score are useful to assess the severity of an acute poisoning as they can predict the duration of mechanical ventilation and intensive care length of stay. The SOFA score seems the better score to use even in a context of poisoning because of its good interrater reliability and it being potentially useful for future toxicology studies. 


1. Bouch DC, Thompson JP. Severity Scoring Systems in the Criticaly Ill. Continuing Education in Anaesthesia, Critical Care & Pain, Volume 8 Number 5 2008.
2. Persson H, Sjöberg G, Haines J, Pronczuk de Garbino J. Poisoning Severity Score: Grading of acute poisoning. J Toxicology - Clinical Toxicology (1998) 36:205-13.
3. Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related organ failure assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intens Care Med 1996; 22: 707–10
4. Minne L, Abu-Hanna A, de Jonge E. Evaluation of SOFA-based models for predicting mortality in the ICU: A systematic review. Crit Care. 2008; 12(6):R161. Epub 2008 Dec 17.
5. Persson H, Sjöberg G, Haines J, Pronczuk de Garbino J. Poisoning Severity Score: Grading of acute poisoning. J Toxicology - Clinical Toxicology (1998) 36:205-13.
6. Pandharipande Pratik P et al. Derivation and validation of SpO2/FiO2 ratio to impute for PaO2/ FiO2 ratio in the respiratory component of the Sequential Organ Failure Assessment (SOFA) Score Crit Care Med. 2009 April ; 37(4): 1317–1321.
 

ePoster
Topic: Retrospective or Prospective Cohort Study or Case Series

Lacroix, Geneviève 1; St-Onge, Maude Neveu, Xavier 3
1. Department of Family Medicine and Emergency medicine, Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Université Laval, Quebec, Canada
2. Department of Family Medicine and Emergency medicine, 
Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Université Laval, Quebec, Canada
3. Research center of CHU de Québec, Université Laval, Quebec, Canada


INTRODUCTION
The Poisoning Severity Score has been developed in the 1990s as a four-point severity-classification scale for grading the severity of poisoning regardless of the type of agents involved. It was initially designed in Europe to retrospectively assess the severity of poisonings reported to poison centers. Even if this score has been used as a prognostic tool in toxicologic studies, it has never been validated nor formally compared to other general prognostic scores in acute poisoning. The SOFA score, on the other hand, has been developed and validated as an organ dysfunction score in a mixed population of surgical and medical patients.
OBJECTIVES
The goals of this study were to test the validity of using the poisoning severity score to assess the severity of acute poisoning while testing its capacity of predicting the duration of mechanical ventilation and to compare its performance with that of the SOFA score.
METHOD
We did a retrospective assessment of poisoning cases reported to the Quebec Poison Control Centre between January 2013 and January 2016. We needed 440 cases to have a power of 80% and a p- value of 0,05 to assess the PSS's capacity of predicting the duration of mechanical ventilation, assuming that 24hr is a clinically significant difference. 463 cases of acute poisoning from this period were randomly selected from the Poison Centre database and information was recorded with an approved research data form. For each of these cases, the PSS and the SOFA score were calculated at the patient arrival and on repeated intervals until 72hrs after admission. The duration of mechanical ventilation as well as the intensive care unit and hospital length of stay (until transfer in psychiatry department) were recorded. The interrater reliability of the PSS and SOFA scoring in 75 cases was calculated between two independent reviewers.
RESULTS
The Poisoning Severity Score can predict the duration of mechanical ventilation in acute poisoning. In fact, there is a dose-response relationship between both. The initial value of the PSS and SOFA score can predict a duration of mechanical ventilation of more than 48hr with an area under the ROC curve of 0,82 and 0,88 respectively, without any statistical difference of performance between them. The capacity of the PSS and SOFA score at 12hr and 24hr after arrival to predict the duration of ventilation only improves over time as shown by the different areas under the ROC curve. On the same idea, the PSS and SOFA score have a good capacity to predict a length of stay of more than 48hr. However, the interrater reliability of the PSS is poor. The SOFA score performs better with an interrater reliability coefficient of 0,839 than the PSS with a coefficient of 0,409. No case of mortality was recorded.
CONCLUSION
This study demonstrates that both the Poisoning Severity Score and the SOFA score are useful to assess the severity of an acute poisoning as they can predict the duration of mechanical ventilation and intensive care length of stay. The SOFA score seems the better score to use even in a context of poisoning because of its good interrater reliability and it being potentially useful for future toxicology studies. 


1. Bouch DC, Thompson JP. Severity Scoring Systems in the Criticaly Ill. Continuing Education in Anaesthesia, Critical Care & Pain, Volume 8 Number 5 2008.
2. Persson H, Sjöberg G, Haines J, Pronczuk de Garbino J. Poisoning Severity Score: Grading of acute poisoning. J Toxicology - Clinical Toxicology (1998) 36:205-13.
3. Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related organ failure assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intens Care Med 1996; 22: 707–10
4. Minne L, Abu-Hanna A, de Jonge E. Evaluation of SOFA-based models for predicting mortality in the ICU: A systematic review. Crit Care. 2008; 12(6):R161. Epub 2008 Dec 17.
5. Persson H, Sjöberg G, Haines J, Pronczuk de Garbino J. Poisoning Severity Score: Grading of acute poisoning. J Toxicology - Clinical Toxicology (1998) 36:205-13.
6. Pandharipande Pratik P et al. Derivation and validation of SpO2/FiO2 ratio to impute for PaO2/ FiO2 ratio in the respiratory component of the Sequential Organ Failure Assessment (SOFA) Score Crit Care Med. 2009 April ; 37(4): 1317–1321.
 

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