ICU Admission Score of Brandenburg et al for an Intoxicated/Poisoned Patient

Description

Brandenburg et al reported a score to help in the decision whether to admit an intoxicated or poisoned patient to the intensive care unit (ICU). This can help to reduce unnecessary admission. The authors are from University of Utrecht, University of Amsterdam and the Dutch National Poisons Information Centre.

Patient selection: intoxicated or poisoned

Parameters:

(1) age in years

(2) systolic blood pressure in mm Hg

(3) heart rate in beats per minute

(4) Glasgow coma score (GCS)

(5) intoxication type

(6) second diagnosis (presence of another diagnosis requiring ICU admission)

(7) cirrhosis

(8) dysrhythmia

(9) respiratory insufficiency

Parameter	Finding	Points
age in years	< 25 years	0
	25 to 34.99 years	2
	35 to 44.99 years	4
	45 to 54.99 years	6
	55 to 64.99 years	8
	>=65 years	10
systolic blood pressure	>= 140	-3
	130 to 139	-1
	120 to 129	0
	110 to 119	1
	100 to 109	2
	< 100	4
heart rate	< 75	0
	75 to 84	1
	85 to 94	2
	95 to 104	3
	>= 105	4
GCS	14 or 15	0
	9 to 13	3
	6 to 8	7
	< 6	9
intoxication type	carbon monoxide, arsenic, cyanide	-6
	alcohol	-5
	sedative	-1
	antidepressant	0
	analgesic, street drug	1
	toxins not otherwise specified	2
second diagnosis	no	0
	yes	7
cirrhosis	no	0
	yes	7
dysthythmia	no	0
	yes	5
respiratory insufficiency	no	0
	yes	8

where:

• The original table shows overlap in ranges for several of the parameters.

total score =

= SUM(points for all 9 parameters)

Interpretation:

• minimum score: -9

• maximum score: 56 (paper says 54)

• A score >= 6 was proposed for admission of a patient to the ICU.

Indicators for ICU admission:

(1) age > 55 years

(2) GCS < 6

(3) respiratory insufficiency

(4) another diagnosis requiring ICU admission

Performance:

• The score had a sensitivity of 93% and specificity of 36%.

• The negative predictive value at the cutoff is 98.7%.

• The maximum Youden index if for a score >=12.

• The maximum negative predictive value is for a score >=3.

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ICU Admission Score of Brandenburg et al for an Intoxicated/Poisoned Patient

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