Assessment of rehabilitation treatment for patients with acute poisoning-induced toxic encephalopathy

doi:10.5847/wjem.j.1920-8642.2024.095

Abstract

Abstract:

BACKGROUND: Poisoned patients often suffer damage to multiple systems, and those experiencing central nervous system disorders present more severe conditions, prolonged hospital stays, and increased mortality rates. We aimed to assess the efficacy of rehabilitation interventions for patients with toxic encephalopathy.

METHODS: This retrospective, observational, comparative cohort study was performed at the teaching hospital affiliated of Nanjing Medical University, from October 2020 to December 2022. Patients who met the diagnostic criteria for toxic encephalopathy and exclusion criteria were included, and patients were divided into three subgroups according to Glasgow Coma Scale (GCS). Demographic and clinical characteristics were collected. The effect of the rehabilitation intervention on patients were assessed in the improvement of consciousness status (Glasgow Coma Scale [GCS] score), muscle strength and movement and swallowing function (Fugl-Meyer Assessment [FMA] scale, Water Swallow Test [WST], and Standardized Swallowing Assessment [SSA]). Subgroup analysis was based on different toxic species.

RESULTS: Out of the 464 patients with toxic encephalopathy, 184 cases received rehabilitation treatments. For the severe toxic encephalopathy patients, patients without rehabilitation intervention have a 2.21 times higher risk of death compared to patients with rehabilitation intervention (Hazard ratio [HR]=2.21). Subgroup analysis revealed that rehabilitation intervention significantly increased the survival rate of patients with pesticide poisoning (P=0.02), while no significant improvement was observed in patients with drug/biological agent poisoning (P=0.44). After rehabilitation intervention, significant improvement in GCS and FMA were observed in severe patients with toxic encephalopathy (P<0.01).

CONCLUSION: Active rehabilitation intervention for patients exposed to poisons that can potentially cause toxic encephalopathy may improve the prognosis and reduce the mortality rate in clinical practice.

Key words: Toxic encephalopathy, Poisoning, Rehabilitation, Efficacy

Hao Wu, Yu Zhou, Baogen Xu, Wen Liu, Jinquan Li, Chuhan Zhou, Hao Sun, Yu Zheng. Assessment of rehabilitation treatment for patients with acute poisoning-induced toxic encephalopathy[J]. World Journal of Emergency Medicine, 2024, 15(6): 441-447.

Figures/Tables 5

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Characteristics	Total (n=464)	Mild (n=104)	Moderate (n=108)	Severe (n=252)	P-value
Age, year, mean±SD	47.0±23.0	40.7±23.3	46.9±25.0	49.2±21.8	0.30
Male, n (%)	252 (54.3)	56 (53.9)	60 (55.6)	136 (54.0)	0.73
Toxic species, n (%)					<0.01
Pharmaceutical/biological products	234 (50.43)	59 (56.7)	47 (43.5)	128 (50.8)
Quetiapine	68	25	13	30
Estazolam	59	12	35	14
Zopiclone	55	4	6	45
Sertraline	55	53	1	1
Alprazolam	32	4	3	25
Oxazepam	29	19	3	7
Diazepam	24	16	1	7
Citalopram	13	3	1	9
Midazolam	10	1	2	7
Pesticide type toxins, n (%)	208 (44.83)	36 (34.6)	53 (49.0)	119 (47.2)
Diquat	151	21	34	96
Paraquat	21	3	5	13
Emamectin benzoate	17	5	6	6
Acetamiprid	6	2	0	4
Monosultap	5	2	3	0
Buprofezin	4	1	3	0
Bromadiolone	4	2	2	0
Industrial chemical substances, n (%)	22 (4.74)	9 (8.7)	8 (7.4)	5 (2.0)
Ethanol	12	3	4	5
Ethylene glycol	4	3	1	0
Eethyl hippuric acid	2	0	2	0
Parachloroaniline	2	2	0	0
Dimethylbenzyl ammonium bromide	1	0	1	0
Heptane	1	1	0	0
Time from toxics exposure to detection, h, mean±SD	16.2±32.9	24.6±41.9	12.6±16.1	14.4±34.2	0.35
Clinical symptoms, n (%)					<0.01
Dizziness/headache/limb numbness and fatigue	142 (30.60)	102 (98.1)	40 (37.0)	0 (0)
Convulsions/irritability/delirium	85 (18.32)	2 (1.9)	68 (63.0)	15 (6.0)
Coma	237 (51.08)	0 (0)	0 (0)	237 (94.1)
ICU hospitalization rate, n (%)	163 (35.13)	35 (33.7)	12 (11.1)	116 (46.0)	<0.01
Mortality, n (%)	108 (23.28)	5 (4.8)	19 (17.6)	84 (33.3)	0.02

Variables	Patients with rehabilitation (n=184)	Patients without rehabilitation (n=280)	P-value
Age, year, mean±SD	46.9±23.0	47.1±23.1	0.95
Male, n (%)	88 (47.8)	164 (58.6)	0.26
Toxic species, n (%)			0.10
Pharmaceutical/biological products	95 (51.6)	139 (49.6)
Pesticide type toxins	85 (46.2)	123 (43.9)
Industrial chemical substances	4 (2.2)	18 (6.4)
Time from toxics exposure to detection, h, mean±SD	12.7±15.6	18.3±40.2	0.37
Severity, n (%)			0.80
Mild TE	44 (23.9)	60 (21.4)
Moderate TE	41 (22.3)	67 (23.9)
Severe TE	99 (53.8)	153 (54.6)
ICU hospitalization, n (%)	40 (21.7)	124 (44.3)	0.01
Mortality, n (%)	38 (20.7)	70 (25.0)	0.54

Variables	Before rehabilitation (day 3)	After rehabilitation (day 14)	P-value
Awareness
GCS score	3 (3, 4)	8 (7, 11)	< 0.01
Muscle strength and motor function
FMA	25 (4, 30)	66 (57, 81)	< 0.01
Swallowing function
WST	/	4 (2, 4)	/
SSA	/	29 (25, 33)	/