Abd Elghany et al reported the PASS (Poisoning Agitation-Sedation Score) for evaluating an acute poisoning patient. This can help to identify a patient who should be intubated and receive mechanical ventilation. The authors are from Tanta University in Egypt.
Patient selection: acutely poisoned patient with disturbed consciousness<=9),"Yes"
Parameters:
(1) reflexes
(2) respiration
(3) Glasgow coma scale motor scale
(4) agitaton
|
Parameter
|
Finding
|
Points
|
|
reflexes
|
pupil and cornea reflexes present
|
4
|
|
|
one pupil wide and fixed
|
3
|
|
|
pupil or corneal reflexes absent
|
2
|
|
|
pupil and corneal reflexes absent
|
1
|
|
|
absent pupil, corneal, and cough reflex
|
0
|
|
respiration
|
not intubated, regular breathing pattern
|
4
|
|
|
not intubated, Cheyne-Stokes breathing
|
3
|
|
|
not intubated, irregular breathing
|
2
|
|
|
breathes above ventilator rate
|
1
|
|
|
apnea or breathes at ventilator rate
|
0
|
|
GCS motor scale
|
obeys commands
|
6
|
|
|
localizes pain
|
5
|
|
|
flexion withdrawal
|
4
|
|
|
decerebrate flexion
|
3
|
|
|
decerebrate extension
|
2
|
|
|
no response
|
1
|
|
agitation
|
overly combative or violent
|
4
|
|
|
pulls on or removes tubes or catheters; aggressive towards staff
|
3
|
|
|
frequent non purposeful movement or patient-ventilator dyssynchrony
|
2
|
|
|
anxious or apprehensive; movements not aggressive or vigorous
|
1
|
where:
• The scoring for agitation may need review. First, there probably should be a no agitation option at 0 points. Second, all of the other parameters have more normal findings scored high, while the opposite is for agitation.
• On the other hand, it may be unwise to intubate a person who is extremely agitated
total score for a patient who is not agitated =
= SUM(points for the first three parameters)
total score for a patient who is agitated =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 1 if nonagitated; 2 if agitated
• maximum score: 14 if nonagitated; 18 if agitated
• A cutoff <= 9 indicates a nonagitated person who needs intubation and mechanical ventilation.
• A cutoff <= 14 indicates an agitated person who needs intubation and mechanical ventilation.
Performance:
• The area under the ROC curve is 0.98.
