Pach J, Persson H, Sancewicz-Pach K, Groszek B
Kliniki Toksykologii KMPiChS Collegium Medicum Uniwersytetu Jagiellońskiego w Krakowie.
Przegl Lek. 1999;56(6):401-8.
The aim of the present study has been to assess the concordance in severity grading when using the Poisoning Severity Score (PSS), proposed by IPCS/EC/EAPCCT vs. some specific grading scales. Cases of acute poisoning admitted to the Department of Clinical Toxicology in Kraków during months January, March, May, July, August and October 1998 (n = 820) were evaluated. Severity grading was performed in all cases using both the PSS and special grading scales developed by the poisons centre in Kraków. The PSS is assessing severity on the basis of observed clinical signs and symptoms (at their maximum), but does not take into account potential risks or plasma/serum concentrations. The Kraków scales include both clinical symptoms on admission and results of toxicological analyses. Ethanol (39.4%), drugs (36.2%) and carbon monoxide (7.9%) were the most commonly involved toxic agents. Overall concordance between the PSS and the Kraków scales was at hand in 596 cases (72.7%). The lack of concordance was most evident for ethanol and carbon monoxide cases--the PSS generally giving a lower grade. The discordance was less pronounced for grade 3 (life-threatening) poisonings. Significant number of ethanol poisoning in Kraków centre require medicolegal certification thus ethanol concentration (blood or expired air) is considered while evaluating the poisoning severity. Moreover majority (more than 70%) of acutely ethanol poisoned patients treated at the Department are chronic alcoholics so clinical evidence of intoxication may be minimal at blood ethanol levels higher than 3.0 g/L. For ethanol intoxication the blood ethanol concentration was considered in the Kraków scale but not in the PSS, and when the blood concentrations were disregarded and clinical symptoms only were evaluated the concordance improved between the different systems from 72.7% to 92.3%. Thereby also the overall concordance in the study increased to 82.9%. The less satisfying concordance for carbon monoxide cases was mainly caused by discrepancies in the evaluation of neurological symptoms. Also the blood lactate concentration, COHb level, duration of exposure and patient's age are considered in the Kraków scale but not in PSS. The PSS is intended as a general scheme for grading severity of acute poisoning. In this study an acceptable concordance between the PSS and some locally developed grading scales was at hand in the majority of cases, but it seems that for specific poisons, like carbon monoxide, some modifications and additional criteria may be justified. Further studies to test the reliability of the PSS are encouraged.
本研究的目的是评估在使用由国际化学品安全规划署/欧洲委员会/欧洲中毒控制中心和临床毒理学家协会提议的中毒严重程度评分（PSS）与一些特定分级量表时，严重程度分级的一致性。对1998年1月、3月、5月、7月、8月和10月期间克拉科夫临床毒理学部门收治的急性中毒病例（n = 820）进行了评估。所有病例均使用PSS和克拉科夫中毒控制中心制定的特殊分级量表进行严重程度分级。PSS是根据观察到的临床体征和症状（在其最严重时）评估严重程度，但不考虑潜在风险或血浆/血清浓度。克拉科夫量表包括入院时的临床症状和毒理学分析结果。乙醇（39.4%）、药物（36.2%）和一氧化碳（7.9%）是最常涉及的有毒物质。PSS与克拉科夫量表之间的总体一致性在596例病例中出现（72.7%）。乙醇和一氧化碳病例中一致性缺乏最为明显——PSS通常给出较低的等级。3级（危及生命）中毒的不一致性不太明显。克拉科夫中心大量乙醇中毒病例需要法医鉴定，因此在评估中毒严重程度时会考虑乙醇浓度（血液或呼出气体）。此外，该部门治疗的大多数（超过70%）急性乙醇中毒患者是慢性酒精中毒者，因此当血液乙醇水平高于3.0 g/L时，中毒的临床证据可能很少。对于乙醇中毒，克拉科夫量表考虑血液乙醇浓度，而PSS不考虑，当不考虑血液浓度仅评估临床症状时，不同系统之间的一致性从72.7%提高到92.3%。因此，该研究中的总体一致性也提高到了82.9%。一氧化碳病例一致性不太令人满意主要是由于神经症状评估存在差异。克拉科夫量表还考虑血液乳酸浓度、碳氧血红蛋白水平、接触时间和患者年龄，而PSS不考虑。PSS旨在作为急性中毒严重程度分级的一般方案。在本研究中，大多数情况下PSS与一些当地制定的分级量表之间存在可接受的一致性，但对于特定毒物，如一氧化碳，似乎进行一些修改和增加额外标准可能是合理的。鼓励进一步研究以测试PSS的可靠性。
