The Prospective Value of the IPCS/EC/EAPCCT Poisoning Severity Score in Cases of Poisoning

Abstract

Introduction: The poisoning severity score is a four-point severity-classification scale, developed by the International Programme on Chemical Safety, the Commission of the European Union, and the European Association of Poison Centres and Clinical Toxicologists (IPCS/EC/EAPCCT), for the retrospective assessment of cases of poisoning reported to poisons information centers. Objectives: The aims of this study were to test the validity of using the poisoning severity score obtained at initial referral to assess clinical severity and the likelihood of subsequent deterioration, to select cases for follow-up, and also to determine the need for referral to a clinical toxicologist. Methods; The poisoning severity score was determined at the time of initial inquiry. Follow-up was then undertaken until either the patient was discharged from medical attention or died. A second poisoning severity score was then calculated taking note of the most severe features present after the initial inquiry. Results; Of 718 consecutive telephone inquiries, 397 were given an initial poisoning severity score of 0 (no signs and symptoms), 225 a score of 1 (mild symptoms), 71 a score of 2 (moderate symptoms), and 25 a score of 3 (severe symptoms). Follow-up data are available only in 638 cases because the patient or referring doctor could not be traced in 80 instances. Of the 638 cases, 41 deteriorated; 31 of these were graded initially as poisoning severity score 0, four as 1, and six as 2. Five patients died (two with an initial score of 2 and three with an initial score of 3). Conclusions: This study demonstrates that it is useful to score telephone inquiries to a poisons information service at initial referral with the poisoning severity score. First, the poisoning severity score is helpful in assessing accurately the clinical severity and the likelihood of further deterioration. Second, the poisoning severity score is useful in determining the need for referral of the inquiry to a clinical toxicologist, thus ensuring that more serious and complicated cases of poisoning receive expert medical advice on management. Third, the poisoning severity score is helpful in selecting those cases which warrant follow-up for medical and epidemiological reasons.