Predicting In-Hospital Outcomes in Acute Organophosphorus Poisoning: A Comparative Study of the POP Scale and Glasgow Coma Scale at Rajshahi Medical College Hospital

Abstract

Background: Organophosphorus (OP) pesticide poisoning is a critical public health issue, particularly in rural Asia, contributing to a significant proportion of self-harm-related deaths. The Peradeniya Organophosphorus Poisoning (POP) scale and the Glasgow Coma Scale (GCS) are clinical tools that may aid in predicting patient outcomes in resource-limited settings. Aim: This study aimed to assess and compare the predictive value of the POP scale and GCS for in-hospital outcomes of acute OP poisoning patients at Rajshahi Medical College Hospital, Bangladesh. Methods: This prospective observational study included 200 patients with acute OP poisoning admitted to the Department of Medicine at Rajshahi Medical College from January to December 2021. Patients were evaluated using the POP scale and GCS at admission. Clinical management included standard atropine and pralidoxime protocols, with continuous monitoring for complications such as respiratory failure and seizures. The primary outcome measure was in-hospital mortality. Data was analyzed using SPSS version 26, with predictive accuracy evaluated through ROC and AUC analyses. Results: The study population had a mean age of 27.1 ± 12.8 years, with 57% males and 82% from rural areas. Suicidal intent accounted for 94% of poisoning cases. The overall in-hospital mortality rate was 14%, with seizure (19%) and respiratory failure (18%) as the predominant complications. There was a strong association between higher severity scores on the POP scale and GCS and increased mortality (p < 0.001). The POP scale showed an AUC of 0.934 (sensitivity 96.4%, specificity 80%), while the GCS demonstrated an AUC of 0.948 (sensitivity 100%, specificity 84%). Conclusion: Both the POP scale and GCS are valuable tools for predicting in-hospital outcomes in OP poisoning.