Clinical problems in organophosphate insecticide poisoning: the use of a computerized information system

A computerized medical information system has been constructed, which contains clinical data from 236 case records of organophosphate and carbamate insecticides poisoning in Israel. A computer program was used to retrieve, analyze, and cross- tabulate data contained in 162 variables per patient. Clinical criteria were used to distinguish mild (66%) from moderate (19%) and severe (15%) cases. The majority of exposures were occupational (58%), whereas the rest were accidental (31%) or suicidal (11%). Parathion was the toxic compound most frequently involved (153 cases). Grouping signs and symptoms according to the cholinergic synapse systems showed peripheral muscarinic signs to be the most prevalent (92.5% of cases), whereas involvement of all three synapse systems was rare (17%). Listing individual symptoms emphasized the high prevalence of nonspecific symptoms such as vomiting (142 cases) and abdominal pain (115 cases). The mean atropine dose given to adult patients during the first 24 hr after poisoning ranged from 6.0 +/- 0.7 mg in mild cases to 49.8 +/- 4.5 mg in severe cases. Evaluation of clinical decision making was demonstrated through analysis of the guidelines used by physicians to gauge atropine administration. Five of the eighteen fatalities were delayed deaths, one of which was due to a polymorphous ventricular arrhythmia. The same arrhythmia occurred also in four nonfatal cases. Other delayed effects included nonspecific EEG changes and neuropsychiatric symptoms. Matching individual cases with comparable cases in the data bank was demonstrated, using a previously published case report. Computerized consultation may help inexperienced physicians to improve the quality of medical care given to cases of organophosphate insecticide poisoning in small hospitals located in rural areas.