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

Abstract

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.

Keywords

• Aluminum phosphide
• toxicology
• mortality
• prognostic factors