A clinical decision aid for triage of children younger than 5 years and with organophosphate or carbamate insecticide exposure in developing countries.
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).


CONCLUSIONS
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.
Drug and Poison Information Center, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA. randall.bond@cchmc.org
G Randall
GR
Bond
Sergio
S
Pièche
Zdenko
Z
Sonicki
Hany
H
Gamaluddin
Mahmoud
M
El Guindi
Mahmoud
M
Sakr
Amir
A
El Seddawy
Mohammed
M
Abouzaid
Ahmad
A
Youssef
D001285:Atropine / Q000627:therapeutic use*; D002219:Carbamates / Q000506:poisoning*; D002675:Child, Preschool; D002801:Cholinesterase Reactivators / Q000627:therapeutic use*; D003657:Decision Making; D003906:Developing Countries; D004534:Egypt; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007223:Infant; D007306:Insecticides / Q000506:poisoning*; D008297:Male; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D009768:Obidoxime Chloride / Q000627:therapeutic use*; D062025:Organophosphate Poisoning; D011039:Poison Control Centers / Q000706:statistics & numerical data*; D011041:Poisoning / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy*; D011446:Prospective Studies; D014218:Triage
D002219:Carbamates; D002801:Cholinesterase Reactivators; D007306:Insecticides; D018727:Muscarinic Antagonists; D009768:Obidoxime Chloride; D001285:Atropine