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

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.

Accuracy of prehospital point-of-care lactate in early in-hospital mortality

BACKGROUND

Emergency medical services (EMS) routinely face complex scenarios where decisions should be taken with limited clinical information. The development of fast, reliable and easy to perform warning biomarkers could help in such decision-making processes. The present study aims at characterizing the validity of point-of-care lactate (pLA) during prehospital tasks for predicting in-hospital mortality within two days after the EMS assistance.

MATERIALS AND METHODS

Prospective, multicentric, ambulance-based and controlled observational study without intervention, including six advanced life support and five hospitals. The pLA levels were recorded during EMS assistance of adult patients. The validity of pLA to determine the in-hospital mortality was assessed by the area under the curve (AUC) of the receiver operating curve (ROC).

RESULTS

A total of 2997 patients were considered in the study, with a median of 69 years (IQR 54-81) and 41.4% of women. The median pLA value was 2.7 mmol/L (1.9-3.8) in survivors and 5.7 mmol/L (4.4-7.6) in nonsurvivors. The global discrimination level of pLA reached an AUC of 0.867, being 1.9 mmol/L and 4 mmol/L the cut-off point for low and high mortality. The discrimination value of pLA was not affected by sex, age or pathology.

CONCLUSIONS

Our results highlight the clinical importance of prehospital pLA to determine the in-hospital risk of mortality. The incorporation of pLA into the EMS protocols could improve the early identification of risky patients, leading to a better care of such patients.

Analysis of the effects of COHb, lactate, and troponin levels on the clinical process and outcome in patients who were admitted to the emergency service due to carbon monoxide poisoning

OBJECTIVE

The aim of the present study was to determine the demographic, medical, and treatment characteristics of patients followed up with the diagnosis of carbon monoxide (CO) poisoning in emergency care and also to determine the relationship of these patients' clinical process and outcome between carboxyhemoglobin (COHb), lactate, and troponin levels.

METHODS

The present study was conducted retrospectively between 01/01/2013 and 01/01/2016 by examining 450 patients who were referred to the emergency service for CO poisoning. The ages; sexualities; manners of application; clinical findings; levels of blood COHb, lactate, and troponin; applied oxygen treatment method; and outcome of patients were evaluated. Data analysis was done by Shapiro-Wilk, Student's t, Mann-Whitney U, and chi-square tests.

RESULTS

A total of 450 patients were included in the study. The median age of the patients was 35 (interquartile range (IQR) 26.75-45.00) years. In the study where data are not homogeneously distributed, the median levels of COHb, lactate, and troponin were 11.80% (IQR 3-23), 1.60 (IQR 1.10-2.5) mmol/l, and 0.00 (IQR 0.000-0.003) ng/ml, respectively. The levels of lactate were detected to be statistically high in patients who had syncope and who received hyperbaric oxygen treatment (p<0.05). In addition, the levels of lactate and troponin were significantly higher in patients who were hospitalized (p<0.05).

CONCLUSION

The levels of COHb, lactate, and troponin can provide an insight to the clinician about hospitalization and the type of treatment.