The Prognostic Value of Admission AVPU and Glasgow Coma Scales in Acute Drug Poisoning Patients

Abstract

Background: Glasgow coma scale (GCS) was originally designed to be used in standardizing the assessment of conscious level in head trauma patients. However, GCS is now widely used in emergency departments as an indicator of the CNS status in patients regardless of their primary etiology. Alongside with GCS, AVPU scale (an acronym from “alert, verbal, painful and unresponsive”) is a simpler system which can be used to measure and record a patient’s level of consciousness. Therefore, the study investigated the values of admission GCS and AVPU as outcome predictor in mixed poisoned patients. Method: A retrospective study in toxicology unit was performed on patients presented with mixed poisoning. Outcomes were recorded as patient necessity of GI decontamination, length of neurology observation and the length of hospital stay in toxicology unit. Results: There was longer duration of hospital stay in toxicology unit and requirement of neurology observation in patients presented with lower GCS score (whether using cut-off point at 13 or 8). Similar findings were observed in AVPU scale analysis. Majority of patients did not require GI decontamination in both GCS score and AVPU analysis. However, it did not show any statistical significance (P > 0.05) in both group analyses. Conclusion: Admission GCS score and AVPU scale both are not good indicators to predict severity in acute mixed poisoning patients. However, the use of AVPU scale may not be inferior to the use of GCS score in assessing acute poisoning patients.