Advanced Life Support, Emergency Medical Services, Valladolid, Spain; School of Medicine, Universidad de Valladolid, Avda. Ramón y Cajal, 7, 47005, Valladolid, Spain.
Emergency Department, Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain.
Aust Crit Care. 2021 May;34(3):209-216. doi: 10.1016/j.aucc.2020.07.004. Epub 2020 Oct 13.
The objective of this study was to design a risk model with variables determined before hospital arrival to predict the risk of serious adverse events in patients with acute poisoning.
A preliminary prospective, multicentre cohort study of adults with prehospital diagnosis of acute intoxication was conducted. The study was carried out in the Public Health System of the Community of Castilla-Leon (Spain), including seven advanced life support units and five hospitals, between April 1, 2018, and June 30, 2019. People aged >18 years with a main prehospital diagnosis of acute poisoning admitted to a referral hospital on advanced life support were included. The main outcome measure was prehospital and hospital serious adverse events in patients with acute poisoning.
We included 221 patients, with a median age of 47 years (interquartile range: 33-61). The most frequent cause of poisoning was psychopharmaceuticals (111 cases, 49.8%): 38 (17.2%) patients had a serious adverse event, with a hospital mortality of 4.1% (nine cases) in the 30 days after the index event. The final model included age ≥65 years (odds ratio [OR]: 9.59, 95% confidence interval [CI]: 3.48-26.45; p < 0.001), oxygen saturation/fraction of inspired oxygen index ≤300 (OR: 15.03, 95% CI: 5.74-39.33; p < 0.001), and point-of-care lactate ≥4 mmol/L (OR: 7.68, 95% CI: 2.88-20.45; p < 0.001). The poisoning Early Warning Score was constructed from these three variables, and 1 point was assigned to each variable. The area under the curve of the score was 0.896 (95% CI: 0.82-0.96; p < 0.001).
The poisoning Early Warning Score may help in decision-making and promote early identification of high-risk patients with acute poisoning in the prehospital context.
本研究旨在设计一个在到达医院前确定变量的风险模型，以预测急性中毒患者发生严重不良事件的风险。
对有院前诊断为急性中毒的成年人进行了一项初步的前瞻性多中心队列研究。该研究于 2018 年 4 月 1 日至 2019 年 6 月 30 日在西班牙卡斯蒂利亚-莱昂社区的公共卫生系统中进行，包括 7 个高级生命支持单位和 5 家医院。纳入标准为年龄＞18 岁、在高级生命支持下被转至转诊医院的以急性中毒为主要院前诊断的患者。主要结局指标为急性中毒患者的院前和院内严重不良事件。
我们纳入了 221 例患者，中位年龄为 47 岁（四分位间距：33-61）。最常见的中毒原因是精神类药物（111 例，占 49.8%）：38 例（17.2%）患者发生严重不良事件，事件发生后 30 天内院内死亡率为 4.1%（9 例）。最终模型纳入了年龄≥65 岁（比值比[OR]：9.59，95%置信区间[CI]：3.48-26.45；p＜0.001）、氧饱和度/吸入氧分数指数≤300（OR：15.03，95%CI：5.74-39.33；p＜0.001）和床边乳酸≥4mmol/L（OR：7.68，95%CI：2.88-20.45；p＜0.001）。从这三个变量构建了中毒预警评分，每个变量赋值 1 分。评分的曲线下面积为 0.896（95%CI：0.82-0.96；p＜0.001）。
中毒预警评分可帮助决策，并促进在院前环境中识别高危急性中毒患者。
