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

Autori
Bond, Randall G. ; Pieche, Sergio ; Sonicki, Zdenko ; Gamaluddin, Hany ; El Guindi, Mahmoud ; Sakr, Mahmoud ; El Seddawy, Amir ; Abouzaid, Mohammed ; Youssef, Ahmad

Izvornik
Annals of emergency medicine (0196-0644) 52 (2008), 6; 617-622

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, članak, znanstveni

Ključne riječi
organophosphate; carbamate; insecticide; pediatric; poisoning; clinical decision aid

Sažetak
Unintentional pediatric exposure to insecticides is common in developing countries. A clinical decision aid could guide early triage decisionmaking. 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. 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). 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.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti, Javno zdravstvo i zdravstvena zaštita

POVEZANOST RADA