A Clinical Decision Aid for Triage of Children Younger Than 5 Years and With Organophosphate or Carbamate Insecticide Exposure in Developing Countries

• Published in: Annals of emergency medicine 2008-12, Vol.52 (6), p.617-622
• Main Authors: Bond, G. Randall, MD, Pièche, Sergio, MD, Sonicki, Zdenko, MD, PhD, Gamaluddin, Hany, MD, El Guindi, Mahmoud, MD, Sakr, Mahmoud, MD, El Seddawy, Amir, MD, Abouzaid, Mohammed, MD, Youssef, Ahmad, MBBCH
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Atropine - therapeutic use; Biological and medical sciences; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Carbamates - poisoning; Child, Preschool; Cholinesterase Reactivators - therapeutic use; Decision Making; Developing Countries; Egypt; Emergency; Environmental Exposure - adverse effects; Female; Humans; Infant; Insecticides - poisoning; Intensive care medicine; Male; Medical sciences; Muscarinic Antagonists - therapeutic use; Obidoxime Chloride - therapeutic use; Organophosphate Poisoning; Poison Control Centers - statistics & numerical data; Poisoning - classification; Poisoning - diagnosis; Poisoning - drug therapy; Prospective Studies; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Triage
• ISSN: 0196-0644; 1097-6760
• DOI: 10.1016/j.annemergmed.2008.03.026

Study objective Unintentional pediatric exposure to insecticides is common in developing countries. A clinical decision aid could guide early triage decisionmaking. Methods Study design was prospective observational data collection in a specialty poisoning hospital in Cairo, Egypt. Patients were children 2 months to 59 months of age, without pretreatment, presenting within 2 hours of an exposure to an organophosphate or carbamate insecticide. A resource-requiring course was defined as any occurrence of hypoxia, use of atropine or obidoxime, use of ICU care, or death. The goal of analysis was derivation of a clinical decision aid to predict a resource-requiring course with 100% sensitivity. Results During the 21-month study, 197 children 2 months to 59 months of age exposed to an organophosphate or carbamate insecticide were treated at the center. One hundred two of these children met the study inclusion criteria: 95 had parental consent and completed the study observation period of which 65 used resources (4 died). All patients who ultimately met resource-requiring criteria initially did so at arrival. Pinpoint pupil alone identified 63 of 65 of these patients yet wrongly identified only 5 of 30 minimally ill patients. Pinpoint pupil or diarrhea identified 65 of 65 patients with a resource-requiring course while identifying 7 of 30 patients with a non–resource-requiring course (sensitivity 1.00; 95% confidence interval 0.95 to 1.00; specificity 0.77; 95% confidence interval 0.58 to 0.90). Conclusion Using 2 features, pinpoint pupils and diarrhea, we identified at presentation all patients who ultimately had a course using medications or advanced resources. According to this preliminary study, symptoms occur rapidly, so using an early triage aid may be feasible. A validation study is necessary.