Predicting the outcome in poisoned patients: look at the past!

Abstract

Introduction

When predicting future events, we often rely on analyzing past occurrences and projecting them forward. This methodology is crucial in various fields, including toxicology, in which predicting outcomes in poisoned patients plays a vital role in guiding treatment decisions and improving patient care.

Importance of predicting outcomes in poisoned patients

In cases of poisoning, understanding a patient’s medical history, current physiological status, and the toxicokinetics of the ingested substance is essential for predicting potential outcomes and determining appropriate interventions.

What to predict?

Predicting whether an intoxicated patient needs (further) treatment or even admission to the hospital is one of the most difficult decisions a clinician needs to make. The prediction of the course of an intoxication often lacks crucial information, leaving physicians with a sense of uncertainty in treating and advising patients. A significant source of this uncertainty stems from patients’ limited awareness of the specific chemical(s) causing their symptoms, making a targeted approach challenging. Adding to the complexity, both patients and physicians frequently lack knowledge of the exposure dose, onset time, and potential interactions, further complicating the prediction of symptom progression. Patients are commonly placed in observation wards until the pharmacodynamic effects have diminished, leading to extended observation periods and unnecessary healthcare utilization and costs. Therefore, a key objective of a predictive model is to determine the necessity for intensive care unit admission.

Predicting the requirement for admission to an intensive care unit

Factors such as age, Glasgow Coma Scale, and specific comorbidities like dysrhythmias and chronic respiratory insufficiency significantly influence the likelihood of intensive care unit admission. By examining a patient’s trajectory based on past medical history and organ function deterioration, clinicians can better anticipate the need for critical care support.

Enhancing prediction models for improved patient care

To enhance prediction models, leveraging modern methodologies like machine learning on large datasets (big data) are crucial. These advanced techniques can uncover previously unknown patient groups with similar outcomes or treatment responses, leading to more personalized and effective interventions. Regular updates to clustering, discrimination, and calibration processes ensure that predictive models remain accurate and relevant as new data emerges.

Conclusions

The field of clinical toxicology stands to benefit greatly from the creation and integration of large datasets to advance toxicological prognostication. By embracing innovative approaches and incorporating diverse data sources, clinicians can enhance their ability to predict outcomes in poisoned patients and improve overall patient management strategies.

Keywords:

• Intoxication
• outcome
• prediction
• modelling
• predictive value

Acknowledgement

This manuscript is based on a European Association of Poisons Centres and Clinical Toxicologists Fellows webinar that was broadcast in October 2023.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

Not applicable.

Additional information

Funding

This article and its authors did not receive external funding.