Development and validation of a novel poisoning agitation-sedation score for predicting the need for endotracheal intubation and mechanical ventilation in acutely poisoned patients with disturbed consciousness.

Soha A Abd Elghany, Heba I Lashin, Ghada N El-Sarnagawy, Merfat M Oreby, Eman Soliman
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Abstract

Background: Accurate assessment of disturbed consciousness level (DCL) is crucial for predicting acutely poisoned patients' outcomes.

Aim: Development of a novel Poisoning Agitation-Sedation Score (PASS) to predict the need for endotracheal intubation (ETI) and mechanical ventilation (MV) in acutely poisoned patients with DCL. Validation of the proposed score on a new set of acutely poisoned patients with DCL.

Methods: This study was conducted on 187 acutely poisoned patients with DCL admitted to hospital from June 2020 to November 2021 (Derivation cohort). Patients' demographics, toxicological data, neurological examination, calculation of the Glasgow Coma Scale (GCS), Full Outline of Unresponsiveness (FOUR) score, Richmond Agitation-Sedation Scale (RASS), and outcomes were gathered for developing a new score. The proposed score was externally validated on 100 acutely poisoned patients with DCL (Validation cohort).

Results: The PASS assessing sedation consists of FOUR (reflexes and respiration) and GCS (motor) and provides a significantly excellent predictive power (AUC = 0.975) at a cutoff ≤9 with 100% sensitivity and 92.11% specificity for predicting the need for ETI and MV in sedated patients. Additionally, adding RASS (agitation) to the previous model exhibits significantly good predictive power (AUC = 0.893), 90.32% sensitivity, and 73.68% specificity at a cutoff ≤14 for predicting the need for ETI and MV in disturbed consciousness patients with agitation.

Conclusion: The proposed PASS could be an excellent, valid and feasible tool to predict the need for ETI and MV in acutely poisoned disturbed consciousness patients with or without agitation.

开发并验证用于预测意识障碍的急性中毒患者是否需要气管插管和机械通气的新型中毒躁动-镇静评分。
背景:准确评估意识障碍程度(DCL)对于预测急性中毒患者的预后至关重要:准确评估意识障碍水平(DCL)对于预测急性中毒患者的预后至关重要。目的:开发一种新的中毒躁动-镇静评分(PASS),用于预测急性中毒且意识障碍水平较高的患者是否需要进行气管插管(ETI)和机械通气(MV)。在一组新的急性中毒的 DCL 患者身上验证提议的评分:本研究针对 2020 年 6 月至 2021 年 11 月期间入院的 187 名急性中毒的 DCL 患者(衍生队列)。研究收集了患者的人口统计学特征、毒理学数据、神经学检查、格拉斯哥昏迷量表(GCS)计算、反应迟钝评分(FOUR)、里士满躁动-镇静量表(RASS)和结果,以制定新的评分标准。对 100 名急性中毒的 DCL 患者(验证队列)进行了外部验证:结果:评估镇静的 PASS 由 FOUR(反射和呼吸)和 GCS(运动)组成,在临界值≤9 时具有极佳的预测能力(AUC = 0.975),在预测镇静患者是否需要 ETI 和 MV 方面具有 100% 的灵敏度和 92.11% 的特异性。此外,将 RASS(躁动)添加到之前的模型中,可显示出明显良好的预测能力(AUC = 0.893)、90.32% 的灵敏度和 73.68% 的特异性,其临界值≤14,可预测意识障碍伴躁动患者是否需要 ETI 和 MV:结论:拟议的 PASS 是预测急性中毒意识障碍患者是否需要 ETI 和 MV 的有效、可行的工具。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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