POISONING SEVERITY SCORE - GRADING OF ACUTE-POISONING

Background: A standardized and generally applicable scheme for grading the severity of poisoning allows a qualitative evaluation of morbidit y and facilitates comparability of data. Working from a simple grading scale proposed by the European Association of Poisons Centres and Cli nical Toxicologists, a Poisoning Severity Score has been developed joi ntly with the International Programme on Chemical Safety and the Europ ean Commission. Methods: The Poisoning Severity Score has been elabora ted, tested, and gradually revised during a project running 1991-1994. Fourteen poisons centers from various countries have participated. Ea ch center independently graded 371 cases of acute poisoning by ten dif ferent toxic agents. The data were then analyzed and compared. Results : The concordance in grading the severity increased during the study p eriod, and in the last phase there was an acceptable concordance among centers in 80% or more of the cases. Given the condition and quality of the original case records, this result was considered satisfactory and agreement was reached on the scoring scheme presented here. The Po isoning Severity Score grades severity as (0) none, (1) minor, (2) mod erate, (3) severe, and (4) fatal poisoning. It is intended to be an ov erall evaluation of the case, taking into account the most severe clin ical features. Use of the Poisoning Severity Score normally requires a follow-up of all cases, but may be used on admission or other times d uring the course of poisoning if this is dearly stated when data are p resented. Conclusions: A Poisoning Severity Score has been developed a nd found applicable for grading the severity of poisoning. It is fores een that the Poisoning Severity Score will meet the expectations and b e used in practice, but its future use and evaluation may result in so me further revision and refinement.