McFarland Sarah E, Bronstein Alvin C, Banerji Shireen, LeBlond Jane, Mischke Reinhard H, Begemann Kathrin, Desel Herbert, Greiner Matthias
a Department of Exposure , Federal Institute for Risk Assessment , Berlin , Germany.
b Hawaii State Department of Health , Emergency Medical Services & Injury Prevention System Branch , Hawaii , USA.
Clin Toxicol (Phila). 2017 Aug;55(7):629-635. doi: 10.1080/15563650.2017.1304554. Epub 2017 Mar 28.
To date, there are no publicly available schemes designed and evaluated specifically for severity assessment of animal poisonings. This poses challenges for the evaluation and comparison of animal poisoning exposure data.
Our objective for this pilot study was to evaluate agreement between raters using the Poisoning Severity Score (PSS) and National Poison Data System (NPDS) medical outcome scheme for severity assessment of canine exposures reported to a multistate poison center (PC) and to identify issues regarding their use for severity assessment of animal poisonings. Agreement between both schemes was also assessed.
The first 196 canine exposures reported to a multistate PC between 1 January and 31 August 2016 were selected and initial inquiry data from exposures was scored by four independent raters. Interrater agreement and agreement between the severity systems was calculated using weighted kappa (Κ) (Light's kappa). Reported clinical effects were also described.
Interrater agreement for both the PSS (Κ 0.31; 95% CI 0.19, 0.43) and NPDS schemes (Κ 0.34; 95% CI 0.22, 0.44) was low. Agreement between the schemes was slight (Κ 0.05; 95% CI -0.08, 0.16) for pooled results from all four raters. For the PSS, 71.7% (n = 281) of ratings were minor, 23.0% (n = 90) moderate, and 5.4% (n = 21) severe. For the NPDS, 69.6% (n = 273) of ratings were minor, 27.0% (n = 106) moderate, and 3.3% (n = 13) severe. The top three reported clinical effects included vomiting (n = 86, 29.9%) drowsiness/lethargy (n = 38, 13.2%), and diarrhea (n = 24, 8.3%).
This study shows considerable variability between raters using either the PSS or NPDS schemes for canine exposures severity assessment. The subjective nature of the schemes, the influence of intra- and interrater variation, and predominance of minor cases on the study findings should be taken into account when interpreting this data. Further evaluation of these schemes is warranted and could help inform their future use for animal poisoning severity assessment.
迄今为止，尚无专门设计并评估用于动物中毒严重程度评估的公开可用方案。这给动物中毒暴露数据的评估和比较带来了挑战。
本试点研究的目的是评估评估者之间使用中毒严重程度评分（PSS）和国家中毒数据系统（NPDS）医疗结果方案对向多州中毒控制中心（PC）报告的犬类暴露进行严重程度评估的一致性，并确定在将其用于动物中毒严重程度评估方面存在的问题。还评估了两种方案之间的一致性。
选取了2016年1月1日至8月31日期间向多州PC报告的前196例犬类暴露病例，由四名独立评估者对暴露的初始询问数据进行评分。使用加权kappa（Κ）（莱特kappa）计算评估者间一致性以及严重程度系统之间的一致性。还描述了报告的临床症状。
PSS方案（Κ 0.31；95%可信区间0.19，0.43）和NPDS方案（Κ 0.34；95%可信区间0.22，0.44）的评估者间一致性都较低。对于所有四名评估者的汇总结果，两种方案之间的一致性很微弱（Κ 0.05；95%可信区间 -0.08，0.16）。对于PSS，71.7%（n = 281）的评级为轻度，23.0%（n = 90）为中度，5.4%（n = 21）为重度。对于NPDS，69.6%（n = 273）的评级为轻度，27.0%（n = 106）为中度，3.3%（n = 13）为重度。报告的前三大临床症状包括呕吐（n = 86，29.9%）、嗜睡/昏睡（n = 38，13.2%）和腹泻（n = 24，8.3%）。
本研究表明，使用PSS或NPDS方案对犬类暴露严重程度进行评估时，评估者之间存在相当大的差异。在解释这些数据时，应考虑方案的主观性、评估者内部和评估者之间变异的影响以及轻度病例在研究结果中的主导地位。有必要对这些方案进行进一步评估，这可能有助于为它们未来用于动物中毒严重程度评估提供参考。
