A study to assess the utility of poison severity score, pseudocholinesterase levels and Glasgow coma scale in predicting severity and clinical outcome of organophosphorus poisoning

Nitin Bhat, Ramachandra Prabhu H. D., Adarsha Gopadi Krishna Bhat


Background: Suicides due to organophosphate self-poisoning is a major cause of concern world over. Organophosphate compounds (OP) possess a major cause of suicide in India.  There is a greater need for tools to predict severity of OP poisoning. We in this study try to assess the utility of the Glasgow coma scale (GCS), pseudocholinesterase levels and the poisoning severity score (PSS) in estimating severity and clinical prognosis of OP poisoning in patients of south India.

Methods: A prospective study was conducted over 2 years in department of medicine, KIMS hospital and research centre, patients who were >18 years of age were included. OP poisoning was determined by either history of consumption or clinical features. Pseudocholinesterase levels at admission, PPS and GCS scores were assessed at admission and at 24 hours. Clinical, demographical, and certain laboratory investigation were recorded. Patients were followed till the patient stayed in intensive care unit.

Results: In present study 100 patients were enrolled. Significant association was observed between GCS (p<0.001), PSS (p<0.001) and outcome of OP poisoning. Unexpectedly no significant association was observed with pseudocholinesterase level (p=0.118). A total of 83% patients were improved after treatment and mortality rate observed was 17%. Out of these 83% severe complications were observed in 14% of the patients.

Conclusions: The findings of this study highlight the usefulness of GCS and PSS systems for predicting severity of OP poisoning. Identification of severity at an early stage followed by prompt treatment can prevent deaths. Our study did not find any association between pseudocholinesterase levels at admission and severity of OP poisoning.


OP, Pseudocholinesterase, GCS, PSS

Full Text:



Organophosphate Toxicity, Practice Essentials, Background, Pathophysiology. Available from: Accessed on 2021 Jan 10.

Sam KG, Kondabolu K, Pati D, Kamath A, Pradeep Kumar G, Rao PGM. Poisoning severity score, APACHE II and GCS: Effective clinical indices for estimating severity and predicting outcome of acute organophosphorus and carbamate poisoning. J Forensic Legal Med. 2009;16(5):239-47.

Mew EJ, Padmanathan P, Konradsen F, Eddleston M, Sen CS, Phillips MR. The global burden of fatal self-poisoning with pesticides 2006-15: Systematic review. J Affective Disord. 2017;219;93-104.

Crime in India year. National Crime Records Bureau. 2014. Available from: Accessed on 2021 Jan 10.

Karalliedde L. Organophosphorus poisoning and anaesthesia. Anaesthesia. 1999;54(11):107388.

Persson HE, Sjöberg GK, Haines JA, Pronczuk de Garbino J. Poisoning severity score. Grading of acute poisoning. J Toxicol Clin Toxicol. 1998;36(3):205-13.

Davies JOJ, Eddleston M, Buckley NA. Predicting outcome in acute organophosphorus poisoning with a poison severity score or the Glasgow coma scale. QJM. 2008;101(5):371-9.

Eddleston M. Patterns and problems of deliberate self-poisoning in the developing world. QJM-Monthly J Asso Physicians. 2000;93(11):715-31.

Pawar KS, Bhoite RR, Pillay CP, Chavan SC, Malshikare DS, Garad SG. Continuous pralidoxime infusion versus repeated bolus injection to treat organophosphorus pesticide poisoning: a randomised controlled trial. Lancet. 2006;368(9553):2136-41.

Akdur O, Durukan P, Ozkan S, Avsarogullari L, Vardar A, Kavalci C et al. Poisoning severity score, Glasgow coma scale, corrected QT interval in acute organophosphate poisoning. Human Exp Toxicol. 2010;29(5):419-25.

Thunga G, Ganna Sam K, Khera K, Pandey S, Vidya Sagar S. Evaluation of incidence, clinical characteristics and management in organophosphorus poisoning patients in a tertiary care hospital. J Toxicol Environmental Health Sci. 2010;2(5):73-6.

Kar N. Lethality of suicidal organophosphorus poisoning in an Indian population: Exploring preventability. Ann General Psychiatry. 2006;5:17.

Kora SA, Doddamani GB, Halagali GR, Vijayamahantesh SN, Umakanth B. Sociodemographic profile of the organophosphorous poisoning cases in southern India. J clin diagnostic res. 2011;5(5):953-6.

Rao CS, Venkateswarlu V, Surender T, Eddleston M, Buckley NA. Pesticide poisoning in south India: Opportunities for prevention and improved medical management. Trop Med Int Health. Europe PMC Funders. 2005;10:581-8.

Banerjee I, Tripathi S, Roy AS. Clinico-epidemiological characteristics of patients presenting with organophosphorus poisoning. N Am J Med Sci. 2012;4(3):147.

Bilgin TE, Camdeviren H, Yapici D, Doruk N, Altunkan AA, Altunkan Z et al. The comparison of the efficacy of scoring systems in organophosphate poisoning. Toxicol Industrial Health. 2005;21(5-6):141-6.

Goswamy R, Chaudhuri A, Mahashur A. Study of respiratory failure in organophosphate and carbamate poisoning. Heart and lung. J critical care. 1994;23(6):466.

Hiremath P, Rangappa P, Jacob I, Rao K. Pseudocholinesterase as a predictor of mortality and morbidity in organophosphorus poisoning. Indian J Crit Care Med. 2016;20(10):601-4.

Aygun D, Doganay Z, Altintop L, Guven H, Onar M, Deniz T et al. Serum acetylcholinesterase and prognosis of acute organophosphate poisoning. Clin Toxicol. 2002;40(7):903-10.

Cherian M, Roshini C, Visalakshi J, Jeyaseelan L, Cherian A. Biochemical and clinical profile after organophosphorus poisoning--a placebo-controlled trial using pralidoxime. JAPI. 2005;53.

Nouira S, Abroug F, Elatrous S, Boujdaria R, Bouchoucha S. Prognostic value of serum cholinesterase in organophosphate poisoning. Chest. 1994;106(6):1811-4.

Casey PB. The prospective value of the IPCS/EC/EAPCCT poisoning severity score in cases of poisoning. J Toxicol Clin Toxicol. 1998:36:215-7.

Chan B, Gaudary P, Grattan-Smith TM, McNeil R. The use of Glasgow coma scale in poisoning. J Emerg Med. 1993;11:579-82.