Comparison between various scoring systems in predicting the need for intensive care unit admission of acute pesticide-poisoned patients

The decision of intensive care unit (ICU) admission in acute pesticide poisoning is often challenging, especially in developing countries with limited resources. This study was conducted to compare the efficacy of the Acute Physiology and Chronic Health Evaluation II (APACHE II), Modified Early Warning Score (MEWS), and Poisoning Severity Score (PSS) in predicting ICU admission and mortality of acute pesticide-poisoned patients. This prospective cohort study included all patients admitted to Tanta University Poison Control Center with acute pesticide poisoning from the start of March 2018 to the end of March 2019. Patient data, including demographic and toxicological data, clinical examination, laboratory investigation, and score values, were collected on admission. Out of 337 acute pesticide-poisoned patients, 30.5% were admitted to the ICU, including those poisoned with aluminum phosphide (ALP) (81.5%) and organophosphates (OP) (18.5%). Most non-survivors (86.6%) were ALP poisoning. The PSS had the best discriminatory power in predicting ICU admission and mortality, followed by APACHE II and MEWS. However, no significant difference in predicting ICU admission of OP-poisoned patients was detected between the scores. Additionally, no significant difference in mortality prediction of ALP-poisoned patients was found between the PSS and APACHE II. The PSS, APACHE II, and MEWS are good discriminators for outcome prediction of acute pesticide poisoning on admission. Although the PSS showed the best performance, MEWS was simpler, more feasible, and practicable in predicting ICU admission of OP-poisoned patients. Moreover, the APACHE II has better sensitivity for mortality prediction of ALP-poisoned patients.