Organo Phosphorus Poisoning: Prognostic Value of GCS Score & Other Clinical Indicators in Assessing the Final Outcome

Organophosphorous [OP] poisoning has an important effect on community health. In Central India, in Vidarbha region of Maharashtra, large number of intentional Insecticidal or OP self-poisoning is common amongst farmers due debt ridden or natural calamities. In agriculturally dominant parts its accidental poisoning is also frequently encountered in clinical practice. The mortality rate in Central India due to OP poisoning is 15–30%. The present study was conceived to know, demographic profile of OP poisoning and the role of clinical indices in predicting the outcome. In the study, 106 cases of OP poisoning were analyzed and it was found that OP poisoning was more common in males; particularly in the age group of 21–30 years and that the manner of poisoning is commonly suicidal, through oral route, along with stray cases of accidental exposure during handling or spraying in the fields.

Clinical parameters were determined immediately after admission to the hospital prior to any treatment. In the present study, GCS was found to have a good co-relation with the outcome of the patients. Another clinical indicator, APACHE II, [Acute Physiological and Chronic Health Evaluation] also had a definite role in predicting the outcome; however GCS score was found to be better in terms of specificity and sensitivity, as measured by ROC curve. In addition, GCS scoring, particularly in primary and secondary health care situations, is more feasible in terms of its simplicity as against the elaborate and time consuming assessment required for determination of APACHE II score.

In view of the above, it was clear that GCS score, as a clinical indicator, can predict the outcome better than APACHE II. GCS scoring system, is simpler and less time consuming yet equally specific and sensitive, can be preferred above the APACHE II. The examination of GCS can help the clinicians to screen the patients according to the severity of poisoning and plan the treatment and referral modalities based upon the scoring pattern. Early clinical decision making with GCS shall ensure better outcome and reduce the mortality to a considerable level. The results of the study can be availed for ensuring effective clinical management and development of evidence based protocol for effective clinical decision making.