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Identifying early warning signs for acute poisoning (AP) is crucial for better emergency department care. Factors like altered mental status, vital sign abnormalities, and elevated acute-phase reactants predict poor outcomes, aiding risk stratification.

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Area of Science:

  • Clinical Toxicology
  • Emergency Medicine
  • Medical Informatics

Background:

  • Acute poisoning (AP) presents a significant challenge to emergency departments (EDs).
  • Early identification of prognostic determinants is vital for timely intervention and improved patient outcomes.
  • Effective risk stratification for AP cases remains an ongoing clinical need.

Purpose of the Study:

  • To identify predictive factors associated with poor outcomes in acute poisoning cases managed in a tertiary hospital's emergency department.
  • To establish key parameters for a novel early warning system for acute poisoning.

Main Methods:

  • Retrospective observational study analyzing medical records of acute poisoning patients.
  • Multivariable logistic regression and Chi-squared Automatic Interaction Detection (CHAID) were employed for predictive analysis.
  • Factors analyzed included epidemiological, clinical, and laboratory data.

Main Results:

  • Female sex, younger age, intentional poisoning, and exposure to caustics, fumes, or medications were linked to adverse outcomes.
  • Clinical predictors of poor outcomes included altered mental status, hypotension, cardiac arrhythmias, and hyperthermia.
  • Laboratory markers such as altered blood pH, glucose levels, and elevated acute-phase reactants indicated poor prognosis.
  • The RITA-AE (Respiratory distress, Cardiovascular instability, Temperature abnormalities, Neurological impairment, Metabolic acidosis, Elevated acute-phase reactants) score was proposed as an early warning system.

Conclusions:

  • Key parameters for an early warning system for acute poisoning have been identified.
  • These findings can facilitate early risk stratification and enhance the management of acute poisoning cases in the ED.
  • The proposed RITA-AE system offers a potential tool for improving clinical decision-making in AP management.