Examining the effectiveness of prognostic scoring systems and mortality predictors in aluminum phosphide poisoning: insights from emergency department settings

Submitted: 10 April 2024
Accepted: 16 July 2024
Published: 23 July 2024
Abstract Views: 605
PDF: 246
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Aluminum Phosphide (AlP), a potent rodenticide and fumigant pesticide, poses a significant health threat, especially in agricultural communities. This study aimed to investigate demographic trends and predictive factors influencing outcomes in AlP poisoning patients presenting to the Emergency Department (ED). With an alarming mortality rate of 80.4%, identifying predictors of mortality became imperative. Non-survivors tended to be older and presented with distinct vital signs, such as tachycardia and shock upon ED arrival. Prognostic scoring systems like the Modified Early Warning Score (MEWS), Shock Index (SI), Mean Arterial Pressure (MAP), Glasgow Coma Scale (GCS), and serum lactate emerged as robust mortality predictors, with good accuracy (Area Under the Curve, AUC, MEWS=0.904, SI=0.914, MAP=0.869, GCS=0.829, lactate=0.962). This study favors integrating these predictors into routine ED practices, particularly in Low- and Middle-Income Countries (LMICs), to prognosticate and enhance management outcomes in patients with AlP poisoning, offering essential guidance for emergency physicians.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Mew EJ, Padmanathan P, Konradsen F, et al. The global burden of fatal self‑poisoning with pesticides 2006‑15: systematic review. J Affect Disord 2017;219:93‑104. DOI: https://doi.org/10.1016/j.jad.2017.05.002
Chugh SN, Dushayant K, Ram S, Arora B. Incidence and outcome of aluminium phosphide poisoning in a hospital study. Indian J Med Res 1991;94:232-5.
Singh D, Jit I, Tyagi S. Changing trends in acute poisoning in chandigarh zone: a 25-year autopsy experience from a tertiary care hospital in Northern India. Am J Forensic Med Pathol 1999;20:203-10. DOI: https://doi.org/10.1097/00000433-199906000-00019
Mehrpour O, Jafarzadeh M, Abdollahi M. A systematic review of aluminium phosphide poisoning. Arch Ind Hyg Toxicol 2012;63:61-73. DOI: https://doi.org/10.2478/10004-1254-63-2012-2182
Wahab A, Zaheer M, Wahab S, Khan R. Acute aluminium phosphide poisoning: an update. Hong Kong J Emerg Med. 2008;15:152-5. DOI: https://doi.org/10.1177/102490790801500306
Thundiyil JG, Stober J, Besbelli N, Pronczuk J. Acute pesticide poisoning: a proposed classification tool. Bull World Health Organ 86:205-9. DOI: https://doi.org/10.2471/BLT.08.041814
Anand R, Binukumar BK, Gill KD. Aluminum phosphide poisoning: an unsolved riddle. J Appl Toxicol 2011;31:499‑505. DOI: https://doi.org/10.1002/jat.1692
Chefurka W, Kashi KP, Bond EJ. The effect of phosphine (gas toxic to insects) on electron transport in mitochondria. Pestic Biochem Physiol 1976;6:65-84. DOI: https://doi.org/10.1016/0048-3575(76)90010-9
Villa‑Manzano AI, Zamora‑Lopez XX, Huerta‑Viera M, et al. Mortality and factors associated with phosphide poisoning: prospective cohort study. Rev Med Inst Mex Seguro Soc 2019;57:156‑61.
Ghonem MM, Abdelnoor AA, Hodeib AA. Shock and modified shock indices in predicting poisoning severity and outcomes in acute aluminum phosphide poisoned patients. Toxicol Res 2023;13:124-8. DOI: https://doi.org/10.1093/toxres/tfad124
Gurjar M, Baronia AK, Azim A, Sharma K. Managing aluminum phosphide poisonings. J Emerg Trauma Shock 2011;4:378-84. DOI: https://doi.org/10.4103/0974-2700.83868
Aggarwal N, Sawlani KK, Chaudhary SC, et al. Study of pattern and outcome of acute poisoning cases at tertiary care hospital in North India. J Family Med Prim Care 2023;12:2047-52. DOI: https://doi.org/10.4103/jfmpc.jfmpc_592_23
Senapati RE, Jena S, Parida J, et al. The patterns, trends and major risk factors of suicide among Indian adolescents - a scoping review. BMC Psychiatry 2024;24:35. DOI: https://doi.org/10.1186/s12888-023-05447-8
Boedeker W, Watts M, Clausing P, Marquez E. The global distribution of acute unintentional pesticide poisoning: estimations based on a systematic review. BMC Public Health 2020;20:1875. DOI: https://doi.org/10.1186/s12889-020-09939-0
Sandhu N. Dynamics of banks' lending practices to farmers in India. J Small Business Enterprise Develop 2020;28:102-20. DOI: https://doi.org/10.1108/JSBED-05-2019-0161
Moeis FR, Dartanto T, Moeis JP, Ikhsan M. A longitudinal study of agriculture households in Indonesia: the effect of land and labor mobility on welfare and poverty dynamics. World Dev Perspect 2020;20:100261. DOI: https://doi.org/10.1016/j.wdp.2020.100261
Sheta AA, El-Banna AS, Elmeguid RA, et al. A study of the predictive factors of mortality in acute poisoning with aluminum phosphide with special reference to echocardiography and SOFA score. Environ Sci Pollut Res Int 2019;26:33135-45. DOI: https://doi.org/10.1007/s11356-019-06457-4
Singh M, Shekhar C, Shri N. Patterns in age at first marriage and its determinants in India: a historical perspective of last 30 years (1992-2021). SSM Popul Health 2023;22:101363. DOI: https://doi.org/10.1016/j.ssmph.2023.101363
Anbalagan LC, Pannu AK, Bhalla A, et al. Prognostic significance of poison-related factors and consumption patterns in acute aluminum phosphide poisoning. Turk J Emerg Med 2023;23:88-95. DOI: https://doi.org/10.4103/tjem.tjem_253_22
Farzaneh E, Ghobadi H, Akbarifard M, et al. Prognostic factors in acute aluminium phosphide poisoning: a risk-prediction nomogram approach. Basic Clin Pharmacol Toxicol 2018;123:347-55. DOI: https://doi.org/10.1111/bcpt.13005
Mathai A, Bhanu MS. Acute aluminium phosphide poisoning: can we predict mortality? Indian J Anaesth 2010;54:302-7. DOI: https://doi.org/10.4103/0019-5049.68372
Shakeri K, Jafari M, Khankeh H, Seyedin H. history and structure of the fourth leading emergency medical service in the world; a review Article. Arch Acad Emerg Med 2019;7:e17
Hajouji Idrissi M, Oualili L, Abidi K, et al. Severity factors of aluminium phosphide poisoning (Phostoxin). Ann Fr Anesth Reanim 2006;25:382-5. DOI: https://doi.org/10.1016/j.annfar.2005.12.004

How to Cite

Vijay Kumar, S. S., Shekhli, S., & Jose, A. (2024). Examining the effectiveness of prognostic scoring systems and mortality predictors in aluminum phosphide poisoning: insights from emergency department settings. Emergency Care Journal, 20(3). https://doi.org/10.4081/ecj.2024.12557