Acute poisoning is a significant health issue that leads to considerable morbidities and mortalities. Early diagnosis, assessment of severity and prompt care in the emergency department and intensive care unit are crucial to minimize hospital morbidity and mortality and allocate health care resources. Scoring systems are used commonly in medical practice to support clinical decision-making. Consequently, we aimed to compare different scoring systems (PSS, APACHE II, REMS and NEWS2) in prediction of mortality in acute poisoning.

This prospective observational study was conducted on 260 acutely poisoned patients admitted to the intensive care unit (ICU) of the Poison Control Center of Ain Shams University Hospitals from January 2021 to June 2021. We assessed their condition using APACHE II, PSS, NEWS 2, and REMS scores within the first 24hours.

Suicidal poisoning occurred in 182 patients (70%) while 47 patients (18.1%) were considered as drug abusers. Oral route was the main route of poisoning followed by inhalation. Centrally acting drugs were the commonest toxic agents accounting for 30.8% of all cases followed by insecticides representing 25.8% of all cases. Only 54 patients (20.8%) needed mechanical ventilation. Overall in-hospital mortality was 14.2% and insecticides carried more than four times risk of death than other toxic agents (odds ratio 4.7). All the studied scores in all patients were significantly lower in survivors compared to non-survivors (P<0.05). APACHE II and PSS had higher discrimination power to predict mortality (AUC=0.802 at 10 points, and AUC=0.89 at 2 points, respectively) than NEWS2 and REMS (AUC=0.628 at 10 points, and AUC=0.781 at 7 points, respectively).

Toxicological exposures are a significant cause of morbidity and mortality necessitating ICU admission with mortality rate of 14.2%. Centrally acting drugs and insecticides were the most commonly reported toxic agents. Poisoning with insecticides carried more than four times risk of death. APACHE II and PSS are simple tools and good prognostic markers to predict mortality in acutely poisoned patients.