The Poisoning Severity Score was developed in Europe to grade the findings in a person with acute poisoning. It is somewhat long but it is fairly complete and provides an organized approach to patient evaluation.
Systems evaluated:
(1) gastrointestinal tract
(2) respiratory tract
(3) cardiovascular system
(4) nervous system
(5) local symptoms
(6) kidney
(7) liver
(8) metabolic
(9) hematologic system
(10) muscular system
Severity grades:
(1) grade 1: mild
(2) grade 2: moderate
(3) grade 3: severe
(4) grade 4: fatal
Gastrointestinal Tract
Parameter |
Grade 1 |
Grade 2 |
Grade 3 |
---|---|---|---|
symptoms |
vomiting diarrhea abdominal pain oral ulcers
|
prolonged vomiting prolonged diarrhea severe abdominal pain ileus dysphagia |
severe dysphagia massive hemorrhage perforation |
endoscopy |
erythema edema |
transmucosal ulcerations |
extensive and circumferential ulcerations perforation |
burn |
first degree oral irritation |
first degree over large area focal 2° or 3° |
extensive 2° or 3° |
Respiratory Tract
Parameter |
Grade 1 |
Grade 2 |
Grade 3 |
---|---|---|---|
symptoms |
mild irritation mild cough |
prolonged cough
|
|
respiratory function |
breathlessness, mild dyspnea |
dyspnea hypoxemia requiring oxygen |
respiratory insufficiency |
bronchospasm |
mild |
moderate |
severe |
other |
|
stridor |
glottal edema pulmonary edema ARDS airway obstruction pneumonia pneumonitis pneumothorax |
chest X-ray |
abnormal with no or minor symptoms |
abnormal with moderate symptoms |
abnormal with severe symptoms |
Cardiovascular System
Parameter |
Grade 1 |
Grade 2 |
Grade 3 |
---|---|---|---|
sinus bradycardia (beats/minute) |
|
80 - 90 neonates 60 - 80 infants 40 - 50 adults |
< 80 neonates < 60 infants < 40 adults |
sinus tachycardia (beats/minute) |
|
160-200 neonates 160-190 infants or children 140-180 adults |
> 200 neonates > 190 infants or children > 180 adults |
arrhythmias |
isolate extrasystole |
frequent extrasystoles atrial flutter or fibrillation 1° or 2° AV block prolonged QRS prolonged QTc repolarization |
life threatening ventricular arrhythmias 3° AV block asystole |
hypotension |
mild and transient |
moderate |
shock |
hypertension |
mild and transient |
moderate |
hypertensive crisis |
perfusion |
|
ischemia |
infarction |
Nervous System
Parameter |
Grade 1 |
Grade 2 |
Grade 3 |
---|---|---|---|
function |
drowsy ataxia vertigo |
unconscious but responds to pain |
coma with inappropriate or no response to pain |
respiratory |
|
apnea, bradypnea |
respiratory depression |
activity |
restless |
confusion agitation hallucinations delirium |
extreme agitation |
seizures |
|
infrequent, local |
frequent, generalized status epilepticus opisthotonus |
extrapyramidal symptoms |
mild |
pronounced |
|
cholinergic or anticholinergic symptoms |
mild |
pronounced |
|
peripheral nerves |
paresthesias |
localized paralysis |
generalized paralysis paralysis vital function |
vision |
mild disturbances |
moderate |
blind |
auditory function |
mild disturbances |
moderate |
deaf |
Local Symptoms
Parameter |
Grade 1 |
Grade 2 |
Grade 3 |
---|---|---|---|
skin |
irritation first degree burn second degree < 10% BSA |
second degree 10-50% BSA in adult second degree 10-30% in child third degree <= 2% BSA |
second degree > 50% in adult second degree > 30% in child third degree > 2% BSA |
eyes |
irritation redness lacrimation mild palpebral edema |
intense irritation |
|
cornea |
|
corneal abrasion minor ulcer |
ulceration perforation permanent damage |
reaction to bites and stings |
mild itching |
moderate local necrosis |
extreme extensive necrosis |
swelling from bites and stings |
local |
whole limb |
whole limb and significant adjacent areas critical location (airway) |
Kidney
Parameter |
Grade 1 |
Grade 2 |
Grade 3 |
---|---|---|---|
proteinuria |
minimal |
massive |
|
hematuria |
minimal |
massive |
|
serum creatinine |
(see below) |
200- 500 µmol/L (2.26 - 5.66 mg/dL) |
> 500 µmol/L (> 5.55 mg/dL) |
function |
|
oliguria polyuria |
anuria |
where:
• No value is given for serum creatinine in Grade 1; could use 133 - 199 µmol/L (1.5 to 2.25 mg/dL).
Liver
Parameter |
Grade 1 |
Grade 2 |
Grade 3 |
---|---|---|---|
AST |
2 - 5 times upper limit of normal |
5 - 50 times |
> 50 times |
ALT |
2 - 5 times upper limit of normal |
5 - 50 times |
> 50 times |
other |
|
|
clinical failure; biochemical failure (elevated ammonia, coagulopathy) |
Metabolic
Parameter |
Grade 1 |
Grade 2 |
Grade 3 |
---|---|---|---|
acid base disorder |
mild |
moderate |
severe |
pH |
7.25 - 7.32 7.50 - 7.59 |
7.15 - 7.24 7.60 - 7.69 |
< 7.15 > 7.7 |
bicarbonate in mEq/L |
15 - 20 mEq/L 30 - 40 |
10 - 14 > 40 |
< 10
|
fluid and electrolyte abnormality |
mild |
moderate |
severe |
potassium |
3.0 - 4.0 mEq/L 5.2 - 5.9 |
2.5 - 2.9 6.0 - 6.9 |
< 2.5 > 7.0 |
hypoglycemia |
mild (50- 70 mg/dL in adult) |
moderate (30 - 50 mg/dL in adult) |
severe (< 30 mg/dL in adult) |
hyperthermia |
brief |
longer |
dangerous |
hypothermia |
|
|
dangerous |
Hematologic System
Parameter |
Grade 1 |
Grade 2 |
Grade 3 |
---|---|---|---|
hemolysis |
mild |
moderate |
massive |
methemo-globinemia |
mild (10-30%) |
30 - 50% |
> 50% |
coagulopathy |
|
present without bleeding |
present with bleeding |
cytopenias |
|
anemia leukopenia thrombocytopenia (TCP) |
severe anemia severe leukopenia severe TCP |
Muscular System
Parameter |
Grade 1 |
Grade 2 |
Grade 3 |
---|---|---|---|
muscle pain |
mild |
moderate |
intense |
muscle symptoms |
tenderness |
rigidity cramping fasciculations |
extreme rigidity extreme cramping extensive fasciculations compartment syndrome |
muscle damage |
|
rhabdomyolysis |
rhabdomyolysis with complications |
CK |
250 - 1,500 IU/L |
1,500 - 10,000 IU/L |
> 10,000 IU/L |
Purpose: To use the Poisoning Severity Score to grade the severity of an acute poisoning.
Specialty: Toxicology, Emergency Medicine, Critical Care
Objective: severity, prognosis, stage, adverse effects
ICD-10: T36-T50,