UMEM Educational Pearls

Category: Toxicology

Title: Clinical severity score for acute poisoned patients ICU requirement score (IRS)

Keywords: ICU requirement score, physiologic score system (PubMed Search)

Posted: 8/19/2021 by Hong Kim, MD, MPH (Updated: 8/20/2021)
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There are several clinical scoring systems (SAPS II, SAPS III, SOFA, etc.) to assess the severity and/or risk of mortality in critically ill patients. However, the routinely used physiologic scoring systems are not always suitable for poisoned patient. 

ICU requirement score (IRS) has been recently developed by investigators from Europe and a validation study (retrospective cohort) has been performed.

ICU requirement score (IRS) components (see inserted table)

  • Age
  • Systolic blood pressure
  • Heart rate
  • GCS
  • Type of intoxication
  • Comorbidities (dysrhythmia, cirrhosis, and/or respiratory insufficiency, secondary diagnosis requiring ICU admission)

Retrospective cohort 

  • Study duration: Jan 1, 2009 to Dec 31 ,2019
  • Positive IRS score: >= 6
  • Comparison to SAPS II, SAPS III, SOFA score, and PSS
  • End point: need for ICU treatment

Results

N=1503

Area under the curve for IRS ROC: 0.736 (95% CI: 0.702-0.770)

IRS <6

  • Negative predictive value: 95% (95% CI: 93-97)
  • Positive predictive value: 21% (95% CI: 18-24)
  • Sensitivity: 89% (95% CI: 85-93)
  • Specificity: 38% (95% CI:36-41)

Conclusion

  • IRS of < 6 demonstrated excellent negative predictive value for ICU admission.
  • A larger study of ICU requirement score will be needed to further assess its usefulness/limitation prior to clinical use.  

References

  1. Brandenburg R et al. The need for ICU admission in intoxicated patients: a predition model. Clin Toxicol  (Phila) 2017. https://doi.org/10.1080/15563650.2016.1222616
  2. El Gharbi F. et al. Does the ICU requirment score allow the poisoned patient to be safely managed without admission to the intensive care unit? - a validation cohort study. Clin Toxicol (Phila) 2021. https://doi.org/10.1080/15563650.2021.1961145

Attachments

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